Zhou Yuanqun, Li Qinghui, Xiang Xinming, Wu Yue, Zhu Yu, Peng Xiaoyong, Liu Liangming, Li Tao
State Key Laboratory of Trauma, Burns and Combined Injury, Shock and Transfusion of Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China.
Front Physiol. 2022 Sep 19;13:1004714. doi: 10.3389/fphys.2022.1004714. eCollection 2022.
Hypotension resuscitation is an important principle for the treatment after trauma. Current hypotensive resuscitation strategies cannot obtain an ideal outcome for remote regions. With the uncontrolled hemorrhagic shock (UHS) model in rats, the effects of norepinephrine (NE) on the tolerance time of hypotensive resuscitation, blood loss, vital organ functions, and animal survival were observed. Before bleeding was controlled, only the LR infusion could effectively maintain the MAP to 50-60 mmHg for 1 h, while the MAP gradually decreased with prolonging time, even with increasing infusion volume. Low-dose NE during hypotensive resuscitation prolonged the hypotensive tolerance time to 2-3 h, and the effect of 0.3 μg/kg/min NE was the best. Further studies showed that 0.3 μg/kg/min NE during hypotensive resuscitation significantly lightened the damage of organ function induced by UHS via protecting mitochondrial function, while the LR infusion did not. At the same time, NE administration improved Hb content, DO, and VO, and restored liver and kidney blood flow. The survival results showed that low-dose NE administration increased the survival rate and prolonged the survival time. Together, low-dose NE during hypotensive resuscitation was suitable for the early treatment of UHS, which can strive for the golden window of emergency treatment for serious trauma patients by reducing blood loss and protecting vital organ functions.
低血压复苏是创伤后治疗的一项重要原则。目前的低血压复苏策略在偏远地区无法取得理想效果。采用大鼠未控制出血性休克（UHS）模型，观察去甲肾上腺素（NE）对低血压复苏耐受时间、失血量、重要器官功能及动物存活情况的影响。在出血得到控制之前，仅输注乳酸林格液（LR）能有效将平均动脉压（MAP）维持在50 - 60 mmHg达1小时，而随着时间延长，即使增加输注量，MAP仍逐渐下降。低血压复苏期间给予低剂量NE可将低血压耐受时间延长至2 - 3小时，其中以0.3 μg/kg/min NE的效果最佳。进一步研究表明，低血压复苏期间给予0.3 μg/kg/min NE可通过保护线粒体功能显著减轻UHS诱导的器官功能损伤，而输注LR则无此作用。同时，给予NE可改善血红蛋白含量、氧输送（DO）和氧消耗（VO），并恢复肝、肾血流。存活结果显示，给予低剂量NE可提高存活率并延长存活时间。总之，低血压复苏期间给予低剂量NE适用于UHS的早期治疗，可通过减少失血量和保护重要器官功能为严重创伤患者争取急诊治疗的黄金窗口。
