Department of Emergency Medicine, School of Medicine, South China University of Technology, Guangzhou 510006, China; Department of Emergency Medicine, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing 100048, China.
Department of Emergency Medicine, The First Medical Center of PLA General Hospital of Beijing, Beijing 100853, China.
Shock. 2023 Sep 1;60(3):434-442. doi: 10.1097/SHK.0000000000002182. Epub 2023 Jul 25.
Background: Resuscitative balloon occlusion of the aorta (REBOA) is an endovascular hemostasis method used for the management of traumatic abdominal and pelvic hemorrhages. However, REBOA-associated ischemia-reperfusion injury complication limits its blocking time. We hypothesized that mild therapeutic hypothermia would relieve ischemia-reperfusion injury caused by prolonged zone 1 REBOA. Methods: Ten pigs were anesthetized, intubated, and subsequently struck with the experimental sliding-chamber ballistic gun to inflict liver damage. Animals were randomized to hypothermia (60 min of zone 1 REBOA with external cooling for 180 min, n = 5) or control (60 min of zone 1 REBOA with no external cooling, n = 5). Physiological and laboratory parameters were monitored and assessed. Distal organs were obtained for histologic analysis. Results: At 180 min, compared with the control, the hypothermia animals exhibited significantly increased pH and significantly reduced lactate, hemoglobin, and hematocrit (all P < 0.05). The change of lactate from 0 to 180 min in hypothermia animals was less than that in the control ( P = 0.02). The total bleeding in the control group was significantly less than the hypothermia ( P < 0.01). In the hypothermia group, prothrombin time at 120 and 180 min was significantly longer than that at baseline (all P < 0.05). Compared with the control, animals in the hypothermia group showed slighter pathological injury of the distal organs and significantly lower overall injury score (all P < 0.05). Conclusions: Mild therapeutic hypothermia during prolonged zone 1 REBOA offered extraordinary distal organ preservation and decreased metabolic acidosis.
主动脉球囊阻断复苏（REBOA）是一种用于治疗创伤性腹部和骨盆出血的血管内止血方法。然而，REBOA 相关的缺血再灌注损伤并发症限制了其阻断时间。我们假设轻度治疗性低温会缓解长时间 Zone1 REBOA 引起的缺血再灌注损伤。
10 头猪麻醉、气管插管后，用实验性滑动室弹道枪撞击造成肝损伤。动物随机分为低温组（Zone1 REBOA 60min，外部冷却 180min，n=5）或对照组（Zone1 REBOA 60min，无外部冷却，n=5）。监测和评估生理和实验室参数。获取远端器官进行组织学分析。
与对照组相比，低温组在 180min 时 pH 值显著升高，乳酸、血红蛋白和血细胞比容显著降低（均 P<0.05）。低温组从 0 到 180min 的乳酸变化小于对照组（P=0.02）。对照组的总出血量明显少于低温组（P<0.01）。在低温组，120 和 180min 的凝血酶原时间明显长于基线（均 P<0.05）。与对照组相比，低温组的远端器官病理损伤较轻，整体损伤评分明显较低（均 P<0.05）。
长时间 Zone1 REBOA 期间的轻度治疗性低温可提供卓越的远端器官保护并减少代谢性酸中毒。
