Institute of Anesthesiological Pathophysiology and Process Engineering, University Hospital, Ulm, Germany.
Department of Anesthesiology, University Hospital, Ulm, Germany.
Shock. 2019 Apr;51(4):472-478. doi: 10.1097/SHK.0000000000001165.
Hemorrhagic shock is a major cause of death after trauma. An additional blunt chest trauma independently contributes to mortality upon the development of an acute lung injury (ALI) by aggravating pathophysiological consequences of hemorrhagic shock. The maintenance of hydrogen sulfide availability is known to play an important role during hemorrhage and ALI. We therefore tested the impact of a genetic 3-mercaptopyruvate sulfurtransferase mutation (Δ3-MST) in a resuscitated murine model of traumatic-hemorrhagic shock.
Anesthetized wild-type (WT) and Δ3-MST mice underwent hemorrhagic shock with/without blunt chest trauma. Hemorrhagic shock was implemented for 1 h followed by retransfusion of shed blood and intensive care therapy for 4 h, including lung-protective mechanical ventilation, fluid resuscitation, and noradrenaline titrated to maintain a mean arterial pressure at least 50 mmHg. Systemic hemodynamics, metabolism, and acid-base status were assessed together with lung mechanics and gas exchange. Postmortem tissue samples were analyzed for immunohistological protein expression and mitochondrial oxygen consumption.
3-MST-deficient mice showed similar results in parameters of hemodynamics, gas exchange, metabolism, acid base status, and survival compared with the respective WT controls. Renal albumin extravasation was increased in Δ3-MST mice during hemorrhagic shock, together with a decrease of LEAK respiration in heart tissue. In contrast, mitochondrial oxygen consumption in the uncoupled state was increased in kidney and liver tissue of Δ3-MST mice subjected to the combined trauma.
In summary, in a resuscitated murine model of traumatic-hemorrhagic shock, 3-MST deficiency had no physiologically relevant impact on hemodynamics and metabolism, which ultimately lead to unchanged mortality regardless of an additional blunt chest trauma.
出血性休克是创伤后死亡的主要原因。在发生急性肺损伤 (ALI) 时,额外的钝性胸部创伤通过加重出血性休克的病理生理后果,独立导致死亡率增加。已知硫化氢的维持在出血和 ALI 期间发挥重要作用。因此,我们在复苏的创伤性出血性休克小鼠模型中测试了 3-巯基丙酮酸硫转移酶基因 (Δ3-MST) 突变的影响。
麻醉的野生型 (WT) 和 Δ3-MST 小鼠接受伴有/不伴有钝性胸部创伤的出血性休克。出血性休克持续 1 小时,然后回输失血,并进行 4 小时的重症监护治疗,包括肺保护性机械通气、液体复苏和去甲肾上腺素滴定,以维持平均动脉压至少 50mmHg。评估全身血流动力学、代谢和酸碱状态以及肺力学和气体交换。对死后组织样本进行免疫组织化学蛋白表达和线粒体耗氧量分析。
与相应的 WT 对照相比,3-MST 缺陷小鼠在血流动力学、气体交换、代谢、酸碱状态和存活的参数方面表现出相似的结果。在出血性休克期间,Δ3-MST 小鼠的肾脏白蛋白渗出增加,同时心脏组织的 LEAK 呼吸减少。相反,在接受联合创伤的 Δ3-MST 小鼠的肾脏和肝脏组织中,解偶联状态下的线粒体耗氧量增加。
总之,在复苏的创伤性出血性休克小鼠模型中,3-MST 缺乏对血流动力学和代谢没有生理相关的影响,无论是否存在额外的钝性胸部创伤,最终死亡率都没有改变。