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Introducción: El choque hemorrágico traumático es una de las principales causas de muerte en pacientes con trauma grave. Objetivo: Describir las características de los pacientes con choque hemorrágico traumático. Métodos: Estudio observacional, descriptivo, transversal, que incluyó 207 pacientes con choque hemorrágico traumático. Para la descripción de las características de los pacientes se consideraron variables sociodemográficas, clínicas y quirúrgicas. Se realizó un análisis de frecuencias, con un nivel de significación de p< 0,05 y para las variables cuantitativas se estimó la media, desviación típica. Resultados: Hubo predominio del sexo masculino (85 % de los pacientes), con una edad media de 43,7 ± 15,7 años. El 42,5 % (p= 0,000) de los pacientes eran hipertensos. Predominaron los accidentes de tránsito (63,2 %), los traumas contusos (57,5 %) y politraumatizados (42,5 %). La acidosis metabólica estuvo presente en 66,7 % (p= 0,000) de los pacientes. La media del tiempo entre ingreso y tratamiento definitivo fue de 3,52 ± 1,19 horas El tratamiento médico quirúrgico de control de daño se aplicó en el 2,9 % y 5,4 % de los pacientes respectivamente. La muerte precoz fue de 30 %. Conclusiones: Predominaron los pacientes masculinos, menores de 60 años, las complicaciones precoces que tuvieron significación estadística y el tiempo entre ingreso y comienzo del tratamiento definitivo de 3 horas y más. El tratamiento médico quirúrgico de control de daño no se aplicó con frecuencia y la muerte precoz fue elevada.
Introduction: Traumatic hemorrhagic shock is one of the main causes of death in patients with severe trauma. Objective: To describe the characteristics of patients with traumatic hemorrhagic shock. Methods: Observational, descriptive, cross-sectional study, which included 207 patients with traumatic hemorrhagic shock. To describe the characteristics of the patients, sociodemographic, clinical, and surgical variables were considered. A frequency analysis was performed, with a significance level of p<0.05 and for the quantitative variables the mean and standard deviation were estimated. Results: There was a predominance of the male sex (85% of the patients), with a mean age of 43.7 ± 15.7 years. 42.5% (p= 0.000) of the patients were hypertensive. Traffic accidents (63.2%), blunt trauma (57.5%) and polytraumatized (42.5%) predominated. Metabolic acidosis was present in 66.7% (p= 0.000) of the patients. The mean time between admission and definitive treatment was 3.52 ± 1.19 hours. Surgical medical treatment for damage control was applied in 2.9% and 5.4% of the patients, respectively. Early death was 30%. Conclusions: There was a predominance of male patients, under 60 years of age, more, and early complications that had statistical significance and the time between admission and the start of definitive treatment of 3 hours. Damage control surgical medical treatment was not frequently applied and early death was high.
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Abstract Objectives Traumatic hemorrhagic shock is a major death-related factor contributing to mortality in emergencies and can be effectively handled by the Limited Fluid Resuscitation (LFR) method. In the current investigation, the authors analyzed the influence of different administrating blood pressure on the treatment outcomes of LFR. Methods 276 participants were enrolled in the current study retrospectively from January 2016 to December 2021 and were divided into three groups based on the administrating blood pressure of LFR. The difference among the three groups regarding serum levels of cytokines as well as blood hemodynamics parameters was analyzed. Results The results showed after the T2 stage treatment, cytokine levels in the three groups were all significantly influenced by different LFR strategies with medium MAP showing the strongest effects on the expression of all cytokine genes. Moreover, the MAP value was in positive correlation with IL-6, IL-10, and TNF-α levels, but showed no clear relation with IL-4 level in all three groups. Regarding the effects on hemodynamics parameters, the levels of CVP, CO, and CI were slightly increased by the different LFR administrating strategies, and the effect of medium and high MAP was statistically stronger than that of low MAP. Conclusion The present results showed that LFR would influence serum inflammatory levels by improving blood hemodynamics parameters. Medium MAP showed the strongest improving effects with the least side effects, which can be employed as the optimal administrating strategy for LFR in the future.
