Department of Anesthesia and Surgical Intensive Care, Bicetre Hospital, Paris-Saclay University, Assistance Publique -Hôpitaux de Paris, Le Kremlin-Bicetre, France; Microcirculation Laboratory, UMR 942, Paris Cité University, Paris, France; UMRS 999, Emerging Team DYNAMIC - Organ Dysfunction and Microcirculation, Paris-Saclay University, Le Kremlin-Bicetre, France.
Microcirculation Laboratory, UMR 942, Paris Cité University, Paris, France.
Anesthesiology. 2024 Sep 1;141(3):554-565. doi: 10.1097/ALN.0000000000005097.
Hemorrhagic shock (HS) and rhabdomyolysis (RM) are two important risk factors for acute kidney injury after severe trauma; however, the effects of the combination of RM and HS on kidney function are unknown. The purpose of this study was to determine the impact of RM and HS on renal function, oxygenation, perfusion, and morphology in a pig model.
Forty-seven female pigs were divided into five groups: sham, RM, HS, HS and moderate RM (RM4/HS), and HS and severe RM (RM8/HS). Rhabdomyolysis was induced by intramuscular injection of glycerol 50% with a moderate dose (4 ml/kg for the RM4/HS group) or a high dose (8 ml/kg for the RM and RM8/HS groups). Among animals with HS, after 90 min of hemorrhage, animals were resuscitated with fluid followed by transfusion of the withdrawn blood. Animals were followed for 48 h. Macro- and microcirculatory parameters measurements were performed.
RM alone induced a decrease in creatinine clearance at 48 h (19 [0 to 41] vs. 102 [56 to 116] ml/min for RM and sham, respectively; P = 0.0006) without alteration in renal perfusion and oxygenation. Hemorrhagic shock alone impaired temporarily renal microcirculation, function, and oxygenation that were restored with fluid resuscitation. The RM4/HS and RM8/HS groups induced greater impairment of renal microcirculation and function than HS alone at the end of blood spoliation that was not improved by fluid resuscitation. Mortality was increased in the RM8/HS and RM4/HS groups in the first 48 h (73% vs. 56% vs. 9% for the RM8/HS, RM4/HS, and HS groups, respectively).
The combination of HS and RM induced an early deleterious effect on renal microcirculation, function, and oxygenation with decreased response to resuscitation and transfusion compared with HS or RM alone.
出血性休克 (HS) 和横纹肌溶解症 (RM) 是严重创伤后急性肾损伤的两个重要危险因素；然而，RM 和 HS 联合对肾功能的影响尚不清楚。本研究旨在确定 RM 和 HS 对猪模型肾功能、氧合、灌注和形态的影响。
将 47 只雌性猪分为五组：假手术组、RM 组、HS 组、HS 和中度 RM（RM4/HS 组）以及 HS 和重度 RM（RM8/HS 组）。RM4/HS 组肌肉注射中等剂量甘油（4 ml/kg），RM8/HS 组肌肉注射高剂量甘油（8 ml/kg），诱发 RM。在 HS 动物中，出血 90 分钟后，用液体复苏，然后输注抽出的血液。动物观察 48 小时。测量宏观和微循环参数。
单独 RM 导致 48 小时肌酐清除率下降（19 [0 至 41] 与 RM 和假手术组的 102 [56 至 116] ml/min；P = 0.0006），而肾灌注和氧合无变化。单独 HS 暂时损害了肾微循环、功能和氧合，液体复苏后得到恢复。RM4/HS 和 RM8/HS 组在血液流失结束时比单独 HS 组更严重地损害了肾微循环和功能，液体复苏后没有改善。RM8/HS 和 RM4/HS 组在最初的 48 小时内死亡率增加（73%比 56%比 HS 组的 9%，RM8/HS、RM4/HS 和 HS 组分别）。
与 HS 或 RM 单独相比，HS 和 RM 联合可早期对肾微循环、功能和氧合产生有害影响，复苏和输血反应降低。
