当前位置: X-MOL 学术ICMx › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Moderately prolonged permissive hypotension results in reversible metabolic perturbation evaluated by intracerebral microdialysis - an experimental animal study
Intensive Care Medicine Experimental Pub Date : 2019-12-01 , DOI: 10.1186/s40635-019-0282-x
Rasmus Peter Jakobsen 1 , Troels Halfeld Nielsen 2 , Simon Mølstrøm 1 , Carl-Henrik Nordström 2 , Asger Granfeldt 3 , Palle Toft 1
Affiliation  

BackgroundDamage control resuscitation (DCR) and damage control surgery (DCS) is the main strategy in patients with uncontrollable hemorrhagic shock. One aspect of DCR is permissive hypotension. However, the duration of hypotension that can be tolerated without affecting the brain is unknown. In the present study we investigate the effect of 60 min severe hypotension on the brain’s energy metabolism and seek to verify earlier findings that venous cerebral blood can be used as a marker of global cerebral energy state.Material and methodsTen pigs were anaesthetized, and vital parameters recorded. Microdialysis catheters were placed in the left parietal lobe, femoral artery, and superior sagittal sinus for analysis of lactate, pyruvate, glucose, glycerol, and glutamate. Hemorrhagic shock was induced by bleeding the animal until mean arterial pressure (MAP) of 40 mmHg was achieved. After 60 min the pigs were resuscitated with autologous blood and observed for 3 h.ResultsAt baseline the lactate to pyruvate ratios (LP ratio) in the hemisphere, artery, and sagittal sinus were (median (interquartile range)) 13 (8–16), 21 (18–24), and 9 (6–22), respectively. After induction of hemorrhagic shock, the LP ratio from the left hemisphere in 9 pigs increased to levels indicating a reversible perturbation of cerebral energy metabolism 19 (12–30). The same pattern was seen in LP measurements from the femoral artery 28 (20–35) and sagittal sinus 22 (19–26). At the end of the experiment hemisphere, artery and sinus LP ratios were 16 (10–23), 17 (15–25), and 17 (10–27), respectively. Although hemisphere and sinus LP ratios decreased, they did not reach baseline levels (p < 0.05). In one pig hemisphere LP ratio increased to a level indicating irreversible metabolic perturbation (LP ratio > 200).ConclusionDuring 60 min of severe hypotension intracerebral microdialysis shows signs of perturbations of cerebral energy metabolism, and these changes trend towards baseline values after resuscitation. Sagittal sinus microdialysis values followed hemisphere values but were not distinguishable from systemic arterial values. Venous (jugular bulb) microdialysis might have a place in monitoring conditions where global cerebral ischemia is a risk.

中文翻译:

脑内微透析评估中度长期允许性低血压导致可逆性代谢紊乱 - 一项实验动物研究

背景损伤控制复苏(DCR)和损伤控制手术(DCS)是无法控制的失血性休克患者的主要策略。DCR 的一方面是允许性低血压。然而,在不影响大脑的情况下可以忍受的低血压持续时间是未知的。在本研究中,我们研究了 60 分钟严重低血压对大脑能量代谢的影响,并试图验证早期的发现,即静脉脑血可以作为全脑能量状态的标志物。 材料和方法 麻醉 10 头猪,生命参数记录。微透析导管放置在左顶叶、股动脉和上矢状窦,用于分析乳酸、丙酮酸、葡萄糖、甘油和谷氨酸。通过使动物放血直至达到 40 mmHg 的平均动脉压 (MAP) 来诱发失血性休克。60 分钟后,猪用自体血复苏并观察 3 小时。 结果基线时半球、动脉和矢状窦的乳酸与丙酮酸比(LP 比)为(中位数(四分位距))13 (8-16) 、 21 (18–24) 和 9 (6–22) 分别。诱发失血性休克后,9 头猪左半球的 LP 比率增加到表明脑能量代谢可逆扰动的水平 19 (12-30)。在来自股动脉 28 (20-35) 和矢状窦 22 (19-26) 的 LP 测量中观察到相同的模式。在实验结束时,半球、动脉和窦 LP 比率分别为 16 (10-23)、17 (15-25) 和 17 (10-27)。尽管半球和窦性 LP 比率下降,但它们没有达到基线水平 (p < 0.05)。在一只猪的半球LP比率增加到表明不可逆代谢扰动的水平(LP比率> 200)。结论在60分钟的严重低血压脑内微透析显示脑能量代谢紊乱的迹象,并且这些变化在复苏后趋向于基线值。矢状窦微透析值遵循半球值,但与全身动脉值无法区分。静脉(颈静脉球)微透析可能在监测具有全脑缺血风险的情况中占有一席之地。结论 60 min 严重低血压脑微透析显示脑能量代谢紊乱,复苏后这些变化趋向于基线值。矢状窦微透析值遵循半球值,但与全身动脉值无法区分。静脉(颈静脉球)微透析可能在监测具有全脑缺血风险的情况中占有一席之地。结论 60 min 严重低血压脑微透析显示脑能量代谢紊乱,复苏后这些变化趋向于基线值。矢状窦微透析值遵循半球值,但与全身动脉值无法区分。静脉(颈静脉球)微透析可能在监测具有全脑缺血风险的情况中占有一席之地。
更新日期:2019-12-01
down
wechat
bug