Bai Xiaowu, Yu Wenkui, Ji Wu, Duan Kaipeng, Tan Shanjun, Lin Zhiliang, Xu Lin, Li Ning
Research Institute of General Surgery, Jinling Hospital, Nanjing, No. 305, Zhongshan East Road, Nanjing, 210002, China.
Department of General Surgery, Shenyang Northern Hospital, Shenyang, Liaoning, No. 83, Wenhua Road, Shenyang, 110000, China.
Crit Care. 2015 Apr 20;19(1):170. doi: 10.1186/s13054-015-0897-6.
Hypotensive fluid resuscitation has a better effect before and during surgical intervention for multiple trauma patients with haemorrhagic shock. However, it is questionable whether hypotensive fluid resuscitation is suitable after surgical intervention for these patients, and whether resuscitation with different mean arterial pressure (MAP) targets after surgical intervention can obtain different results. The aim of this study was to investigate these questions and to explore the underlying mechanisms.
A total of 30 anesthetized piglets were randomly divided into 3 groups (n = 10 per group): low MAP, middle MAP, and high MAP, which had MAP targets of 60, 80, and 100 mmHg, respectively. All animals underwent femur fracture, intestine and liver injury, haemorrhagic shock, early hypotensive resuscitation, and surgical intervention. Then, the animals received fluid resuscitation with different MAP targets as mentioned above for 24 hours. Hemodynamic parameters and vital organ functions were evaluated.
Fluid resuscitation in the 80 mmHg MAP group maintained haemodynamic stability, tissue perfusion, and organ function better than that in the other groups. The 60 mmHg MAP group presented with profound metabolic acidosis and organ histopathologic damage. In addition, animals in the 100 mmHg MAP group exhibited severe tissue oedema, organ function failure, and histopathologic damage.
In our porcine model of resuscitation, targeting high MAP by fluid administration alone resulted in a huge increase in the infusion volume, severe tissue oedema, and organ dysfunction. Meanwhile, targeting low MAP resulted in persistent tissue hypoperfusion and metabolic stress. Hence, a resuscitation strategy of targeting appropriate MAP might be compatible with maintaining haemodynamic stability, tissue perfusion, and organ function.
对于创伤性失血性休克的多发伤患者，在手术干预前及术中进行控制性液体复苏效果更佳。然而，对于此类患者在手术干预后进行控制性液体复苏是否合适，以及手术干预后采用不同平均动脉压（MAP）目标进行复苏是否会得到不同结果，仍存在疑问。本研究旨在探讨这些问题并探究其潜在机制。
将30只麻醉仔猪随机分为3组（每组n = 10）：低MAP组、中MAP组和高MAP组，其MAP目标分别为60、80和100 mmHg。所有动物均经历股骨骨折、肠和肝损伤、失血性休克、早期控制性复苏及手术干预。然后，动物接受上述不同MAP目标的液体复苏24小时。评估血流动力学参数和重要器官功能。
80 mmHg MAP组的液体复苏在维持血流动力学稳定性、组织灌注和器官功能方面优于其他组。60 mmHg MAP组出现严重代谢性酸中毒和器官组织病理学损伤。此外，100 mmHg MAP组的动物表现出严重组织水肿、器官功能衰竭和组织病理学损伤。
在我们的猪复苏模型中，仅通过补液将MAP目标设定为高水平会导致输液量大幅增加、严重组织水肿和器官功能障碍。同时，将MAP目标设定为低水平会导致持续性组织灌注不足和代谢应激。因此，以适当MAP为目标的复苏策略可能有助于维持血流动力学稳定性、组织灌注和器官功能。
