Department of Pediatrics, Lo-Tung Pohai Hospital, Ilan, Taiwan, ROC.
J Chin Med Assoc. 2011 Oct;74(10):448-54. doi: 10.1016/j.jcma.2011.08.015. Epub 2011 Oct 19.
Acute blood loss linked to severe hypovolemia and hemorrhagic shock is a critical condition in pediatric intensive care. This study was to investigate the role of various fluid resuscitation approaches to cerebral tissue oxygenation using a piglet model of hemorrhagic shock.
Thirty piglets received blood removal to induce hemorrhagic shock, and then were randomly assigned to a control group (no treatment), a control-normal saline (NS) group (treated with bolus normal saline 10 mL/kg only), or one of three treatment groups treated with 15 mL/kg/dose fluid every 30 min with either whole blood (WB), lactated Ringer's solution (LR), or NS in addition to an initial bolus of saline. The piglets' physiological profiles, arterial blood gases, and regional cerebral oxygen saturation (rScO(2)) levels were recorded, fractional tissue oxygen extraction was calculated, and blood hemoglobin levels were measured.
The results showed that no matter whether treated with only one dose of bolus NS (control-NS group) or with extra WB, LR, or NS, all the treated animals had a significantly higher survival rate, mean arterial blood pressure (MAP), arterial oxygen tension, arterial oxygen saturation, and rScO(2) than the control group (p<0.05). Animals treated with WB all survived the full experimental period, and their hemoglobin levels, MAP, and rScO(2) were the highest comparing to all other groups (p<0.05).
Effective resuscitation using a high concentration of inspired oxygen and adequate fluid infusion, either as a single-dose bolus of NS or combining this with a subsequent transfusion of WB, LR, or NS, helped to stabilize the cardiovascular condition of the tested young subjects and improved cerebral tissue oxygenation over the emergent first four hours. Furthermore, WB was the best fluid choice when used in addition to the bolus NS challenge for maintaining better brain tissue oxygenation when treating hemorrhagic shock.
与严重低血容量和出血性休克相关的急性失血是儿科重症监护中的危急情况。本研究旨在通过出血性休克猪模型探讨各种液体复苏方法对脑组织氧合的作用。
30 头小猪接受放血以诱导出血性休克，然后随机分为对照组（无治疗）、对照生理盐水（NS）组（仅给予 10 mL/kg 生理盐水推注）或 3 个治疗组，每组 10 头，每 30 分钟给予 15 mL/kg 剂量的全血（WB）、乳酸林格氏液（LR）或 NS，此外还给予初始生理盐水推注。记录小猪的生理特征、动脉血气和局部脑氧饱和度（rScO2）水平，计算组织氧摄取分数，并测量血红蛋白水平。
结果表明，无论仅给予单次 NS 推注（对照-NS 组）还是给予额外的 WB、LR 或 NS，所有治疗动物的存活率、平均动脉压（MAP）、动脉血氧分压、动脉血氧饱和度和 rScO2 均显著高于对照组（p<0.05）。接受 WB 治疗的动物均存活至整个实验期，其血红蛋白水平、MAP 和 rScO2 均高于其他组（p<0.05）。
使用高浓度吸氧和充足液体输注进行有效复苏，无论是作为单次 NS 推注，还是与随后的 WB、LR 或 NS 输注相结合，有助于稳定受试年轻对象的心血管状况，并在最初的 4 小时内改善脑组织氧合。此外，在 NS 推注挑战中添加 WB 是最佳的液体选择，有助于在治疗出血性休克时更好地维持脑组织氧合。
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