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Objective To observe the changes of potassium ion (K+), lactic acid (Lac) and glucose (Glu) in swine with traumatic hemorrhagic shock (THS) inside the dry-heat environment and to explore its possible mechanism. Methods A total of 40 local Landrace piglets were randomly(random number) divided equally into 4 groups: the normal temperature sham operation group (NS), the normal temperature traumatic hemorrhagic shock group (NTHS), the dry-heat sham operation group (DS group) and the dry-heat traumatic hemorrhagic shock group (DTHS). The experiment was carried out in the artifi cia climate cabin simulated the special environment of northwest of China. After exposed to their respective environment[dry-heat environment: (40.5±0.5), plus(10±2)% humidity; normal temperature environment: (25±0.5), plus(35±5)% humidity] for 3 h. Laparotomy were performed in swine of all groups, and then splenectomy and partial hepatectomy were performed only in NTHS and DTHS. The process of exsanguination from the external iliac artery was established to make the MAP reaching to 40-50 mmHg, and thus the traumatic hemorrhagic shock model of swine was successfully made. Blood samples were collected from external iliac artery at different intervals including the time just after exposure for 3 h and the successful establishment of traumatic hemorrhagic shock model (0 h) and then every 30 min after 0 h, serum levels of K+, Lac and Glu were detected. The features of varied serum K+, Lac and Glu were observed in each group. All data were statistically analyzed using One-way ANOVA and Pearson correlation analysis. Results After exposed , the level of serum K+inside the dry-heat environment was higher than that of swine inside the normal temperature group ( P<0.01), however the Glu level was lower in the swine inside dry-heat environment than that of swine inside the normal temperature ( P<0.01).The level of serum K+and Lac of DTHS group were rapidly increased from the establishment of the model to the death in about 3 h, while those of NTHS group were increased slowly. The level of K+and Lac were positively correlated in the two groups amd the correlation coeffi cient were rDTHS=0.927 (P<0.01) and rNTHS=0.539 (P<0.01),respectively. The level of Glu was progressively decrease in DTHS group, while in NTHS group, it was not noticeable. The level of K+and Glu were negatively correlated in the two group, the correlation coeffi cient were rDTHS=-0.804 (P<0.01) and rNTHS=0.420 (P<0.01),respectively. Conclusions The changes of serum K+, Lac and Glu occurred sooner and more obvious in traumatic hemorrhagic shock models inside dry heat environment (DTHS) group than those in NTHS group. The level of serum K+positively correlated with Lac, however, negatively correlated with Glu, which suggested that hyperkalemia and acidosis should be paid more attention to the treatment of traumatic hemorrhagic shock inside the dry heat environment, and the hypoglycemia should be treated at the same time.
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Objective To study the effect of hypertonic sodium chloride in the treatment of patients with traumatic hemorrhagic shock and the effects of NO and neutrophil surface CD 18 on the serum.Methods 120 patients with traumatic hemorrhagic shock were admitted to the hospital from December 2013 to December 2016,and randomly divided into the observation group and the control group.The control group was given nal-oxone injection,while the observation group was given hypertonic Sodium Chloride Solution.The two groups were compared before and after treatment,hemoglobin concentration,total infusion,24 h mortality,recovery time and adverse reactions,and the patients′hemodynamic and NO and CD18 levels were measured on the ser-um.Results After 24 h treatment,the observation group total infusion was(1 203.13 ± 117.82)mL,the re-covery time was(60.73 ± 5.63)min,24 h mortality rate of 5.00% was significantly lower than the control group total infusion(1 672.38 ± 123.64)mL,the recovery time(71.82 ± 6.19)min,24 h death rate 16.67%, hemoglobin concentration(91.24 ± 5.71)g/L higher than that of the control group(79.45 ± 6.18)g/L,the difference was statistically significant(P<0.05).Before treatment,there was no difference in the contents of NO and CD18 between the two groups.After treatment,two groups of patients with serum NO,CD18 content significantly decreased,but the observation group NO(20.27 ± 6.65)mol/L,CD18(41.67 ± 13.24)ng/mL were significantly lower than the control group NO(29.12 ± 8.23)mol/L,CD18(52.64 ± 13.51)ng/mL,the difference were statistically significant(P<0.05).Before treatment,two groups of patients with hemodynam-ic indexes of arterial and venous pressure,no difference in heart rate(P> 0.05);after treatment,the two groups of patients with arterial and venous pressure and heart rate were improved,but the change index of the observation group than in the control group was stable,the difference was statistically significant(P<0.05). The complication rate of the observation group was 10%(6/60),which was significantly lower than that of the control group(15/60),and the difference was statistically significant(P<0.05).Conclusion The infiltra-tion of sodium chloride intravenous infusion could significantly decreased CD 18 and NO levels in the serum of the patients,the patients with stable hemodynamics,reduced the incidence of complications,worthy of clinical reference.
