在猪出血和复苏模型中评估液体状态的血流动力学参数。
Hemodynamic Parameters in the Assessment of Fluid Status in a Porcine Hemorrhage and Resuscitation Model.
出版信息
Anesthesiology. 2021 Apr 1;134(4):607-616. doi: 10.1097/ALN.0000000000003724.
BACKGROUND
Measuring fluid status during intraoperative hemorrhage is challenging, but detection and quantification of fluid overload is far more difficult. Using a porcine model of hemorrhage and over-resuscitation, it is hypothesized that centrally obtained hemodynamic parameters will predict volume status more accurately than peripherally obtained vital signs.
METHODS
Eight anesthetized female pigs were hemorrhaged at 30 ml/min to a blood loss of 400 ml. After each 100 ml of hemorrhage, vital signs (heart rate, systolic blood pressure, mean arterial pressure, diastolic blood pressure, pulse pressure, pulse pressure variation) and centrally obtained hemodynamic parameters (mean pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac output) were obtained. Blood volume was restored, and the pigs were over-resuscitated with 2,500 ml of crystalloid, collecting parameters after each 500-ml bolus. Hemorrhage and resuscitation phases were analyzed separately to determine differences among parameters over the range of volume. Conformity of parameters during hemorrhage or over-resuscitation was assessed.
RESULTS
During the course of hemorrhage, changes from baseline euvolemia were observed in vital signs (systolic blood pressure, diastolic blood pressure, and mean arterial pressure) after 100 ml of blood loss. Central hemodynamic parameters (mean pulmonary artery pressure and pulmonary capillary wedge pressure) were changed after 200 ml of blood loss, and central venous pressure after 300 ml of blood loss. During the course of resuscitative volume overload, changes were observed from baseline euvolemia in mean pulmonary artery pressure and central venous pressure after 500-ml resuscitation, in pulmonary capillary wedge pressure after 1,000-ml resuscitation, and cardiac output after 2,500-ml resuscitation. In contrast to hemorrhage, vital sign parameters did not change during over-resuscitation. The strongest linear correlation was observed with pulmonary capillary wedge pressure in both hemorrhage (r2 = 0.99) and volume overload (r2 = 0.98).
CONCLUSIONS
Pulmonary capillary wedge pressure is the most accurate parameter to track both hemorrhage and over-resuscitation, demonstrating the unmet clinical need for a less invasive pulmonary capillary wedge pressure equivalent.
背景
术中出血时测量血容量状态具有挑战性，但检测和量化血容量过多要困难得多。通过猪出血和过度复苏模型，假设中心获得的血流动力学参数将比外周获得的生命体征更准确地预测容量状态。
方法
8 只麻醉雌性猪以 30ml/min 的速度出血，失血量为 400ml。每次出血 100ml 后，记录生命体征（心率、收缩压、平均动脉压、舒张压、脉压、脉压变化）和中心获得的血流动力学参数（平均肺动脉压、肺毛细血管楔压、中心静脉压、心输出量）。然后恢复血容量，用 2500ml 晶体液进行过度复苏，每次输注 500ml 后收集参数。分别分析出血和复苏阶段，以确定容量范围内参数之间的差异。评估出血或过度复苏期间参数的一致性。
结果
在出血过程中，从基线正常血容量开始，观察到生命体征（收缩压、舒张压和平均动脉压）在出血 100ml 后发生变化。中心血流动力学参数（平均肺动脉压和肺毛细血管楔压）在出血 200ml 后发生变化，中心静脉压在出血 300ml 后发生变化。在复苏性血容量过多过程中，从基线正常血容量开始，在 500ml 复苏后观察到平均肺动脉压和中心静脉压发生变化，在 1000ml 复苏后观察到肺毛细血管楔压发生变化，在 2500ml 复苏后观察到心输出量发生变化。与出血相比，生命体征参数在过度复苏过程中没有变化。在出血（r2=0.99）和容量过多（r2=0.98）中，观察到与肺毛细血管楔压最强的线性相关性。
结论
肺毛细血管楔压是跟踪出血和过度复苏最准确的参数，这表明需要一种侵入性更小的肺毛细血管楔压等效物来满足临床需求。
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