Goal-directed colloid versus crystalloid therapy and microcirculatory blood flow following ischemia/reperfusion

IF 2.9 4区 医学 Q2 PERIPHERAL VASCULAR DISEASE
Christoph R. Behem , Till Friedheim , Hannes Holthusen , Adina Rapp , Timo Suntrop , Michael F. Graessler , Hans O. Pinnschmidt , Sabine H. Wipper , Mirjam von Lucadou , Edzard Schwedhelm , Thomas Renné , Karin Pfister , Wilma Schierling , Constantin J.C. Trepte
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引用次数: 0

Abstract

Objective

Ischemia/reperfusion can impair microcirculatory blood flow. It remains unknown whether colloids are superior to crystalloids for restoration of microcirculatory blood flow during ischemia/reperfusion injury. We tested the hypothesis that goal-directed colloid – compared to crystalloid – therapy improves small intestinal, renal, and hepatic microcirculatory blood flow in pigs with ischemia/reperfusion injury.

Methods

This was a randomized trial in 32 pigs. We induced ischemia/reperfusion by supra-celiac aortic-cross-clamping. Pigs were randomized to receive either goal-directed isooncotic hydroxyethyl-starch colloid or balanced isotonic crystalloid therapy. Microcirculatory blood flow was measured using Laser-Speckle-Contrast-Imaging. The primary outcome was small intestinal, renal, and hepatic microcirculatory blood flow 4.5 h after ischemia/reperfusion. Secondary outcomes included small intestinal, renal, and hepatic histopathological damage, macrohemodynamic and metabolic variables, as well as specific biomarkers of tissue injury, renal, and hepatic function and injury, and endothelial barrier function.

Results

Small intestinal microcirculatory blood flow was higher in pigs assigned to isooncotic hydroxyethyl-starch colloid therapy than in pigs assigned to balanced isotonic crystalloid therapy (768.7 (677.2–860.1) vs. 595.6 (496.3–694.8) arbitrary units, p = .007). There were no important differences in renal (509.7 (427.2–592.1) vs. 442.1 (361.2–523.0) arbitrary units, p = .286) and hepatic (604.7 (507.7–701.8) vs. 548.7 (444.0–653.3) arbitrary units, p = .376) microcirculatory blood flow between groups. Pigs assigned to colloid – compared to crystalloid – therapy also had less small intestinal, but not renal and hepatic, histopathological damage.

Conclusions

Goal-directed isooncotic hydroxyethyl-starch colloid – compared to balanced isotonic crystalloid – therapy improved small intestinal, but not renal and hepatic, microcirculatory blood flow in pigs with ischemia/reperfusion injury. Whether colloid therapy improves small intestinal microcirculatory blood flow in patients with ischemia/reperfusion needs to be investigated in clinical trials.

Abstract Image

Abstract Image

目标导向胶体与晶体治疗和缺血/再灌注后的微循环血流。
目的:缺血/再灌注可损害微循环血流。在缺血/再灌注损伤中,胶体是否优于晶体恢复微循环血流,目前尚不清楚。我们验证了目标导向胶体治疗(与晶体治疗相比)改善缺血/再灌注损伤猪小肠、肾脏和肝脏微循环血流的假设。方法:32头猪随机试验。我们通过腹腔上主动脉交叉夹持诱导缺血/再灌注。猪随机接受定向等渗羟乙基淀粉胶体或平衡等渗晶体治疗。采用激光散斑对比成像技术测量微循环血流。主要终点是缺血/再灌注后小肠、肾脏和肝脏微循环血流4.5 h。次要结局包括小肠、肾脏和肝脏的组织病理学损伤、大血流动力学和代谢变量,以及组织损伤、肾脏和肝脏功能和损伤的特定生物标志物,以及内皮屏障功能。结果:采用等渗羟乙基淀粉胶体治疗的猪小肠微循环血流量高于采用平衡等渗晶体治疗的猪(768.7(677.2-860.1)比595.6(496.3-694.8)任意单位,p = .007)。肾脏(509.7(427.2-592.1)比442.1(361.2-523.0)任意单位,p = .286)和肝脏(604.7(507.7-701.8)比548.7(444.0-653.3)任意单位,p = .376)微循环血流组间无显著差异。与晶体治疗相比,接受胶体治疗的猪也有更少的小肠,但没有肾脏和肝脏的组织病理学损伤。结论:与平衡等渗晶体治疗相比,目标定向等渗羟乙基淀粉胶体治疗改善了缺血/再灌注损伤猪的小肠微循环血流,但没有改善肾脏和肝脏的微循环血流。胶体治疗是否能改善缺血/再灌注患者的小肠微循环血流,尚需临床试验研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Microvascular research
Microvascular research 医学-外周血管病
CiteScore
6.00
自引率
3.20%
发文量
158
审稿时长
43 days
期刊介绍: Microvascular Research is dedicated to the dissemination of fundamental information related to the microvascular field. Full-length articles presenting the results of original research and brief communications are featured. Research Areas include: • Angiogenesis • Biochemistry • Bioengineering • Biomathematics • Biophysics • Cancer • Circulatory homeostasis • Comparative physiology • Drug delivery • Neuropharmacology • Microvascular pathology • Rheology • Tissue Engineering.
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