部分或完全的大动脉封闭对猪出血性休克的宏观和微循环流的影响
Gustavo A Ospina Tascón1, Jose L Aldana Diaz, Nicolas Orozco
1From the Department of Intensive Care (G.A.O., J.L.A.D., N.O., C.A.P., A.M.M., M.I.V., E.R., G.G.-G., C.P.-T.), Fundación Valle del Lili; Translational Lab in Critical Care Medicine (TransLab-CCM), Universidad Icesi; Centro de Investigaciones Clínicas (N.O., C.A.O., M.B., G.G.G., A.F.G.), Fundación Valle del Lili; Division of Trauma and Acute Surgery, Department of Surgery (H.P., C.A.O., M.B., A.F.G.), Fundación Valle del Lili Translational Lab in Critical Care Medicine (TransLab-CCM), Universidad Icesi, Cali, Colombia; Department of Diagnostic Images (M.R.), Fundación Valle del Lili, Translational Lab in Critical Care Medicine (TransLab-CCM), Universidad Icesi, Cali, Colombia; and Center of Critical Care Nephrology, Department of Critical Care Medicine (H.G.), University of Pittsburgh Medical Center Pittsburgh. Pittsburgh, Pennsylvania.
通过内血管气球阻塞大动脉 (REBOA) 进行部分复苏,与完全的REBOA相比,在休克期间更好地保持中介管血流和微循环. 这表明部分REBOA可能会在重症监护机构提供更好的结果.
科学领域:
- 复苏和重症监护医学 复苏和重症监护医学
- 流血性休克管理的管理.
- 血管外科和干预性放射学.
背景情况:
- 复苏性内血管气球阻塞大动脉 (REBOA) 是无血性休克的关键救援策略.
- 部分和总REBOA通货膨胀对宏观循环和小微循环流的差异性影响仍然不完全理解.
- 澄清这些影响对于优化REBOA在创伤和出血紧急情况中的应用至关重要.
研究的目的:
- 为了比较部分和总REBOA膨胀在受控出血性休克期间对宏观血动力学和状微循环参数的影响.
- 评估不同REBOA膨胀策略对肠道血流和组织输液的影响.
- 评估部分和总REBOA在冲击和再注射期间对乳酸水平和酸平衡的影响.
主要方法:
- 使用了受控出血性休克的猪模型 (n=18).
- 动物被随机分为部分REBOA,总REBOA或没有REBOA的组.
- 在整个冲击,复苏和再注射阶段,监测了宏观动力学参数,中腔动脉流量和直肠微血管流量 (使用LDF和侧流暗场显微镜).
主要成果:
- 整体REBOA最初增加了大动脉根和冠状动脉压力,但在再输血过程中导致显著下降.
- 部分REBOA在膨胀期间保持了一些流量,并且在再输液期间显示出与总REBOA相比的显著更好的阴微血管流量.
- 与部分REBOA相比,总REBOA组在闭塞和再输液期间表现出较高的乳酸盐水平和较不有利的中腔静脉pH值.
结论:
- 部分-REBOA在封闭阶段和早期再输血阶段有效地保持区域介质和肠道微循环血流.
- 部分REBOA与更有利的中腔静脉pH值和乳酸盐值有关,这表明代谢状态有所改善.
- 这些发现表明,部分REBOA可能是维持严重出血性休克时器官输液的优越策略.
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