Karmaniolou Iosifina, Pantos Constantinos, Orfanos Nikolaos, Mylonas Anastasios, Theodoraki Kassiani, Staikou Chryssoula, Stergiou Eirini, Kostopanagiotou Georgia, Smyrniotis Vassilios, Arkadopoulos Nikolaos
1 2nd Department of Anesthesia, Attikon Hospital, University of Athens, Medical School, Chaidari, Greece.
J Invest Surg. 2013 Dec;26(6):305-11. doi: 10.3109/08941939.2013.797055. Epub 2013 Aug 26.
The aim of the present study was to evaluate the effect of triiodothyronine (T3) administration in a porcine model of hemorrhagic shock due to liver surgery, in terms of hemodynamic stability, acid-base status, and hepatic injury markers.
Hemorrhagic shock was induced in swine by left lobe liver resection and allowed bleeding to a mean arterial pressure of 35-40 mmHg for 40 min. Animals were randomly assigned into a sham group (n = 5), a fluid-resuscitated group (n = 7), and a fluid plus T3-resuscitated group (n = 7). T3 was given by continuous intravenous infusion from the beginning of the experiment. After the 40 min of shock animals were resuscitated with the aim of restoring mean arterial pressure (±10% from baseline). Resuscitation lasted for 1 hr and then swine were followed for another 460 min (total 6 hr). Blood loss, hamodynamic parameters, fluids administered, acid-base status, and liver enzymes were measured.
Blood loss was similar in both groups. Animals treated with T3 required less fluids than swine resuscitated with crystalloids and colloids only (N/S 0.9%: 1071 ± 189 ml vs. 2429 ± 535 ml, Voluven 6%: 550 ± 96 ml vs. 1000 ± 289 ml, p < .05), plus they were less acidotic at the end of the observing period (7.38 ± 0.08 vs. 7.26 ± 0.12, p < .05). Tachycardia was not associated with T3 administration. Hepatic enzymes did not exhibit differences between groups.
Our study demonstrates the beneficial impact of T3 administration during controlled hemorrhagic shock and resuscitation. Animals resuscitated with T3 necessitate less amounts of fluids to maintain hemodynamic stability and acid-base status. Moreover, T3 administration does not seem to aggravate blood loss or harm the hepatic tissue.
本研究的目的是在肝手术所致失血性休克的猪模型中，从血流动力学稳定性、酸碱状态和肝损伤标志物方面评估给予三碘甲状腺原氨酸（T3）的效果。
通过左叶肝切除术诱导猪发生失血性休克，并使其出血至平均动脉压为35 - 40 mmHg，持续40分钟。动物被随机分为假手术组（n = 5）、液体复苏组（n = 7）和液体加T3复苏组（n = 7）。从实验开始通过持续静脉输注给予T3。40分钟休克后，对动物进行复苏，目标是恢复平均动脉压（±基线值的10%）。复苏持续1小时，然后对猪再观察460分钟（共6小时）。测量失血量、血流动力学参数、给予的液体量、酸碱状态和肝酶。
两组的失血量相似。用T3治疗的动物比仅用晶体液和胶体液复苏的猪需要的液体更少（0.9%生理盐水：1071 ± 189 ml对2429 ± 535 ml，6%万汶：550 ± 96 ml对1000 ± 289 ml，p < 0.05），此外，在观察期结束时它们的酸中毒程度较轻（7.38 ± 0.08对7.26 ± 0.12，p < 0.05）。心动过速与给予T3无关。两组之间肝酶无差异。
我们的研究证明了在控制性失血性休克和复苏期间给予T3的有益影响。用T3复苏的动物维持血流动力学稳定性和酸碱状态所需的液体量较少。此外，给予T3似乎不会加重失血或损害肝组织。
