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Total resuscitative endovascular balloon occlusion of the aorta causes inflammatory activation and organ damage within 30 minutes of occlusion in normovolemic pigs.
BMC Surgery ( IF 1.9 ) Pub Date : 2020-03-02 , DOI: 10.1186/s12893-020-00700-3
Mitra Sadeghi 1 , Emanuel M Dogan 2 , Christina Karlsson 3 , Kjell Jansson 4 , Jenny Seilitz 1 , Per Skoog 5 , Tal M Hörer 1 , Kristofer F Nilsson 1
Affiliation  

BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) causes physiological, metabolic, end-organ and inflammatory changes that need to be addressed for better management of severely injured patients. The aim of this study was to investigate occlusion time-dependent metabolic, end-organ and inflammatory effects of total REBOA in Zone I in a normovolemic animal model. METHODS Twenty-four pigs (25-35 kg) were randomized to total occlusion REBOA in Zone I for either 15, 30, 60 min (REBOA15, REBOA30, and REBOA60, respectively) or to a control group, followed by 3-h reperfusion. Hemodynamic variables, metabolic and inflammatory response, intraperitoneal and intrahepatic microdialysis, and plasma markers of end-organ injuries were measured during intervention and reperfusion. Intestinal histopathology was performed. RESULTS Mean arterial pressure and cardiac output increased significantly in all REBOA groups during occlusion and blood flow in the superior mesenteric artery and urinary production subsided during intervention. Metabolic acidosis with increased intraperitoneal and intrahepatic concentrations of lactate and glycerol was most pronounced in REBOA30 and REBOA60 during reperfusion and did not normalize at the end of reperfusion in REBOA60. Inflammatory response showed a significant and persistent increase of pro- and anti-inflammatory cytokines during reperfusion in REBOA30 and was most pronounced in REBOA60. Plasma concentrations of liver, kidney, pancreatic and skeletal muscle enzymes were significantly increased at the end of reperfusion in REBOA30 and REBOA60. Significant intestinal mucosal damage was present in REBOA30 and REBOA60. CONCLUSION Total REBOA caused severe systemic and intra-abdominal metabolic disturbances, organ damage and inflammatory activation already at 30 min of occlusion.

中文翻译:

在正常血容量的猪中,完全复苏的主动脉腔内血管球囊闭塞会在闭塞后30分钟内引起炎症激活和器官损伤。

背景技术主动脉的复苏性血管内球囊阻塞(REBOA)引起生理,代谢,终末器官和炎性改变,需要对其进行处置以更好地管理严重受伤的患者。这项研究的目的是在正常血流动物模型中研究I区总REBOA的闭塞时间依赖性代谢,终末器官和炎症效应。方法将24只猪(25-35 kg)随机分为I区的总阻塞REBOA,分别进行15、30、60 min(分别为REBOA15,REBOA30和REBOA60)或对照组,然后再灌流3 h 。在干预和再灌注期间,测量血流动力学变量,代谢和炎症反应,腹膜内和肝内微透析以及终末器官损伤的血浆标志物。进行了肠道组织病理学检查。结果在阻塞期间,所有REBOA组的平均动脉压和心输出量均显着增加,肠系膜上动脉的血流量减少,干预期间的尿液生成减少。腹膜内和肝内乳酸和甘油浓度升高的代谢性酸中毒在再灌注过程中在REBOA30和REBOA60中最明显,而在REBOA60中再灌注结束时未正常化。在REBOA30的再灌注过程中,炎症反应显示促炎和抗炎细胞因子显着且持续增加,而在REBOA60中最为明显。REBOA30和REBOA60再灌注结束时,肝脏,肾脏,胰腺和骨骼肌酶的血浆浓度显着增加。REBOA30和REBOA60中存在明显的肠粘膜损伤。
更新日期:2020-04-22
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