Cerebral effects of resuscitation with either epinephrine or vasopressin in an animal model of hemorrhagic shock

被引：3

作者：

Kuechler, Jan ^{[1
]}

Klaus, Stephan ^{[2
]}

Bahlmann, Ludger ^{[3
]}

Onken, Nils ^{[4
]}

Keck, Alexander ^{[5
]}

Smith, Emma ^{[1
]}

Gliemroth, Jan ^{[1
]}

Ditz, Claudia ^{[1
]}

机构：

[1] Univ Lubeck, Dept Neurosurg, Ratzeburger Allee 160, D-23538 Lubeck, Germany

[2] Herz Jesu Krankenhaus Munster Hiltrup, Dept Anesthesiol, Munster, Germany

[3] Klinikum Weser Egge, Dept Anesthesiol, Hoxter, Germany

[4] Klinikum Bremen Mitte, Dept Pediat, Bremen, Germany

[5] Klinikum Osnabruck, Dept Gynecol & Obstet, Osnabruck, Germany

来源：

EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY | 2020年 / 46卷 / 06期

关键词：

Cerebral metabolism; Hemorrhagic shock; Microdialysis; Neuromonitoring; Vasopressor therapy;

D O I：

10.1007/s00068-019-01158-6

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Purpose The use of epinephrine (EN) or vasopressin (VP) in hemorrhagic shock is well established. Due to its specific neurovascular effects, VP might be superior in concern to brain tissue integrity. The aim of this study was to evaluate cerebral effects of either EN or VP resuscitation after hemorrhagic shock. Methods After shock induction fourteen pigs were randomly assigned to two treatment groups. After 60 min of shock, resuscitation with either EN or VP was performed. Hemodynamics, arterial blood gases as well as cerebral perfusion pressure (CPP) and brain tissue oxygenation (PtiO(2)) were recorded. Interstitial lactate, pyruvate, glycerol and glutamate were assessed by cerebral and subcutaneous microdialysis. Treatment-related effects were compared using one-way ANOVA with post hoc Bonferroni adjustment (p<0.05) for repeated measures. Results Induction of hemorrhagic shock led to a significant (p<0.05) decrease of mean arterial pressure (MAP), cardiac output (CO) and CPP. Administration of both VP and EN sufficiently restored MAP and CPP and maintained physiological PtiO(2) levels. Brain tissue metabolism was not altered significantly during shock and subsequent treatment with VP or EN. Concerning the excess of glycerol and glutamate, we found a significant EN-related release in the subcutaneous tissue, while brain tissue values remained stable during EN treatment. VP treatment resulted in a non-significant increase of cerebral glycerol and glutamate. Conclusions Both vasopressors were effective in restoring hemodynamics and CPP and in maintaining brain oxygenation. With regards to the cerebral metabolism, we cannot support beneficial effects of VP in this model of hemorrhagic shock.

引用

页码：1451 / 1461

页数：11