体外钾结合在挤压伤无尿模型中治疗高钾血症。

Extracorporeal potassium binding for the management of hyperkalemia in an anephric model of crush injury.

机构信息

From the Clinical Investigation Facility (G.L.H., C.A.B., C.W., H.K., A.W., J.K.G., L.W., I.J.S.), David Grant USAF Medical Center, Travis Air Force Base; Department of Surgery (C.A.B., H.K., A.W.), University of California Davis Medical Center, Sacramento, California; Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery (J.D.R.), Oregon Health & Science University, Portland, Oregon; and Department of Medicine Uniformed Services, University of the Health Sciences (IJS), Bethesda, Maryland.

出版信息

J Trauma Acute Care Surg. 2019 Apr;86(4):694-701. doi: 10.1097/TA.0000000000002178.

DOI:10.1097/TA.0000000000002178

PMID:30633103

Abstract

BACKGROUND

Potassium-binding polymers have shown promising results in an anephric porcine hyperkalemia model. The benefits of the polymer in a clinically relevant injury model remain unknown. We hypothesized that potassium-binding cartridges would control serum potassium concentration in a porcine hemorrhagic shock model with supraceliac aortic occlusion and a limb crush injury.

METHODS

Ten Yorkshire-cross swine were anesthetized and instrumented. Pigs underwent splenectomy and bilateral nephrectomy. Hemorrhagic shock was induced for 30 minutes while a leg compression device was applied. Pigs underwent supraceliac aortic occlusion for 60 minutes and were resuscitated with shed blood. The leg compression device was removed 20 minutes after balloon deflation. After 20 minutes of reperfusion, animals were randomized to extracorporeal circulation with (treatment) or without (control) the potassium binding cartridges. In both groups, blood was circulated through a hemodialyzer with a peristaltic pump. In the treatment group, the ultrafiltrate was diverted from the hemodialyzer through cartridges containing the polymer and returned to the extracorporeal circuit. Animals were resuscitated with 0.9% saline boluses and a norepinephrine infusion. The change in serum potassium concentration (ΔK) was calculated as serum [K]T390 - serum [K]T0.

RESULTS

There was a significant difference in serum potassium concentration between groups (p < 0.001). ΔK was significantly higher in the control than the treatment group (3.75 [3.27-4.42] and 1.15 [0.62-1.59] mmol/L, respectively; p = 0.03). There were no differences in mean arterial pressure (p = 0.14), isotonic crystalloids requirement (p = 0.51), or norepinephrine dose (p = 0.83) between groups. Serum lactate concentration was significantly higher in the control group (p < 0.001). At the end of the experiment, the [K] was reduced by 25% (24.9%-27.8%) across the cartridges.

CONCLUSION

The cartridges controlled serum potassium concentrations without dialysate and retained potassium binding capabilities over 4 hours. There were no deleterious effects on hemodynamic parameters. Those cartridges might be beneficial adjuncts for hyperkalemia management in austere environments.

LEVEL OF EVIDENCE

Translational science study, level I.

摘要

背景

钾结合聚合物在去肾猪高钾血症模型中显示出良好的效果。该聚合物在临床相关损伤模型中的益处尚不清楚。我们假设，在伴有腹腔上主动脉阻断和肢体挤压伤的猪失血性休克模型中，钾结合夹可控制血清钾浓度。

方法

10 头约克郡杂交猪接受麻醉和仪器操作。猪接受脾切除术和双侧肾切除术。应用腿部压迫装置时，诱导 30 分钟失血性休克。进行腹腔上主动脉阻断 60 分钟，并用引流血复苏。气球放气后 20 分钟去除腿部压迫装置。再灌注 20 分钟后，动物随机分为接受（治疗）或不接受（对照）钾结合夹的体外循环。在两组中，血液均通过蠕动泵循环通过血液透析器。在治疗组中，将超滤液从血液透析器转移到含有聚合物的夹中，并返回体外回路。动物通过生理盐水推注和去甲肾上腺素输注复苏。血清钾浓度的变化（ΔK）计算为血清 [K]T390-血清 [K]T0。

结果

两组间血清钾浓度有显著差异（p < 0.001）。对照组的 ΔK 明显高于治疗组（分别为 3.75[3.27-4.42]和 1.15[0.62-1.59]mmol/L；p = 0.03）。两组间平均动脉压（p = 0.14）、等渗晶体需要量（p = 0.51）或去甲肾上腺素剂量（p = 0.83）无差异。对照组血清乳酸浓度明显升高（p < 0.001）。实验结束时，通过夹的 [K]降低了 25%（24.9%-27.8%）。