Laboratoire d'Étude de la Microcirculation, UMR 942, Université Paris 7-11-13, Paris, France.
Service d'Anesthésie-Réanimation, Hôpital d'Instruction des Armées Percy, Clamart, France.
Am J Respir Crit Care Med. 2022 Jul 1;206(1):34-43. doi: 10.1164/rccm.202109-2120OC.
Norepinephrine (NE) is commonly used in combination with fluid during resuscitation of hemorrhagic shock, but its impact on kidney microcirculation, oxygenation, and function is still unknown in this setting. During hemorrhagic shock resuscitation, does a combination of fluid and NE affect kidney oxygenation tension, kidney microcirculatory perfusion, and 48-hour kidney function, as compared with fluid alone? Hemorrhagic shock was induced in 24 pigs, and 8 pigs were included as a sham group. Resuscitation of hemorrhagic shock was performed, using a closed-loop device, either by fluid alone (0.9% NaCl; fluid group) or associated with the administration of NE at two doses (moderate dose: mean rate of 0.64 μg ⋅ kg ⋅ min; high dose: mean rate of 1.57 μg ⋅ kg ⋅ min) to obtain a target systolic arterial pressure of 80 to 90 mm Hg. Resuscitation was followed by transfusion of the withdrawn blood. The amount of fluid required to reach the target systolic arterial pressure was lower in the NE groups than in the fluid group, with subsequently less hemodilution. NE restored kidney microcirculation, oxygenation, and function in a manner comparable to that achieved with fluid resuscitation alone. There were no histologic differences between animals resuscitated with fluid and those resuscitated with NE. In pigs with hemorrhagic shock, resuscitation with a combination of NE and fluid restored kidney microcirculation and oxygenation, as well as renal function, in a manner comparable to fluid resuscitation alone and without differences between the two NE doses. NE administration led to a fluid volume-sparing effect with subsequently less hemodilution.
去甲肾上腺素（NE）在失血性休克复苏时通常与液体联合使用，但在这种情况下，其对肾脏微循环、氧合和功能的影响尚不清楚。在失血性休克复苏期间，与单独使用液体相比，液体联合 NE 是否会影响肾脏氧张力、肾脏微循环灌注和 48 小时肾功能？在 24 头猪中诱导失血性休克，并纳入 8 头猪作为假手术组。使用闭环装置进行失血性休克复苏，单独使用液体（0.9%NaCl；液体组）或联合使用 NE 两种剂量（中剂量：平均速率为 0.64 μg ⋅ kg ⋅ min；高剂量：平均速率为 1.57 μg ⋅ kg ⋅ min）以获得目标收缩压 80 至 90mmHg。复苏后输注抽出的血液。NE 组达到目标收缩压所需的液体量低于液体组，随后血液稀释程度较低。NE 以与单独液体复苏相当的方式恢复肾脏微循环、氧合和功能。用液体和 NE 复苏的动物之间没有组织学差异。在失血性休克的猪中，NE 与液体联合复苏以与单独液体复苏相当的方式恢复肾脏微循环和氧合，以及肾功能，并且两种 NE 剂量之间没有差异。NE 给药导致液体量节省效应，随后血液稀释程度较低。