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Objective To study the changes of oxidative stress and caspase-3 in swine with traumatic hemorrhagic shock in dry-heat environment of desert.Methods A total of 48 Landrace small swine were randomly(random number)divided into 2 groups(n=24 in each group), and then the traumatic hemorrhagic shock was established in room temperature environment and in dry-heat environmentin swine.Dry-heat environment traumatic hemorrhagic shock group (DHS), which was made in an artificial experiment cabin mimic the reality included swine exposed in the dry-heat environment of desert for 3 h (T0, n=6), T1 (50 min after shock modeling, n=6), T2 (100 min after shock modeling, n=6), T3 (150 min after shock modeling, n=6).At each interval, blood sample was collected to detect urea nitrogen (BUN) and creatinine, urine sample was collected to detect neutrophil gelatinase-associated lipoprotein (NGAL), kidney tissue samples were collected to evaluate renal morphological and tubular scores, as well as to detect catalase (CAT), superoxide dismutase (SOD) and malondialdehyde (MDA).Western blot was used to detect the level of caspase-3.Traumatic hemorrhagic shock group of room temperature environment (RTS) was established and variety of assays were carried out as same as those deteced in the dry-heat environment group.Results Compared with the room temperature environment exposed group,kidney damage index, antioxidant and caspase-3 were increased in desert dry-heat environment exposed for 3 h group, but there were no statistically significant difference(P> 0.05).And from T1 then on, the levels of NGAL, CAT and SOD in DHS groups were increased which were significant different from those in RTS group (P<0.05 or P<0.01).There were significant differences in BUN and creatinine at T2 between two groups(P<0.05).At T3, caspase-3 protein content in DHS group was significantly different from that in RTS group (P<0.01).Correlation analysis showed that the NGAL level was correlated with the levels to MDA (rRTS=0.935, rDHS =0.858, P<0.01) in RTS group and DHS group.Compared with RTS group, renal tissue under light microscope showed that Bowman appeared dilated with degeneration and exfoliated epithelial cells, proximal tubule epithelial shedding, and interstitial edema in DHS group.Electron microscope showed that mitochondria became pleomorphic, endoplasmic reticulum with fold broadening.Conclusions When traumatic hemorrhagic shock happened in the desert dry-heat environment, desert dry-heat environment can aggravate kidney damage, possibly by reducing the renal tissue antioxidant enzyme content and increase renal tissue caspase-3 activity to promote renal tissue apoptosis.Antioxidant stress and apoptosis may be an important role in the prevention of the secondary kidney injury induced by traumatic hemorrhagic shock in dry-heat environment.
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Objective To explore the effects of Shenmai injection combined with Xuebijing injection on the coagulation function of the early and inflammatory factor traumatic hemorrhagic shock.Method 86 cases of traumatic hemorrhagic shock patients select from December 2012 to December 2015 in our hospital were randomly divided into a control group(n=43)and experimental group(n=43).The control group was fluid resuscitation and Xuebijing injection treatment,the experimental group was increased Shenmai injection treatment in the control group basis.Compared with coagulation function and inflammatory factor levels before and after treatment in two groups of patients.Results 2 groups of patients was no difference in the index values before treatment,compared with before treatment,after treatment,the two groups of patients prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT)and platelet count(PLT)were elevated,fibrinogen(FIB)was decreased,and the two groups were significantly different (P<0.05 or P<0.01),but in the control group was no difference in the index values after 0.5 h treatment;The inflammatory factor in two groups were significantly increased after treatment(P<0.01),the control group was significantly higher than the experimental group,a significant difference between the groups(P<0.01);The hemorheology indexes after treatment 7 d of 2 groups were significantly decreased compared with after treatment 1 d,and the experimental group was significantly lower than the control group(P<0.01).Conclusion The combined therapy of Xuebijing injection combined with Shenmai injection can effectively improve trauma patients with hemorrhagic shock early coagulation function,reduce the levels of inflammatory factors, improve hemorheology indexes,there are good clinical results.
