Soins intensifs médicaux, département de Médecine and Centre de recherche clinique Étienne-Lebel (CRCEL) CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada.
Shock. 2012 Aug;38(3):307-13. doi: 10.1097/SHK.0b013e31825e7ae9.
Along with redistributive shock, myocardial dysfunction is now recognized as highly prevalent in early severe sepsis. Indeed, aside from their distinct loading potency, resuscitation fluids have been poorly investigated as to their specific molecular impact on myocardial dysfunction. The objective of this study was to evaluate the load-independent biological impact of different resuscitation fluids on endotoxin-induced myocardial dysfunction. Adult rats implanted with a central venous catheter were given an intraperitoneal injection of endotoxin (lipopolysaccharides [LPSs], Escherichia coli, 10 mg/kg) or normal saline (sham) and subsequently infused or not with similar "fluid potency" loading resuscitation fluid (normal saline, albumin [Alb], or hypertonic saline solution) for 6 to 24 h, followed by echocardiographic and hemodynamic monitoring together with biochemical and histopathologic evaluation. Intervention was to assess the selective influence of load-independent fluid infusion on the aforementioned parameters in groups of animals challenged or not with LPS. At comparative plasma volumes, Alb improved myocardial homeostasis after LPS challenge by (i) reducing left ventricular relative wall diastolic thickness, interstitial space enlargement, and endogenous Alb content; (ii) limiting cardiac apoptosis and sustaining extracellular signal-regulated mitogen-activated protein kinase activation; and (iii) enhancing the expression pattern of heme-oxygenase 1/inducible nitric oxide synthase. Hypertonic saline solution was also cardioprotective by early prevention of myocardial dysfunction and by reducing cardiac apoptosis. Fluid infusions have distinct load-independent structural/biological impacts on endotoxin-induced myocardial dysfunction. Albumin and hypertonic saline solution are the most pleiotropic fluids in protecting the heart after a "sepsis" hit.
除了重新分布性休克，心肌功能障碍现在也被认为是严重脓毒症早期的高发疾病。事实上，除了它们独特的负荷能力外，复苏液在心肌功能障碍方面的特定分子影响也没有得到很好的研究。本研究的目的是评估不同复苏液对脂多糖（内毒素）诱导的心肌功能障碍的独立于负荷的生物学影响。成年大鼠植入中心静脉导管后，腹腔内注射内毒素（大肠杆菌脂多糖[LPSs]，10mg/kg）或生理盐水（假手术），随后用相同的“液体效力”负荷复苏液（生理盐水、白蛋白[Alb]或高渗盐水溶液）输注或不输注 6 至 24 小时，随后进行超声心动图和血流动力学监测以及生化和组织病理学评估。干预措施是评估在接受或不接受 LPS 挑战的动物组中，独立于负荷的液体输注对上述参数的选择性影响。在比较血浆容量时，Alb 通过以下方式改善 LPS 挑战后的心肌稳态：（i）降低左心室相对壁舒张厚度、间质空间扩大和内源性 Alb 含量；（ii）限制心脏细胞凋亡并维持细胞外信号调节激酶的激活；（iii）增强血红素加氧酶 1/诱导型一氧化氮合酶的表达模式。高渗盐水溶液也具有心脏保护作用，可早期预防心肌功能障碍并减少心脏细胞凋亡。液体输注对脂多糖诱导的心肌功能障碍有独立于负荷的不同结构/生物学影响。白蛋白和高渗盐水溶液是在“脓毒症”发作后保护心脏最具多效性的液体。
