Skarda David E, Mulier Kristine E, George Mark E, Bellman Greg J
Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Acad Emerg Med. 2008 Sep;15(9):845-52. doi: 10.1111/j.1553-2712.2008.00202.x.
The aim of this study was to compare hypotensive and normotensive resuscitation in a porcine model of hemorrhagic shock.
This was a prospective, comparative, randomized survival study of controlled hemorrhagic shock using 28 male Yorkshire-Landrace pigs (15 to 25 kg). In 24 splenectomized pigs, the authors induced hemorrhagic shock to a systolic blood pressure (sBP) of 48 to 58 mm Hg (approximately 35% bleed). Pigs were randomized to undergo normotensive resuscitation (sBP of 90 mm Hg, n = 7), mild hypotensive resuscitation (sBP of 80 mm Hg, n = 7), severe hypotensive resuscitation (sBP of 65 mm Hg, n = 6), or no resuscitation (n = 4). The authors also included a sham group of animals that were instrumented and splenectomized, but that did not undergo hemorrhagic shock (n = 4). After the initial 8 hours of randomized pressure-targeted resuscitation, all animals were resuscitated to a sBP of 90 mm Hg for 16 hours.
Animals that underwent severe hypotensive resuscitation were less likely to survive, compared with animals that underwent normotensive resuscitation. Mean arterial pressure (MAP) decreased with hemorrhage and increased appropriately with pressure-targeted resuscitation. Base excess (BE) and tissue oxygen saturation (StO2) decreased in all animals that underwent hemorrhagic shock. This decrease persisted only in animals that were pressure target resuscitated to a sBP of 65 mm Hg.
In this model of controlled hemorrhagic shock, initial severe hypotensive pressure-targeted resuscitation for 8 hours was associated with an increased mortality rate and led to a persistent base deficit (BD) and to decreased StO2, suggesting persistent metabolic stress and tissue hypoxia. However, mild hypotensive resuscitation did not lead to a persistent BD or to decreased StO2, suggesting less metabolic stress and less tissue hypoxia.
本研究旨在比较失血性休克猪模型中的低血压复苏和正常血压复苏。
这是一项前瞻性、对比性、随机生存研究，使用28头雄性约克夏-长白猪（15至25千克）进行控制性失血性休克实验。在24头脾切除的猪中，作者将失血性休克诱导至收缩压（sBP）为48至58毫米汞柱（约35%失血）。猪被随机分为接受正常血压复苏（sBP为90毫米汞柱，n = 7）、轻度低血压复苏（sBP为80毫米汞柱，n = 7）、重度低血压复苏（sBP为65毫米汞柱，n = 6）或不进行复苏（n = 4）。作者还纳入了一组假手术动物，这些动物接受了仪器植入和脾切除，但未经历失血性休克（n = 4）。在最初8小时的随机压力目标复苏后，所有动物均复苏至sBP为90毫米汞柱并维持16小时。
与接受正常血压复苏的动物相比，接受重度低血压复苏的动物存活可能性较小。平均动脉压（MAP）随出血而降低，并随压力目标复苏而适当升高。所有经历失血性休克的动物碱剩余（BE）和组织氧饱和度（StO2）均降低。这种降低仅在压力目标复苏至sBP为65毫米汞柱的动物中持续存在。
在这个控制性失血性休克模型中，最初8小时的重度低血压压力目标复苏与死亡率增加相关，并导致持续的碱缺失（BD）和StO2降低，提示持续的代谢应激和组织缺氧。然而，轻度低血压复苏并未导致持续的BD或StO2降低，提示代谢应激较小且组织缺氧较少。