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Objective To investigate the relationship of the beneficial effect of CsA on vascular reactivity to Rho-kinase,protein kinase C ( PKC) and mitochondrial permeability transition pore ( MPTP) in traumatic hemorrhagic shock rats. Methods With traumatic hemor-rhagic shock rats and hypoxia-treated vascular smooth muscle cells ( VSMCs) ,the role of Rho-kinase and PKC in CsA-regulating vascular re-activity following shock and their relationship to MPTP was observed. Meanwhile,the effects of CsA on inflammatory mediators including TNF-α, IL-1β and IL-6 were also studied. Results CsA significantly improved the vascular reactivity of superior mesenteric artery following hemor-rhagic shock. Rho-kinase inhibitor Y27632 significantly antagonized CsA-induced increase of vascular reactivity,while PKC inhibitor stauros-porine had no significant influences on the effects of CsA. Further studies showed that CsA and Rho-kinase agonist U46619 inhibited the o-pening of MPTP in hypoxia-treated VSMCs. In addition,shock induced a significant increase of TNF-αand IL-1β,but CsA did not show a sig-nificant inhibitory effect on their level. Conclusion CsA-induced restoration of vascular reactivity following traumatic hemorrhagic shock via inhibiting MPTP opening,and Rho-kinase participate in this process.
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Objective To study the pathological changes and expressions of NO and iNOS mRNA in the lung tissue of traumatic hemorrhagic shock rats under dry heat environment of desert and their relations to the lung injury.Methods A total of 140 male SD rats were randomly (random number) ivided into the room temperature (25 ℃) environment traumatic hemorrhagic shock group (room temperature group) and the dry heat traumatic hemorrhagic shock groups (dry heat group,temperature 40℃,humidity 10％),respectively,and each groups was further randomly divided into 7 subgroups:the control subgroup,post shock subgroups at 0,0.5,1,1.5,2and 3 h (n =10 in each subgroup).The rats of control subgroup were not treated,and rats of dry heat group were placed in dry heat environment for 60 min,then anesthetized,fixed,and insertion of intravenous indwelling needles and catherization of right carotid artery,jugular vein and the right femoral artery were performed.After stabilization for 10 min,2500 g iron wheel was used to be dropped from 30 m height and vertically hit the upper left femoral of SD rats in order to make comminuted fracture,wounds were quickly dressed after injury.Exsanguination from right femoral artery was kept until MAP maintained at (35 ± 5) mmHg,and resuscitation was carried out after continue monitoring for 60 min.After the establishment of traumatic hemorrhagic shock model in each environment,the rats were sacrificed at given intervals,and thoracotomy was performed to take broncho-alveolar lavage fluid (BALF) and lung tissue.Pathological changes of lung tissues were observed by using HE staining and NO concentration of lung tissue was detected by one-step method,and changes of the iNOS mRNA expressions were detected by using fluorescence quantitative PCR.Then t test,ANOVA and Pearson correlation analysis were used for the data analysis.Results The pathological change in dry heat group at each interval was more severe,and pulmonary histopathological injury score was higher,and the protein exudation was more profuse compared with the room temperature group.NO concentration in lung tissue homogenate of dry heat group was higher than that of room temperature group (t =2.472,P ＜ 0.05),and the difference in NO level between different intervals within the dry heat group was statistically significant (F =6.77,P ＜ 0.01).The NO concentration in dry heat group reached its maximum at 2 h (3.35 ± 0.23) μmol / g and the peak value emerged sooner than that in room temperature group.The difference was statistically significant in overall expression of iNOS mRNA between two groups analyzed with t test (t =3.619,P ＜ 0.01),and there was statistically significant difference between intervals within the dry heat group (F =12.34,P ＜0.01).The values of iNOS mRNA in the dry heat group were higher than those in the room temperature group at the same given intervals,and the peak value appears at 1.5 h in dry heat group,and the room temperature group it began to increase at 2 h.The concentration of NO and the expression of iNOS mRNA were positively correlated with each other in two groups (r =0.680,r =0.376).The expression of iNOS mRNA and lung histopathological injury score was positively correlated in two groups (r =0.846,r =0.899).Conclusions When traumatic hemorrhagic shock occurred in the dry heat desert environment,the lung injury was more severe and appeared sooner than that in the room temperature environment.NO and iNOS played important roles in the secondary lung injury in the wake of traumatic hemorrhagic shock in rats under the dry heat environmengt of desert.
