Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
University Department for Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
Microvasc Res. 2022 Sep;143:104383. doi: 10.1016/j.mvr.2022.104383. Epub 2022 May 20.
Spinal cord injury induced by ischemia/reperfusion is a devastating complication of aortic repair. Despite developments for prevention and treatment of spinal cord injury, incidence is still considerably high majorly impacting patient outcome. Microcirculation is paramount for tissue perfusion and oxygen supply and often dissociated from macrohemodynamic parameters used to guide resuscitation. Effects of fluids vs. vasopressors in the setting of hemodynamic resuscitation on spinal cord microperfusion are unknown. Aim of this study was to compare the effects of vasopressor and fluid resuscitation on spinal cord microperfusion in a translational acute pig model of hemorrhagic shock induced ischemia/reperfusion injury.
We designed this study as prospective randomized explorative large animal study. We induced hemorrhagic shock in 20 pigs as a model of global ischemia/reperfusion injury. We randomized animals to receive either fluid or vasopressor resuscitation. We measured spinal cord microperfusion using fluorescent microspheres as well as laser-Doppler probes. We monitored and analyzed macrohemodynamic parameters and cerebrospinal fluid pressure.
Spinal cord microperfusion decreased following hemorrhagic shock induced ischemia/reperfusion injury. Both fluids and vasopressors sufficiently restored spinal cord microperfusion. There were no important changes between groups (percentage changes compared to baseline: fluids 14.0 (0.31-27.6) vs. vasopressors 24.3 (8.12-40.4), p = .340). However, cerebrospinal fluid pressure was higher in animals receiving fluid resuscitation (percentage changes compared to baseline: fluids 27.7 (12.6-42.8) vs. vasopressors -5.56 ((-19.8)-8.72), p = .003). Microcirculatory resuscitation was in line with improvements of macrohemodynamic parameters.
Both, fluids and vasopressors, equally restored spinal cord microperfusion in a porcine acute model of hemorrhagic shock induced ischemia/reperfusion injury. However, significant differences in cerebrospinal fluid pressure following resuscitation were present. Future studies should evaluate these effects in perfusion disruption induced ischemia/reperfusion conditions of microcirculatory deterioration.
缺血/再灌注引起的脊髓损伤是主动脉修复的一种毁灭性并发症。尽管在预防和治疗脊髓损伤方面取得了进展，但发病率仍然相当高，主要影响患者的预后。微循环对于组织灌注和氧气供应至关重要，并且经常与用于指导复苏的宏观血流动力学参数分离。在血流动力学复苏中，液体与血管加压药对脊髓微循环的影响尚不清楚。本研究的目的是比较血管加压药和液体复苏对出血性休克诱导的缺血/再灌注损伤猪模型中脊髓微循环的影响。
我们将这项研究设计为前瞻性随机探索性大动物研究。我们诱导 20 头猪发生出血性休克，作为全身缺血/再灌注损伤的模型。我们将动物随机分为接受液体或血管加压药复苏的组。我们使用荧光微球和激光多普勒探头测量脊髓微循环。我们监测和分析宏观血流动力学参数和脑脊液压力。
出血性休克诱导的缺血/再灌注损伤后，脊髓微循环减少。液体和血管加压药都能充分恢复脊髓微循环。两组之间没有重要变化（与基线相比的百分比变化：液体 14.0（0.31-27.6）与血管加压药 24.3（8.12-40.4），p=0.340）。然而，接受液体复苏的动物的脑脊液压力更高（与基线相比的百分比变化：液体 27.7（12.6-42.8）与血管加压药-5.56（-19.8）-8.72），p=0.003）。微循环复苏与宏观血流动力学参数的改善一致。
在猪急性出血性休克诱导的缺血/再灌注损伤模型中，液体和血管加压药同样恢复了脊髓微循环。然而，复苏后脑脊液压力存在显著差异。未来的研究应在灌注障碍诱导的缺血/再灌注条件下评估这些对微循环恶化的影响。
