比较分析在实验性失血性休克猪骨骼肌代谢特征中使用人血白蛋白和晶体液或 130/0.4 羟乙基淀粉和晶体液复苏的效果：一项随机实验研究。
Comparative analysis of resuscitation using human serum albumin and crystalloids or 130/0.4 hydroxyethyl starch and crystalloids on skeletal muscle metabolic profile during experimental haemorrhagic shock in swine: A randomised experimental study.
机构信息
From the Anesthesia and Intensive Care, Hôpital de Hautepierre, University Hospitals of Strasbourg (EN, JP, PD), EA 3072, Laboratoire de Physiologie, Fédération de Médecine Translationnelle, Strasbourg University (EN, MD, ALC, FS, JP, BG, PD), IHU-Strasbourg, University Institute for Image-Guided Surgery, Strasbourg, France (EN, MD, JP, PD), Department of Anesthesiology, Stony Brook University, Stony Brook, New York, USA (TJG), Biophysics and Nuclear Medicine, Hôpital de Hautepierre, University Hospitals of Strasbourg (F-MM, IJN) and ICube, University of Strasbourg/CNRS UMR 7357, Strasbourg, France (F-MM, IJN).
出版信息
Eur J Anaesthesiol. 2017 Feb;34(2):89-97. doi: 10.1097/EJA.0000000000000537.
BACKGROUND
Protection against acute skeletal muscle metabolic dysfunction and oxidative stress could be a therapeutic target in volume expansion for severely bleeding patients.
OBJECTIVES
This experimental pilot study in swine aims at comparing 130/0.4 hydroxyethyl starch (HES) with 4% albumin along with crystalloid perfusion for first-line volume expansion in haemorrhagic shock with a particular emphasis on oxidative stress and muscular mitochondrial function.
DESIGN
Randomised experimental study.
SETTING
Digestive Cancer Research Institute Preclinical Laboratory, Strasbourg University Hospital, France, from February 2012 to June 2013.
ANIMALS
Twenty large white pigs.
INTERVENTION
Pressure-controlled haemorrhagic shock and volume resuscitation using either 4% human serum albumin or 130/0.4 HES along with crystalloid perfusion were performed in 20 large white pigs.
MAIN OUTCOME MEASURES
Muscular biopsy of gastrocnemius muscle was performed for metabolomics screening, mitochondrial respiratory chain assessment and electron spin resonance reactive oxygen species production along with arterial and venous reactive oxygen species production at baseline, at the completion of shock, at 90 min and at 180 min after volume expansion.
RESULTS
There was no difference between the two groups in measurements of skeletal muscle superoxide production. In a pooled analysis, there was a statistically significant decrease in gastrocnemius muscle creatine content from baseline to 90 min (P < 0.05) and 180 min (P < 0.05). Muscular lactate content and mitochondrial respiratory chain oxidative capacity remained constant at the respective time points.
CONCLUSION
In this pilot experimental study in swine, during pressure-controlled haemorrhagic shock treated with either albumin or 130/0.4 HES in conjunction with crystalloid perfusion, skeletal muscle metabolic profile was unaltered.
ETHICAL APPROVAL NUMBER
38.2012.01.031.
背景
在严重出血患者的容量扩充治疗中，预防急性骨骼肌代谢功能障碍和氧化应激可能是一个治疗靶点。
目的
本项在猪身上进行的实验性初步研究旨在比较 130/0.4 羟乙基淀粉（HES）与 4%白蛋白联合晶体液灌注用于失血性休克的一线容量扩充，并特别关注氧化应激和肌肉线粒体功能。
设计
随机实验研究。
设置
法国斯特拉斯堡大学医院消化癌症研究所临床前实验室，2012 年 2 月至 2013 年 6 月。
动物
20 头大白猪。
干预
采用压力控制失血性休克和容量复苏，使用 4%人血清白蛋白或 130/0.4 HES 联合晶体液灌注，在 20 头大白猪中进行。
主要观察指标
对腓肠肌进行肌肉活检，进行代谢组学筛选、线粒体呼吸链评估和电子自旋共振活性氧（ROS）生成，以及动脉和静脉 ROS 生成的基线、休克结束时、容量复苏后 90min 和 180min。
结果
两组骨骼肌超氧阴离子生成的测量值无差异。在汇总分析中，腓肠肌肌酸含量从基线到 90min（P<0.05）和 180min（P<0.05）均有统计学显著下降。肌肉乳酸含量和线粒体呼吸链氧化能力在各时间点保持不变。
结论
在本项针对猪的初步实验性研究中，在压力控制失血性休克期间，用白蛋白或 130/0.4 HES 联合晶体液灌注治疗，骨骼肌代谢谱没有改变。
伦理批准编号
38.2012.01.031。
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