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Objective Traumatic hemorrhagic shock ( THS) is frequently complicated by liver injury , and IL-1βis one of the important inflammatory factors involved in this process .We ob-served changes of liver injury-related indexes in the rat model of THS and investigated the effects of AS-1, the mimic of the TIR/BB loop of Myd88, an important molecule of the IL-1βsignal pathway, on liver injury triggered by ischemia/reperfusion following THS and resuscita-tion ( THSR) in rats. Methods Thirty-two healthy male SD rats were randomly divided into groups A (THSR), B ( THSR+AS-1), C (THSR+dissolution medium), and D (control).For those of the first three groups , fracture was induced in the left tibia , the mean arterial pressure reduced to 30 mmHg by bloodletting from the femoral artery and maintained at 30-40 mmHg for an hour , and then the rats resuscitated by infusion of blood and Ringer′s solution in proportion at a uniform speed in 30 min.Before resuscitation, the rats in group B were treated with AS-1 (160 mg/kg), group C with dissolution medium, and group D left untreated .At 3 hours after resuscitation in groups A , B and C, and at 3 hours after 2.5h-our in-tubation in group D , we detected the activity of ALT , the levels of AST , IL-1βand TNF-α, and the activity of MPO in the left liver , and observed pathological changes in the liver by light microscopy . Results Compared with group D, groups A, B and C showed ev-ident liver injury and significant increases in the activity of ALT (87.55 ±6.8 vs 206.13 ±23.67, 110.45 ±18.20 and 210.73 ± 28.43), AST (327.03 ±36.23 vs 621.00 ±40.61, 409.13 ±63.53 and 600.25 ±44.05), the levels of IL-1β(327.03 ±36.23 vs 621.00 ±40.61, 409.13 ±63.53 and 600.25 ±44.05) and TNF-α(93.51 ±9.86 vs 214.13 ±21.24, 145.25 ±12.42 and 206.50 ± 36.97), and the activity of MPO (0.90 ±0.21 vs 1.72 ±0.12, 1.20 ±0.11 and 1.67 ±0.14) (all P0.05).Conclusion TIR/BB-loop mimetic AS-1 can attenuate ischemia/reperfusion-induced liver injury after THSR in rats by decrea -sing the levels of IL1-βand TNF-αin the serum.
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Objective To investigate the causes and preventive measures of subclavian venous catheter-related infections oc-curred in traumatic hemorrhagic shock patients .Methods 336 traumatic hemorrhagic shock patients indwelling subclavian vein catheter was included to explore the causes and treatment of catheter-related infections .The outcome was infect rate and strains dis-trubtion .Results Of 336 patients with subclavian vein catheterization average time was 4 .3 days ,including 27 cases of infection , and the infection rate was 8 .04% .All patients were discharged after active treatment ,with no deaths .Conclusion Traumatic hem-orrhagic shock patients with subclavian vein catheter are safe and effective .Risk factors for infection ,improve treatment and patient care ,shorten the time of catheter ,can effectively prevent catheter infections .
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Objective To discuss the feasibility of using serum complement C5a and C5b-9 as predictive indicators of liver injury severity in traumatic rats with hemorrhagic shock.Method Fifry healthy male Wistar rats were randomly(random number)divided into normal group,model 1 hour group,model 3 hours group,model 6 hours group,and model 24 hours group.Plasma CH50,C5a and C5b-9 were detected by using enzyme-linked immunosorbent assay,and rate method was used for determination of plasma aspartate aminotransferase.Paraffin sections of hepatic tissues were used to observe the damage of liver.Results In the model l h group,the CH50 increased significantly and reached the highest value,it began to decline in 3 hours group,and it reached the lowest point in 24 hours group.Compared with the model 3 hours group,6 hours group,and 24 hours group,the level of CH50 in model 1 hour group increased more significantly(respectively P<0.05).A small amount of C5b-9 in the normal group was detected.In the model 1 h group,C5b-9 increased significantly and reach the peak compared with 3hours group,6hours group and 24 hours group,respectively(P<0.05),but in the model 3hours,it began to decline,and in 24 hours group,it reduced to minimum.C5a increased insignificantly in the model 3 hours group,6 hours group and 24 hours group,and peaked in 24 hours group compared with normal group(P<0.05).Aspartate aminotransferase in the model 1 hour group increased significantly and peaked in 24 hours group compared with other groups(P<0.05).Conclusions A large number of complements are activated in the seRing of hemorrhagie shock.C5b-9 and CH50 increase significantly in the early stage,and C5a.increases significantly in the later stage.C5b-9 can be considered as,an initiative factor of liver injury.The low levels of C5a in the early stage may be a mechanism of self-protection of the body.The high levels of CSa in the later stage may be a kind of decompensation,and C5a can be used as a late predictor of disease severity.