Reva V A, Matsumura Y, Hörer T, Sveklov D A, Denisov A V, Telickiy S Y, Seleznev A B, Bozhedomova E R, Matsumoto J, Samokhvalov I M, Morrison J J
Department of War Surgery, Kirov Military Medical Academy, 6, Lebedeva Str., Saint-Petersburg, 194044, Russian Federation.
R. Adams Cowley Shock Trauma Center, University of Maryland, 22 S Green St, Baltimore, MD, 21201, USA.
Eur J Trauma Emerg Surg. 2018 Aug;44(4):511-518. doi: 10.1007/s00068-016-0732-z. Epub 2016 Oct 13.
The aim of this study is to evaluate the early survival and organ damage following 30 and 60 min of thoracic resuscitative endovascular balloon occlusion of the aorta (REBOA) in an ovine model of severe hemorrhagic shock.
Eighteen sheep were induced into shock by undergoing a 35 % controlled exsanguination over 30 min. Animals were randomized into three groups: 60-min REBOA 30 min after the bleeding (60-REBOA), 30-min REBOA 60 min after the bleeding (30-REBOA) and no-REBOA control (n-REBOA). Resuscitation with crystalloids and whole blood was initiated 20 and 80 min after the induction of shock. Animals were observed for 24 h with serial potassium and lactate measurements. Autopsy was performed to evaluate organ damage.
Two animals of the n-REBOA group died within 90 min of shock induction; no hemorrhagic deaths were observed in the REBOA groups. Twenty-four-hour survival for the 60-, 30-, and n-REBOA groups was 0/6, 5/6, and 4/6 (P = 0.002). In 60-REBOA, potassium and lactate were increased at 270-min time point: from 4.3 to 5.1 mEq/l and from 3.7 to 5.1 mmol/L, respectively. Both these values were significantly higher than in the n-REBOA group (P = 0.029 for potassium and P = 0.039 for lactate). Autopsy revealed acute tubular necrosis in all died REBOA group animals.
In this ovine model of severe hemorrhagic shock, REBOA can be used to prevent early death from hemorrhage; however, 60 min of occlusion results in significant metabolic derangement and organ damage that offsets this gain.
本研究旨在评估在严重失血性休克绵羊模型中，进行30分钟和60分钟的胸段复苏性血管内主动脉球囊阻断术（REBOA）后的早期生存率和器官损伤情况。
18只绵羊通过在30分钟内进行35%的控制性放血诱导休克。动物被随机分为三组：出血后30分钟进行60分钟的REBOA（60-REBOA）、出血后60分钟进行30分钟的REBOA（30-REBOA）和无REBOA对照组（n-REBOA）。在休克诱导后20分钟和80分钟开始用晶体液和全血进行复苏。对动物进行24小时观察，并连续测量血钾和乳酸水平。进行尸检以评估器官损伤情况。
n-REBOA组有2只动物在休克诱导后90分钟内死亡；REBOA组未观察到出血性死亡。60-REBOA组、30-REBOA组和n-REBOA组的24小时生存率分别为0/6、5/6和4/6（P = 0.002）。在60-REBOA组中，血钾和乳酸在270分钟时间点升高：分别从4.3升至5.1 mEq/L和从3.7升至5.1 mmol/L。这两个值均显著高于n-REBOA组（血钾P = 0.029，乳酸P = 0.039）。尸检显示所有死亡的REBOA组动物均有急性肾小管坏死。
在这个严重失血性休克的绵羊模型中，REBOA可用于预防出血导致的早期死亡；然而，60分钟的阻断会导致显著的代谢紊乱和器官损伤，抵消了这一益处。
