Nadler Roy, Glassberg Elon, Gabbay Itay E, Wagnert-Avraham Linn, Yaniv Gal, Kushnir David, Eisenkraft Arik, Bobrovsky Ben-Zion, Gabbay Uri
Surgeon General Headquarters, Medical Corps, Israel Defense Forces, Ramat Gan, Israel.
Quality Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
Ann Med Surg (Lond). 2016 Dec 29;14:1-7. doi: 10.1016/j.amsu.2016.12.052. eCollection 2017 Feb.
To estimate the cardiovascular reserve we formulated the Cardiovascular Reserve Index (CVRI) based on physiological measurements. The aim of this study was to evaluate the pattern of CVRI in haemorrhage-related haemodynamic deterioration in an animal model simulating combat injury.
Data were collected retrospectively from a research database of swine exsanguination model in which serial physiological measurements were made under anesthesia in 12 swine of haemorrhagic injury and 5 controls. We calculated the approximated CVRI (CVRI). The course of haemodynamic deterioration was defined according to the cumulative blood loss until shock. The ability of heart rate (HR), mean arterial blood pressure (MABP), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR) and the CVRI to predict haemodynamic deterioration was evaluated according to three criteria: strength of association with the course of haemodynamic deterioration (r > 0.5); threshold for haemodynamic deterioration detection; and range at which the parameter remained consistently monotonous course of deterioration.
Three parameters met the first criterion for prediction of haemodynamic deterioration: HR (r = 0.59), SV (r = 0.57) and CVRI (r = 0.66). Results were negative for MABP (r = 0.27), CO (r = 0.33) and SVR (r = 0.02). The detection threshold of the CVRI was 200-300 ml blood loss whereas HR, SV and CO showed a delay in detection, MABP and CVRI exhibited a wide indicative range toward shock.
The CVRI met preset criteria of a potential predictor of haemorrhage-related haemodynamic deterioration. Prospective studies are required to evaluate use of the CVRI in combat medicine.
Level III.
为评估心血管储备，我们基于生理学测量指标制定了心血管储备指数（CVRI）。本研究旨在在模拟战伤的动物模型中，评估CVRI在出血相关血流动力学恶化中的变化模式。
回顾性收集猪放血模型研究数据库中的数据，该数据库对12只出血性损伤猪和5只对照猪在麻醉状态下进行了系列生理学测量。我们计算了近似的CVRI（CVRI）。根据直至休克的累积失血量定义血流动力学恶化过程。根据以下三个标准评估心率（HR）、平均动脉血压（MABP）、每搏输出量（SV）、心输出量（CO）、全身血管阻力（SVR）以及CVRI预测血流动力学恶化的能力：与血流动力学恶化过程的关联强度（r>0.5）；血流动力学恶化检测阈值；以及该参数在恶化过程中保持一致单调变化的范围。
三个参数符合预测血流动力学恶化的首要标准：HR（r=0.59）、SV（r=0.57）和CVRI（r=0.66）。MABP（r=0.27）、CO（r=0.33）和SVR（r=0.02）的结果为阴性。CVRI的检测阈值为失血量200 - 300ml，而HR、SV和CO检测出现延迟，MABP和CVRI对休克呈现较宽的指示范围。
CVRI符合出血相关血流动力学恶化潜在预测指标的预设标准。需要进行前瞻性研究以评估CVRI在战伤医学中的应用。
三级。
