存活于出血和长时间低血压后出现的肌肉和肝功能障碍指标。

Indices of muscle and liver dysfunction after surviving hemorrhage and prolonged hypotension.

机构信息

From the US Army Institute of Surgical Research (C.H-L., G.W.M., I.L.H., K.L.R.), Fort Sam Houston; Texas Biomedical Research Institute (R.E.S., P.A.F., J.W.D.), San Antonio, Texas; and Program Executive Office Simulation, Training and Instrumentation (R.C.), Orlando, Florida.

出版信息

J Trauma Acute Care Surg. 2019 Jul;87(1S Suppl 1):S101-S109. doi: 10.1097/TA.0000000000002311.

DOI:10.1097/TA.0000000000002311

PMID:31246913

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7159267/

Abstract

BACKGROUND

This study determined the long-term effects of prolonged hypotension (PH) on liver, muscle, and kidney dysfunction. The hypothesis was that longer duration of PH after hemorrhage will result in greater organ dysfunction.

METHODS

Baboons were sedated and hemorrhaged (30% blood volume). Systolic blood pressure greater than 80 mm Hg was maintained for 1 hour (1 hr-PH; n = 5), 2 hours (2 hr-PH; n = 5), or 3 hours (3 hr-PH; n = 5). After PH, hemorrhage volume was replaced. Animals were recovered and monitored for 21 days. Control animals were hemorrhaged and immediately resuscitated (0 hr-PH, n = 3). Data are Mean ± Standard Deviation, and analyzed by 2-way repeated measures ANOVA and Holm-Sidak test.

RESULTS

Hemorrhage resulted in mild hypotension. Minimal resuscitation was required during the hypotensive phase, and survival rate was 100%. Significant increases (p < 0.001) in alanine aminotransferase, aspartate aminotransferase, creatine phosphokinase, and lactate dehydrogenase occurred on Day 1 after PH, and were significantly greater (p < 0.001) in the 2 hr- and 3 hr-PH groups than the 0 hr-PH group. Maximum alanine aminotransferase levels (U/L) were 140 ± 56 (0 hr-PH), 170 ± 130 (1 hr-PH), 322 ± 241 (2 hr-PH), and 387 ± 167 (3 hr-PH). Maximum aspartate aminotransferase levels (U/L) were 218 ± 44 (0 hr-PH), 354 ± 219 (1 hr-PH), 515 ± 424 (2 hr-PH), and 711 ± 278 (3 hr-PH). Maximum creatine phosphokinase values (U/L) were 7834 ± 3681 (0 hr-PH), 24336 ± 22268 (1 hr-PH), 50494 ± 67653 (2 hr-PH), and 59857 ± 32408 (3 hr-PH). Maximum lactic acid dehydrogenase values (U/L) were 890 ± 396 (0 hr-PH), 2055 ± 1520 (1 hr-PH), 3992 ± 4895 (2 hr-PH), and 4771 ± 1884 (3 hr-PH). Plasma creatinine and blood urea nitrogen were unaffected by PH (p > 0.10).

CONCLUSION

These results indicate that PH up to 3 hours in duration results in transient liver and muscle dysfunction that was most severe after 2 hr-PH and 3 hr-PH. Prolonged hypotension produced minimal effects on the kidney.

LEVEL OF EVIDENCE

Basic science research, Level of evidence not required for basic science research.

摘要

背景

本研究旨在确定长时间低血压（PH）对肝、肌肉和肾功能障碍的长期影响。假设是出血后 PH 持续时间越长，器官功能障碍越严重。

方法

狒狒被镇静并出血（30%血容量）。收缩压大于 80mmHg 持续 1 小时（1hr-PH；n=5）、2 小时（2hr-PH；n=5）或 3 小时（3hr-PH；n=5）。在 PH 后，替代出血量。动物恢复并监测 21 天。对照组动物出血并立即复苏（0hr-PH，n=3）。数据为平均值±标准差，采用双因素重复测量方差分析和 Holm-Sidak 检验进行分析。

结果

出血导致轻度低血压。低血压期只需少量复苏，存活率为 100%。PH 后第 1 天，丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酸磷酸激酶和乳酸脱氢酶显著升高（p<0.001），且 2hr-PH 和 3hr-PH 组明显高于 0hr-PH 组（p<0.001）。最大丙氨酸氨基转移酶水平（U/L）分别为 140±56（0hr-PH）、170±130（1hr-PH）、322±241（2hr-PH）和 387±167（3hr-PH）。最大天冬氨酸氨基转移酶水平（U/L）分别为 218±44（0hr-PH）、354±219（1hr-PH）、515±424（2hr-PH）和 711±278（3hr-PH）。最大肌酸磷酸激酶值（U/L）分别为 7834±3681（0hr-PH）、24336±22268（1hr-PH）、50494±67653（2hr-PH）和 59857±32408（3hr-PH）。最大乳酸脱氢酶值（U/L）分别为 890±396（0hr-PH）、2055±1520（1hr-PH）、3992±4895（2hr-PH）和 4771±1884（3hr-PH）。PH 对血浆肌酐和血尿素氮无影响（p>0.10）。