Maier Stephan, Holz-Hölzl Carmen, Pajk Werner, Ulmer Hanno, Hengl Christian, Dünser Martin, Haas Thorsten, Velik-Salchner Corinna, Fries Dietmar, Greiner Andreas, Hasibeder Walter, Knotzer Hans
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
J Trauma. 2009 Feb;66(2):337-45. doi: 10.1097/TA.0b013e31817dac66.
Volume resuscitation is one of the primary therapeutic goals in hemorrhagic shock, but data on microcirculatory effects of different colloidal fluid resuscitation regimen are sparse. We investigated sublingual mucosal microcirculatory parameters during hemorrhage and after fluid resuscitation with gelatin, hydroxyethyl starch, or hypertonic saline and hydroxyethyl starch in pigs.
To induce hemorrhagic shock, 60% of calculated blood volume was withdrawn. Microvascular blood flow was assessed by laser Doppler velocimetry. Microcirculatory hemoglobin oxygen saturation was measured with a tissue reflectance spectrophotometry, and side darkfield imaging was used to visualize the microcirculation and to quantify the flow quality. Systemic hemodynamic variables, systemic acid base and blood gas variables, and lactate measurements were recorded. Measurements were performed at baseline, after hemorrhage, and after fluid resuscitation with a fixed volume regimen.
Systemic hemodynamic parameters returned or even exceeded to baseline values in all three groups after fluid resuscitation, but showed significantly higher filling pressures and cardiac output values in animals treated with isotonic colloids. Microcirculatory parameters determined in gelatin and hydroxyethyl starch resuscitated animals, and almost all parameters except microvascular hemoglobin oxygen saturation in animals treated with hypertonic saline and hydroxyethyl starch, were restored after treatment.
Hemorrhaged pigs can be hemodynamically stabilized with either isotonic or hypertonic colloidal fluids. The main finding is an adequate restoration of sublingual microcirculatory blood flow and flow quality in all three study groups, but only gelatin and hydroxyethyl starch improved microvascular hemoglobin oxygen saturation, indicating some inadequate oxygen supply/demand ratio maybe due to a better restoration of systemic hemodynamics in isotonic colloidal resuscitated animals.
容量复苏是失血性休克的主要治疗目标之一，但关于不同胶体液复苏方案对微循环影响的数据较少。我们研究了猪出血期间及用明胶、羟乙基淀粉或高渗盐水与羟乙基淀粉进行液体复苏后的舌下黏膜微循环参数。
通过抽取计算出血量的60%诱导失血性休克。用激光多普勒测速仪评估微血管血流。用组织反射分光光度法测量微循环血红蛋白氧饱和度，并用侧方暗视野成像观察微循环并量化血流质量。记录全身血流动力学变量、全身酸碱和血气变量以及乳酸测量值。在基线、出血后以及采用固定容量方案进行液体复苏后进行测量。
液体复苏后，所有三组的全身血流动力学参数均恢复甚至超过基线值，但等渗胶体治疗的动物显示出明显更高的充盈压和心输出量值。用明胶和羟乙基淀粉复苏的动物所测定的微循环参数，以及用高渗盐水和羟乙基淀粉治疗的动物除微血管血红蛋白氧饱和度外的几乎所有参数，在治疗后均得以恢复。
失血性猪用等渗或高渗胶体液均可实现血流动力学稳定。主要发现是所有三个研究组的舌下微循环血流和血流质量均得到充分恢复，但只有明胶和羟乙基淀粉改善了微血管血红蛋白氧饱和度，这表明等渗胶体复苏的动物全身血流动力学恢复较好，可能导致氧供需比例存在一些不足。
