Cardoso de Castro Letícia Urbano, Ida Keila Kazue, Otsuki Denise Aya, Sanches Talita Rojas, Volpini Rildo A, Borges Emilyn da Silva, Malbouisson Luiz-Marcelo Sá, Andrade Lúcia
Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil.
Anesthesiology Department, University of São Paulo School of Medicine, São Paulo, Brazil.
Trauma Surg Acute Care Open. 2016 Sep 26;1(1):e000039. doi: 10.1136/tsaco-2016-000039. eCollection 2016.
In hemorrhagic shock (HS), volume replacement with crystalloid solution can restore the hemodynamic status and decrease mortality. However, it can also lead to tissue edema and pulmonary congestion, as well as increasing vascular permeability. Here, we analyzed the effects that resuscitation with lactated Ringer's solution (LRS) or administration of the vasopressin analog terlipressin has on renal function in a porcine model of HS.
Using pressure-controlled bleeding, we induced pigs to HS, maintaining mean arterial pressure (MAP) at 40 mm Hg for 30 min. Animals were divided into 4 groups: sham (anesthesia only); shock-only (HS induction); shock+LRS (HS induction and subsequent resuscitation with LRS at 3 times the volume of blood removed); and shock+Terli (HS induction and subsequent bolus administration of 2 mg of terlipressin). Parameters were evaluated at baseline, then at 30, 60, and 120 min after treatment (T30, T60, and T120, respectively). Animals were euthanized at T60 or T120.
Both treatments restored MAP to baseline values. At T30 and T60, creatinine clearance was highest in shock+LRS pigs, whereas it was highest in shock+Terli pigs at T120. Both treatments initially induced hyponatremia, although urinary excretion of all ions was higher in shock+LRS pigs at T30. Both treatments restored Na-K-2Cl cotransporter expression, whereas only terlipressin restored aquaporin 2 expression. Both treatments also prevented HS-induced acute tubular necrosis. Expression of the vasopressin receptors V1a and V2 was highest in shock-only pigs. At T120, V1a expression was lowest in shock+LRS pigs.
Terlipressin might be useful for preventing HS-induced acute kidney injury.
在失血性休克（HS）中，用晶体溶液进行容量复苏可恢复血流动力学状态并降低死亡率。然而，它也可导致组织水肿和肺充血，以及增加血管通透性。在此，我们分析了在猪HS模型中，用乳酸林格氏液（LRS）复苏或给予血管加压素类似物特利加压素对肾功能的影响。
通过压力控制出血，我们诱导猪发生HS，将平均动脉压（MAP）维持在40 mmHg 30分钟。动物分为4组：假手术组（仅麻醉）；单纯休克组（诱导HS）；休克+LRS组（诱导HS并随后用去除血液量3倍的LRS进行复苏）；以及休克+特利加压素组（诱导HS并随后推注2 mg特利加压素）。在基线时评估参数，然后在治疗后30、60和120分钟（分别为T30、T60和T120）评估。动物在T60或T120处实施安乐死。
两种治疗均将MAP恢复至基线值。在T30和T60时，肌酐清除率在休克+LRS组猪中最高，而在T120时，休克+特利加压素组猪中最高。两种治疗最初均诱发低钠血症，尽管在T30时休克+LRS组猪中所有离子的尿排泄量更高。两种治疗均恢复了钠-钾-2氯共转运体的表达，而只有特利加压素恢复了水通道蛋白2的表达。两种治疗还预防了HS诱导的急性肾小管坏死。血管加压素受体V1a和V2的表达在单纯休克组猪中最高。在T120时，休克+LRS组猪中V1a表达最低。
特利加压素可能有助于预防HS诱导的急性肾损伤。
