Zhao Jing-xiang, Wang Bo, You Guo-xing, Wang Ying, Chen Gan, Wang Quan, Zhang Xi-gang, Zhao Lian, Zhou Hong, He Yue-zhong
Institute of Transfusion Medicine, Academy of Military Medical Sciences, No. 27th Taiping Road, HaiDian, Beijing, China.
Emergency department, Chinese People's Liberation Army 307 hospital, No. 8th Dongda Street, Fengtai, Beijing, China.
PLoS One. 2015 Aug 28;10(8):e0136012. doi: 10.1371/journal.pone.0136012. eCollection 2015.
The goal of this study was to investigate the effect of hypertonic saline with 6% Dextran-70 (HSD) resuscitation on organ damage and the resuscitation efficiency of the combination of HSD and lactated ringers (LR) in a model of hemorrhage shock in dogs.
Beagles were bled to hold their mean arterial pressure (MAP) at 50 ± 5 mmHg for 1 h. After hemorrhage, beagles were divided into three groups (n = 7) to receive pre-hospital resuscitation for 1 h (R1): HSD (4 ml/kg), LR (40 ml/kg), and HSD+LR (a combination of 4 ml/kg HSD and 40 ml/kg LR). Next, LR was transfused into all groups as in-hospital resuscitation (R2). After two hours of observation (R3), autologous blood was transfused. Hemodynamic responses and systemic oxygenation were measured at predetermined phases. Three days after resuscitation, the animals were sacrificed and tissues including kidney, lung, liver and intestinal were obtained for pathological analysis.
Although the initial resuscitation with HSD was shown to be faster than LR with regard to an ascending MAP, the HSD group showed a similar hemodynamic performance compared to the LR group throughout the experiment. Compared with the LR group, the systemic oxygenation performance in the HSD group was similar but showed a lower venous-to-arterial CO2 gradient (Pv-aCO2) at R3 (p < 0.05). Additionally, the histology score of the kidneys, lungs and liver were significantly lower in the HSD group than in the LR group (p < 0.05). The HSD+LR group showed a superior hemodynamic response but higher extravascular lung water (EVLW) and lower arterial oxygen tension (PaO2) than the other groups (p < 0.05). The HSD+LR group showed a marginally improved systemic oxygenation performance and lower histology score than other groups.
Resuscitation after hemorrhagic shock with a bolus of HSD showed a similar hemodynamic response compared with LR at ten times the volume of HSD, but HSD showed superior efficacy in organ protection. Our findings suggest that resuscitation with the combination of HSD and LR in the pre-hospital setting is an effective treatment.
本研究的目的是在犬失血性休克模型中，研究6%右旋糖酐70高渗盐水（HSD）复苏对器官损伤的影响以及HSD与乳酸林格氏液（LR）联合应用的复苏效率。
将比格犬放血使平均动脉压（MAP）维持在50±5 mmHg达1小时。放血后，将比格犬分为三组（n = 7），进行1小时的院前复苏（R1）：HSD组（4 ml/kg）、LR组（40 ml/kg）和HSD+LR组（4 ml/kg HSD与40 ml/kg LR的组合）。接下来，所有组均输注LR进行院内复苏（R2）。观察两小时后（R3），回输自体血。在预定阶段测量血流动力学反应和全身氧合情况。复苏三天后，处死动物，获取包括肾脏、肺、肝脏和肠道在内的组织进行病理分析。
尽管在MAP上升方面，最初用HSD复苏比用LR更快，但在整个实验过程中，HSD组与LR组的血流动力学表现相似。与LR组相比，HSD组的全身氧合表现相似，但在R3时静脉-动脉二氧化碳梯度（Pv-aCO2）较低（p < 0.05）。此外，HSD组肾脏、肺和肝脏的组织学评分显著低于LR组（p < 0.05）。HSD+LR组显示出更好的血流动力学反应，但与其他组相比，血管外肺水（EVLW）更高，动脉血氧分压（PaO2）更低（p < 0.05）。HSD+LR组的全身氧合表现略有改善，组织学评分低于其他组。
与输注HSD体积10倍的LR相比，失血性休克后推注HSD进行复苏显示出相似的血流动力学反应，但HSD在器官保护方面显示出更好的疗效。我们的研究结果表明，院前应用HSD与LR联合复苏是一种有效的治疗方法。
