Dunham C M, Fabian M, Siegel J H, Gettings L
Shock Trauma Center, Maryland Institute for Emergency Medical Services Systems, Baltimore.
Circ Shock. 1991 Oct;35(2):78-86.
Thirty dogs underwent hemorrhage over a 60-min period to a predetermined O2 debt of 60-120 mL O2/kg, monitored with a Beckman metabolic cart, and then were resuscitated with 120% of the shed volume. Twenty survived and were followed over the next 7 days. On day 4, hepatic insufficiency was suggested by an elevation in [total amino acids] and [lactate] and a decrease in [urea] and [branched-chain amino acids]/[aromatic amino acids]. Net whole body catabolism on day 4 is suggested by a decrease in [glutamine] and an increase in plasma [3-methylhistidine], [phenylalanine], and [tyrosine]. These changes were significantly related to cardiac index, mean blood pressure, [lactate], O2 debt, and shed volume during the hemorrhage 4 days earlier. On day 7 there was a significant increase in the cardiac index and the VO2. These data suggest that hemorrhage induces sequelae similar to major injury or sepsis: hepatic insufficiency, net catabolism, hypermetabolism, and a hyperdynamic circulation. The hyperdynamic circulation may be necessary to meet increased tissue delivery requirements for O2 and amino acids.
30只犬在60分钟内进行出血，使其达到预定的60 - 120 mL O₂/kg的氧债，使用贝克曼代谢车进行监测，然后用失血量120%的液体进行复苏。20只犬存活下来，并在接下来的7天内进行随访。在第4天，总氨基酸和乳酸水平升高，尿素和支链氨基酸/芳香族氨基酸水平降低，提示肝功能不全。第4天全身净分解代谢表现为谷氨酰胺水平降低，血浆3 - 甲基组氨酸、苯丙氨酸和酪氨酸水平升高。这些变化与4天前出血期间的心脏指数、平均血压、乳酸、氧债和失血量显著相关。在第7天，心脏指数和VO₂显著增加。这些数据表明，出血会引发类似于严重创伤或脓毒症的后遗症：肝功能不全、净分解代谢、高代谢和高动力循环。高动力循环可能是为了满足组织对氧气和氨基酸增加的输送需求所必需的。
