背景技术在失血性休克患者中获得静脉内(IV)通路通常是困难且长时间的。失败的IV尝试延迟了挽救生命的治疗。骨内(IO)访问通常可以比IV访问更快地获得。白蛋白(5%)是院前容量扩张的一种选择,因为没有凝血和血小板功能的干扰。假设/问题比较5%白蛋白的IO和IV的性能的数据有限。这项研究的目的是比较胫骨IO(TIO)和静脉给药500mL5%白蛋白对输注时间和心率(HR)的血流动力学测量的影响。平均动脉压(MAP),心输出量(CO),失血性休克猪模型中的每搏量(SV)。
方法:将16只雄性猪分为两组:TIO和IV。所有受试者均被麻醉,并通过从股动脉导管中排出31%的估计血容量(EBV)来实现III类出血。放血后,通过TIO或IV途径在加压输注(300mmHg)下施用500mL5%白蛋白,并记录输注时间。HR的血流动力学测量,MAP,CO,在放血之前和之后以及在5%白蛋白输注期间每20秒收集和SV,持续180秒。
结果:独立的t检验确定,与IO相比,IV5%白蛋白输注显着更快(P=0.01)。与IV组的4分32秒(SD=1分08秒)相比,TIO的平均输注时间为7分35秒(SD=2分44秒)。对5%白蛋白输注期间收集的血液动力学数据进行多变量方差分析。分析表明TIO组和IV组之间相对于MAP没有显着差异,CO,HR,或SV(P>0.05)。
结论:虽然通过TIO途径输注5%白蛋白的时间明显更长,较长的TIO输注时间可能会被取消,因为与重复的IV尝试相比,IO设备可以更快地放置。相对于血液动力学测量,TIO和IV途径之间缺乏显著差异表明TIO途径是在III类出血的猪模型中输注5%白蛋白的可行途径。MuirSL,SheppardLB,Maika-WilsonA,BurgertJM,加西亚-布兰科J,约翰逊广告,CoynerJL.在失血性休克猪模型中,骨内和静脉内5%白蛋白对输注时间和血液动力学指标的影响的比较。预科灾难医院。2016;31(4):436–442。
Introduction Obtaining intravenous (IV) access in patients in hemorrhagic shock is often difficult and prolonged. Failed IV attempts delay life-saving treatment. Intraosseous (IO) access may often be obtained faster than IV access. Albumin (5%) is an option for prehospital volume expansion because of the absence of interference with coagulation and platelet function. Hypothesis/Problem There are limited data comparing the performance of IO and IV administered 5% albumin. The aims of this study were to compare the effects of tibial IO (TIO) and IV administration of 500 mL of 5% albumin on infusion time and hemodynamic measurements of heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), and stroke volume (SV) in a swine model of hemorrhagic shock.
METHODS: Sixteen male swine were divided into two groups: TIO and IV. All subjects were anesthetized and a Class III hemorrhage was achieved by exsanguination of 31% of estimated blood volume (EBV) from a femoral artery catheter. Following exsanguination, 500 mL of 5% albumin was administered under pressurized infusion (300 mmHg) by the TIO or IV route and infusion time was recorded. Hemodynamic measurements of HR, MAP, CO, and SV were collected before and after exsanguination and every 20 seconds for 180 seconds during 5% albumin infusion.
RESULTS: An independent t-test determined that IV 5% albumin infusion was significantly faster compared to IO (P=.01). Mean infusion time for TIO was seven minutes 35 seconds (SD=two minutes 44 seconds) compared to four minutes 32 seconds (SD=one minute 08 seconds) in the IV group. Multivariate Analysis of Variance was performed on hemodynamic data collected during the 5% albumin infusion. Analyses indicated there were no significant differences between the TIO and IV groups relative to MAP, CO, HR, or SV (P>.05).
CONCLUSIONS: While significantly longer to infuse 5% albumin by the TIO route, the longer TIO infusion time may be negated as IO devices can be placed more quickly compared to repeated IV attempts. The lack of significant difference between the TIO and IV routes relative to hemodynamic measures indicate the TIO route is a viable route for the infusion of 5% albumin in a swine model of Class III hemorrhage. Muir SL , Sheppard LB , Maika-Wilson A , Burgert JM , Garcia-Blanco J , Johnson AD , Coyner JL . A comparison of the effects of intraosseous and intravenous 5% albumin on infusion time and hemodynamic measures in a swine model of hemorrhagic shock. Prehosp Disaster Med. 2016;31(4):436-442.