Roger Claire, Louart Benjamin, Louart Guillaume, Bobbia Xavier, Claret Pierre-Geraud, Perez-Martin Antonia, Muller Laurent, Lefrant Jean-Yves
Department of Anesthesiology, Emergency and Critical Care Medicine, Nimes University Hospital, 30029 Nîmes, France; Physiology Department, EA 2992, Faculté de Médecine de Nîmes, Université Montpellier 1, 30029 Nîmes, France.
Department of Anesthesiology, Emergency and Critical Care Medicine, Nimes University Hospital, 30029 Nîmes, France.
Am J Emerg Med. 2016 Sep;34(9):1743-9. doi: 10.1016/j.ajem.2016.05.019. Epub 2016 May 13.
This study aimed to compare 2 fluid infusion rates of lactated Ringer (LR) and hydroxyethyl starch (HES) 130/0.4 on hemodynamic restoration at the early phase of controlled hemorrhagic shock.
Fifty-six anesthetized and ventilated piglets were bled until mean arterial pressure (MAP) reached 40 mm Hg. Controlled hemorrhage was maintained for 30 minutes. After this period, 4 resuscitation groups were studied (n=14 for each group): HES infused at 1 or 4mL/kg per minute or LR1 infused at 1 or 4mL/kg per minute until baseline MAP was restored. Hemodynamic assessment using PiCCO monitoring and biological data were collected.
Time to restore baseline MAP ±10% was significantly lower in LR4 group (11±11 minutes) compared to LR1 group (41±25 minutes) (P=.0004). Time to restore baseline MAP ±10% was significantly lower in HES4 group (4±3 minutes) compared to HES1 (11±4 minutes) (P=.0003). Time to restore baseline MAP ±10% was significantly lower with HES vs LR whatever the infusion rate. No statistically significant difference was observed in cardiac output, central venous saturation, extravascular lung water, and arterial lactate between 4 and 1 mL/kg per minute groups.
In this controlled hemorrhagic shock model, a faster infusion rate (4 vs 1mL/kg per minute) significantly decreased the time for restoring baseline MAP, regardless of the type of infused fluid. The time for MAP restoration was significantly shorter for HES as compared to LR whatever the fluid infusion rate.
本研究旨在比较乳酸林格液（LR）和羟乙基淀粉（HES）130/0.4两种液体输注速率对控制性失血性休克早期血流动力学恢复的影响。
56只麻醉并通气的仔猪放血直至平均动脉压（MAP）达到40mmHg。维持控制性出血30分钟。在此期间后，研究4个复苏组（每组n = 14）：以每分钟1或4mL/kg的速率输注HES，或以每分钟1或4mL/kg的速率输注LR1，直至恢复基线MAP。使用脉搏指示连续心输出量（PiCCO）监测进行血流动力学评估并收集生物学数据。
与LR1组（41±25分钟）相比，LR4组恢复基线MAP±10%的时间显著缩短（11±11分钟）（P = 0.0004）。与HES1组（11±4分钟）相比，HES4组恢复基线MAP±10%的时间显著缩短（4±3分钟）（P = 0.0003）。无论输注速率如何，HES恢复基线MAP±10%的时间均显著短于LR。在每分钟4和1mL/kg组之间，心输出量、中心静脉饱和度、血管外肺水和动脉乳酸水平无统计学显著差异。
在本控制性失血性休克模型中，更快的输注速率（每分钟4 vs 1mL/kg）显著缩短了恢复基线MAP的时间，无论输注液体的类型如何。无论液体输注速率如何，HES恢复MAP的时间均显著短于LR。
