Cavus Erol, Meybohm Patrick, Dörges Volker, Stadlbauer Karl-Heinz, Wenzel Volker, Weiss Heiko, Scholz Jens, Bein Berthold
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
J Trauma. 2008 Mar;64(3):641-8; discussion 648-9. doi: 10.1097/TA.0b013e3181637a6c.
Patients with uncontrolled hemorrhage may benefit if resuscitation with large amounts of fluids is replaced by a small volume or vasopressor until surgery. Norepinephrine (NE) is commonly used as a vasopressor to control hypotension. The purpose of this study was to compare the effects of hypertonic-hyperoncotic saline starch solution (HHS) either alone or combined with NE on brain tissue oxygen pressure (PbtO2) and brain oxygen saturation (rSO2) in a model of uncontrolled hemorrhage.
After approval of the animal investigation committee, 22 anesthetized pigs underwent simulated penetrating liver trauma. At hemodynamic decompensation, animals were randomly assigned to receive HHS (Hyperhaes; 4 mL/kg; n = 8) with normal saline placebo, low-dose NE (low NE; 500 microg, and 1 microg/kg/min; n = 7), or high-dose NE (high NE; 1,000 microg, and 1 microg/kg/min; n = 7). Bleeding was controlled manually 30 minutes after drug administration.
Cerebral perfusion pressure (CePP), PbtO2, and rSO2 decreased with hemorrhage in all groups (baseline vs. decompensation, CePP-HHS, 83 +/- 5 mm Hg vs. 9 +/- 1 mm Hg; low NE, 67 +/- 6 mm Hg vs. 16 +/- 2 mm Hg; high NE, 77 +/- 7 mm Hg vs. 15 +/- 1 mm Hg. PbtO2-HHS, 100% vs. 29%; low NE, 100% vs. 33%; high NE, 100% vs. 27%. rSO2-HHS, 100% vs. 70%; low NE, 100% vs. 76%; high NE, 100% vs. 63%). Therapy with HHS, low NE, and high NE resulted in a comparable increase of CePP, PbtO2, and rSO2, respectively (5 minutes after therapy, CePP-HHS, 29 +/- 3 mm Hg; low NE, 27 +/- 3 mm Hg; high NE, 28 +/- 3 mm Hg. PbtO2-HHS, 207%; low NE, 129%; high NE, 170%. rSO2-HHS, 94%; low NE, 83%; high NE, 87%). Overall survival was six of eight, four of seven, and six of seven, respectively.
After uncontrolled hemorrhagic shock, addition of different dosages of NE to HHS, compared with HHS alone, showed no beneficial effect on CePP, rSO2, or PbtO2.
对于出血未得到控制的患者，如果在手术前用小容量液体或血管升压药替代大量液体复苏，可能会有所益处。去甲肾上腺素（NE）是常用的血管升压药，用于控制低血压。本研究的目的是比较高渗高胶盐淀粉溶液（HHS）单独使用或与NE联合使用对未控制出血模型中脑组织氧分压（PbtO2）和脑氧饱和度（rSO2）的影响。
经动物研究委员会批准后，22只麻醉猪接受了模拟穿透性肝损伤。在血流动力学失代偿时，将动物随机分为接受HHS（Hyperhaes；4 mL/kg；n = 8）加生理盐水安慰剂、低剂量NE（低NE；500微克，1微克/千克/分钟；n = 7）或高剂量NE（高NE；1000微克，1微克/千克/分钟；n = 7）。给药30分钟后手动控制出血。
所有组的脑灌注压（CePP）、PbtO2和rSO2随出血而降低（基线与失代偿时，CePP-HHS，83±5毫米汞柱对9±1毫米汞柱；低NE，67±6毫米汞柱对16±2毫米汞柱；高NE，77±7毫米汞柱对15±1毫米汞柱。PbtO2-HHS，100%对29%；低NE，100%对33%；高NE，100%对27%。rSO2-HHS，100%对70%；低NE，100%对76%；高NE，100%对63%）。HHS、低NE和高NE治疗分别使CePP、PbtO2和rSO2有类似程度的升高（治疗后5分钟，CePP-HHS，29±3毫米汞柱；低NE，27±3毫米汞柱；高NE，28±3毫米汞柱。PbtO2-HHS，207%；低NE，129%；高NE，170%。rSO2-HHS，94%；低NE，83%；高NE，87%）。总体生存率分别为8只中的6只、7只中的4只和7只中的6只。
在未控制的失血性休克后，与单独使用HHS相比，在HHS中添加不同剂量的NE对CePP、rSO2或PbtO2没有有益影响。
