Coisy Fabien, Tikvesa Dino, Ajavon Florian, Gamel Augustin, Grau-Mercier Laura, Sanchez Thomas, Bacle Marylène, Lefrant Jean-Yves, Markarian Thibaut, Bobbia Xavier
IMAGINE UR UM 103, Montpellier University, Department of Emergency Medicine, Nîmes University Hospital, 4 Place du Pr Robert Debré, 30900, Nîmes, France.
IMAGINE UR UM 103, Montpellier University, Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France.
Sci Rep. 2025 Jul 21;15(1):26497. doi: 10.1038/s41598-025-12273-3.
In the management of hemorrhagic shock (HS), the restoration of adequate mean arterial pressure (MAP) while minimizing complications is critical. Whole blood (WB) has demonstrated physiological advantages over crystalloids such as normal saline (NS), yet direct comparisons in non-traumatic HS remain scarce. This study sought to evaluate the volume and hemodynamic efficacy of WB compared to NS in achieving a MAP of 60 mmHg in a porcine model of non-traumatic HS. The WB requirement and the NS volume necessary to restore MAP were 12 [10-14] and 23 [20-24] mL·kg, respectively (p < 0.01). One hour after resuscitation, mean arterial pressure (MAP) in the WB group was 69 [66-73] mmHg, and MAP in the NS group was 57 [55-64] mmHg (p < 0.05). Immediately after resuscitation, a median change of 1.4 [0.8-2.0] mmol·L and -0.4 [-1.0-0.3] mmol·L was observed in the WB and NS groups for base excess, respectively (p < 0.05). One hour after resuscitation, lactate levels decreased in median by -3.5 [-4.5 to -2.3] and -1.3 [-2.0 to -0.9] mmol·L in the WB and NS groups, respectively (p < 0.05). Cardiac output and Syndecan-1 levels did not differ significantly between the groups. In this model of non-traumatic HS, WB showed greater efficacy in restoring MAP with a reduced infusion volume (1:2 WB:NS), exhibiting enhanced markers of metabolic recovery. Despite the comparable endothelial response, as indicated by Syndecan-1 levels, WB yielded more protracted hemodynamic benefits. These findings support the potential use of WB in early HS resuscitation and highlight the need for further investigation in non-trauma HS.
在失血性休克（HS）的管理中，恢复足够的平均动脉压（MAP）同时将并发症降至最低至关重要。全血（WB）已显示出比晶体液（如生理盐水（NS））更具生理优势，但在非创伤性HS中的直接比较仍然很少。本研究旨在评估在非创伤性HS猪模型中，与NS相比，WB在达到60 mmHg MAP时的容量和血流动力学效果。恢复MAP所需的WB量和NS量分别为12 [10 - 14] 和23 [20 - 24] mL·kg（p < 0.01）。复苏后1小时，WB组的平均动脉压（MAP）为69 [66 - 73] mmHg，NS组的MAP为57 [55 - 64] mmHg（p < 0.05）。复苏后即刻，WB组和NS组的碱剩余中位数变化分别为1.4 [0.8 - 2.0] mmol·L和 - 0.4 [-1.0 - 0.3] mmol·L（p < 0.05）。复苏后1小时，WB组和NS组的乳酸水平中位数分别下降 - 3.5 [-4.5至 - 2.3] 和 - 1.3 [-2.0至 - 0.9] mmol·L（p < 0.05）。两组之间的心输出量和Syndecan - 1水平无显著差异。在这个非创伤性HS模型中，WB在以减少的输注量（1:2 WB:NS）恢复MAP方面显示出更大的效果，表现出代谢恢复的增强标志物。尽管Syndecan - 1水平表明内皮反应相当，但WB产生了更持久的血流动力学益处。这些发现支持了WB在早期HS复苏中的潜在应用，并强调了在非创伤性HS中进一步研究的必要性。
