尽管创伤后生命参数恢复正常,但隐匿性灌注不足(OH)被定义为持续的乳酸性酸中毒。这项研究的目的是分析猪多外伤模型中隐匿性灌注不足与局部循环和损伤软组织炎症的关系。
这项实验研究是对遭受标准化多发性创伤的雄性长白猪进行的,包括股骨骨折,钝性胸部创伤,肝裂伤和平均动脉压(MAP)控制的出血性休克。创伤诱发后一小时,这些动物用逆行股骨钉复苏,肝脏包装和体积置换。将动物分为Norm组(复苏后乳酸水平正常化)和隐匿性灌注不足(OH)组(持续的乳酸水平高于2mmol/l,复苏后生命参数正常化)。局部循环(氧饱和度,血红蛋白量,血流量)是用光学传感器在四肢骨折的皮下软组织以及胃和结肠进行测量的。在骨折肢体的皮下组织中分析了局部炎症参数[白介素(IL)6、8、10和热休克蛋白(HSP)]。
组标准(n=19)和组OH(n=5)在基线生命和实验室参数方面是相当的。规范组和OH组的休克严重程度和失血总量相当。复苏后,与Norm组相比,OH组骨折肢体受伤软组织的局部相对血红蛋白量明显较低(39.4,SD5.3vs.63.9,SD27.6A.U.,p=0.031)。与标准组相比,OH组的局部氧合明显较低(60.4,SD4.6与75.8,SD12.8,p=0.049)。与正常组(73.9,SD96.3[pg/ml]相比,OH组(318.3,SD326.6[pg/ml])中脂肪组织中的局部IL-6明显更高,p=0.03)。两组的腹部器官局部循环相当。
OH与多发性创伤中肢体受伤软组织的局部循环减少和局部炎症增加有关。OH可能反映局部软组织损伤的严重程度,指导治疗策略。
Occult hypoperfusion (OH) is defined as persistent lactic acidosis despite normalization of vital parameters following trauma. The aim of this study was to analyze the association of occult hypoperfusion with local circulation and inflammation of injured soft tissue in a porcine polytrauma model.
This experimental study was performed with male landrace pigs who suffered a standardized polytrauma, including a femoral fracture, blunt chest trauma, liver laceration and a mean arterial pressure (MAP) controlled hemorrhagic shock. One hour after induction of trauma, the animals were resuscitated with retrograde femoral nailing, liver packing and volume replacement. Animals were stratified into Group Norm (normalizing lactate levels after resuscitation) and Group occult hypoperfusion (OH) (persistent lactate levels above 2 mmol/l with normalizing vital parameters after resuscitation). Local circulation (oxygen saturation, hemoglobin amount, blood flow) was measured with optical sensors at the subcutaneous soft tissue at the fractured extremity as well as at the stomach and colon. Local inflammatory parameters [interleukin (IL) 6, 8, 10, and heat shock protein (HSP)] were analyzed in the subcutaneous tissue of the fractured extremity.
Group Norm (n = 19) and Group OH (n = 5) were comparable in baseline vital and laboratory parameters. The shock severity and total amount of blood loss were comparable among Group Norm and Group OH. Following resuscitation Group OH had significantly lower local relative hemoglobin amount at the injured soft tissue of the fractured extremity when compared with Group Norm (39.4, SD 5.3 vs. 63.9, SD 27.6 A.U., p = 0.031). The local oxygenation was significantly lower in Group OH compared to Group Norm (60.4, SD 4.6 vs. 75.8, SD 12.8, p = 0.049). Local IL-6 in the fatty tissue was significantly higher in Group OH (318.3, SD 326.6 [pg/ml]) when compared with Group Norm (73.9,SD 96.3[pg/ml], p = 0.03). The local circulation at the abdominal organs was comparable in both groups.
OH is associated with decreased local circulation and increased local inflammation at the injured soft tissue of the extremity in polytrauma. OH might reflect the severity of local soft tissue injuries, and guide treatment strategies.