Weil Institute of Critical Care Medicine, Rancho Mirage, California 92270, USA.
Shock. 2013 Apr;39(4):361-5. doi: 10.1097/SHK.0b013e31828936aa.
To avoid aggressive fluid resuscitation during hemorrhagic shock, fluid resuscitation is best guided by a specific measurement of tissue perfusion. We investigated whether fluid resuscitation guided by sublingual PCO2 would reduce the amount of resuscitation fluid without compromising the outcomes of hemorrhagic shock. Ten male domestic pigs weighing between 34 and 37 kg were used. Forty-five percent of estimated blood volume was removed during an interval of 1 h. The animals were then randomized to receive fluid resuscitation based on either sublingual PCO2 or blood pressure (BP). In the sublingual PCO2-guided group, resuscitation was initiated when sublingual PCO2 exceeded 70 Torr and stopped when it decreased to 50 Torr. In the BP-guided group, resuscitation was initiated when mean aortic pressure decreased to 60 mmHg and stopped when it increased to 90 mmHg. First, Ringer's lactate solution (RLS) of 30 mL kg was administered; subsequently, the shed blood was transfused if sublingual PCO2 remained greater than 50 Torr in the sublingual PCO2-guided group or mean aortic pressure was less than 90 mmHg in the BP-guided group. All the animals were monitored for 4 h and observed for an additional 68 h. In the sublingual PCO2-guided group, fluid resuscitation was required in only 40% of the animals. In addition, a significantly lower volume of RLS (170 ± 239 mL, P = 0.005 vs. BP-guided group) was administered without the need for blood infusion in this group. However, in the BP-guided group, all the animals required a significantly larger volume of fluid (955 ± 381 mL), including both RLS and blood. There were no differences in postresuscitation tissue microcirculation, myocardial and neurologic function, and 72-h survival between groups. During hemorrhagic shock, fluid resuscitation guided by sublingual PCO2 significantly reduced the amount of resuscitation fluid without compromising the outcomes of hemorrhagic shock.
为避免在失血性休克期间进行激进的液体复苏，最好通过特定的组织灌注测量来指导液体复苏。我们研究了在失血性休克期间，通过舌下 PCO2 指导的液体复苏是否可以减少复苏液的量而不影响休克的结果。使用了 10 只体重在 34 至 37 公斤之间的雄性家猪。在 1 小时的间隔内，去除了估计血容量的 45%。然后，将动物随机分为两组，一组根据舌下 PCO2 或血压 (BP) 指导进行液体复苏。在舌下 PCO2 指导组中，当舌下 PCO2 超过 70 托时开始复苏，并在降至 50 托时停止。在 BP 指导组中，当平均主动脉压降至 60mmHg 时开始复苏，并在升至 90mmHg 时停止。首先，给予 30mL/kg 的乳酸林格氏液 (RLS)；随后，如果舌下 PCO2 指导组中舌下 PCO2 仍大于 50 托或 BP 指导组中平均主动脉压小于 90mmHg，则输注所失血。所有动物均监测 4 小时，并观察额外的 68 小时。在舌下 PCO2 指导组中，只有 40%的动物需要进行液体复苏。此外，该组的 RLS 用量明显减少（170±239ml，P=0.005 与 BP 指导组相比），且无需输注血液。然而，在 BP 指导组中，所有动物都需要大量的液体（955±381ml），包括 RLS 和血液。两组之间的复苏后组织微循环、心肌和神经功能以及 72 小时存活率均无差异。在失血性休克期间，通过舌下 PCO2 指导的液体复苏可显著减少复苏液的量，而不影响休克的结果。
