出血性休克中S100B蛋白的释放：小容量复苏联合精氨酸加压素的作用

Release of protein S100B in haemorrhagic shock: effects of small volume resuscitation combined with arginine vasopressin.

作者信息

Meybohm Patrick, Cavus Erol, Dörges Volker, Weber Bernd, Stadlbauer Karl-Heinz, Wenzel Volker, Scholz Jens, Steffen Martin, Bein Berthold

机构信息

Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105 Kiel, Germany.

出版信息

Resuscitation. 2008 Mar;76(3):449-56. doi: 10.1016/j.resuscitation.2007.09.002. Epub 2007 Oct 31.

DOI:10.1016/j.resuscitation.2007.09.002

PMID:17976887

Abstract

BACKGROUND

The present study was designed to evaluate the effect of conventional fluid resuscitation and small volume resuscitation alone and combined with arginine vasopressin (AVP) on cerebral perfusion pressure (CPP) and protein S100B during experimental haemorrhagic shock.

MATERIAL AND METHODS

Thirty anaesthetised pigs underwent a penetrating liver trauma. Following haemodynamic decompensation, pigs received either (1) a combination of crystalloid (40 mL kg(-1)) and colloid (20 mL kg(-1)) solutions (fluid, n=10), (2) hypertonic-hyperoncotic solution (HHS; 4 mL kg(-1)) combined with normal saline (HHS+NS; n=10) or (3) HHS combined with AVP (0.2 U kg(-1) followed by an infusion of 2 U kg(-1)h(-1); HHS+AVP; n=10).

RESULTS

Compared to baseline, CPP decreased and S100B levels increased significantly at haemodynamic decompensation (S100B: fluid, 0.52+/-0.23 microg L(-1) vs. 0.85+/-0.37 microg L(-1), p<0.05; HHS+NS, 0.47+/-0.18 microg L(-1) vs. 0.90+/-0.33 microg L(-1), p<0.05; HHS+AVP, 0.53+/-0.18 microg L(-1) vs. 0.90+/-0.39 microg L(-1), p<0.01). During the initial 10 min of therapy, CPP of HHS+NS was significantly higher compared to the fluid group, increased more rapidly in the HHS+AVP group, but was not significantly different thereafter. S100B levels decreased close to baseline values (p<0.001), and did not differ between groups.

CONCLUSION

HHS+AVP resulted in higher CPP compared to fluid and HHS+NS in the initial phase of therapy, but did not differ thereafter. Haemorrhage-induced hypotension yielded increased S100B levels that were comparable in groups throughout the study period.

摘要

背景

本研究旨在评估单纯常规液体复苏、小容量复苏以及联合精氨酸加压素（AVP）对实验性失血性休克期间脑灌注压（CPP）和蛋白S100B的影响。

材料与方法

30只麻醉猪接受穿透性肝损伤。血流动力学失代偿后，猪被分为三组，分别接受：（1）晶体液（40 mL·kg⁻¹）和胶体液（20 mL·kg⁻¹）联合输注（液体组，n = 10）；（2）高渗高胶溶液（HHS；4 mL·kg⁻¹）联合生理盐水（HHS + NS组，n = 10）；（3）HHS联合AVP（0.2 U·kg⁻¹静脉推注，随后以2 U·kg⁻¹·h⁻¹持续输注；HHS + AVP组，n = 10）。

结果

与基线相比，血流动力学失代偿时CPP降低，S100B水平显著升高（S100B：液体组，0.52±0.23 μg·L⁻¹ 对比 0.85±0.37 μg·L⁻¹，p < 0.05；HHS + NS组，0.47±0.18 μg·L⁻¹ 对比 0.90±0.33 μg·L⁻¹，p < 0.05；HHS + AVP组，0.53±0.18 μg·L⁻¹ 对比 0.90±0.39 μg·L⁻¹，p < 0.01）。治疗最初10分钟内，HHS + NS组的CPP显著高于液体组，HHS + AVP组升高更快，但此后差异无统计学意义。S100B水平降至接近基线值（p < 0.001），且各组间无差异。