Experimental study of controlled fluid resuscitation in the treatment of severe and uncontrolled hemorrhagic shock.

BACKGROUND: Hemorrhagic shock is a common clinic emergency case. The fluid resuscitation method in the presurgical care of hypotensive trauma patients is open to debate. This study was conducted to evaluate the general and pathophysiologic effects of controlled fluid resuscitation in the treatment of severe and uncontrolled hemorrhagic shock. METHODS: A model of rat with severe hemorrhagic shock and active bleeding was established in 32 Sprague-Dawley rats. The rats were randomly divided into the control group, no fluid resuscitation group (NF group), controlled fluid resuscitation group (NS40 group), and aggressive fluid resuscitation group (NS80 group). Each group contained eight rats. The changes of survival, blood loss, blood platelet, hemoglobin, hematocrit, and serum lactate level were dynamically monitored in the "prehospital phase". In addition, the apoptosis in the liver, kidney, lung, and small intestinal mucosa of survivors after hemorrhage and resuscitation was detected by light microscopy in hematoxylin-eosin stained tissue sections, flow cytometry, and terminal deoxynucleotidyl transferase dUTP nick end labeling. Via the above-mentioned indexes, the curative effects of three fluid resuscitation methods were compared. RESULTS: Compared with the survival in the NF group (3 of 8), the higher survival rate of the NS40 and NS80 groups (14 of 16) showed significant difference (p < 0.05). After fluid resuscitation, serum lactate levels in the NS40 and NS80 groups obviously decreased (p < 0.01 compared with control and NF groups). The shed blood loss from bleeding tail in the NS80 group was obviously increased (p < 0.01 for the NS80 group compared with the control, NF, and NS40 groups). Compared with that of the control, NF, and NS40 groups, the hemoglobin, hematocrit, and blood platelet of the NS80 group quickly descended in the prehospital phase and showed statistical differences. At the same time, there was some apoptosis in the liver, kidney, lung, and small intestinal mucosa of all survivors. Compared with that of the NF and NS40 groups, the apoptosis of liver, kidney, and small intestinal mucosa of the NS80 group was obviously increased, and showed statistical differences. CONCLUSIONS: In severe and uncontrolled hemorrhagic shock, some fluid must be given in proper time to improve tissue perfusion and avoid early death. Among three fluid resuscitation methods, controlled fluid resuscitation can effectively decrease additional blood loss, avoid excessive hemodilution and coagulopathy, improve the early survival rate, and reduce the apoptosis of visceral organs in rats with severe and uncontrolled hemorrhagic shock. This model supports the concept that when surgical care is not readily available, controlled fluid resuscitation should be considered in the treatment of uncontrolled hemorrhagic shock.

Effects of three fluid resuscitation methods on apoptosis of visceral organs in rats with hemorrhagic shock.

OBJECTIVE: To observe the effects of three fluid resuscitation methods on apoptosis of visceral organs in rats with hemorrhagic shock. METHODS: A model of rat with severe hemorrhagic shock and active bleeding was established in 32 SD (Sprague-Dawley) rats. The rats were randomly divided into control group, no fluid resuscitation group (NF group), controlled fluid resuscitation group (NS40 group) and rapid large scale fluid resuscitation group (NS80 group). Each group contained 8 rats. The curative effects were compared. At the same time, the apoptosis in liver, kidney, lung and small intestinal mucosa of survivors after hemorrhage and resuscitation was detected by light microscopy in HE (hematoxylin and eosin) stained tissue sections, flow cytometry and terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL). RESULTS: The survival rate of early fluid resuscitation (14/16) was markedly higher than that of NF group (3/8). There was some apoptosis in liver, kidney, lung and small intestinal mucosa of all survivors. Compared with NF and NS40 groups, the apoptosis of liver, kidney and small intestinal mucosa of NS80 group was obviously increased. CONCLUSIONS: Among three fluid resuscitation methods, controlled fluid resuscitation can obviously improve the early survival rate and the apoptosis of liver, kidney and small intestinal mucosa in rats with severe and uncontrolled hemorrhagic shock, and may benefit improvement of prognosis.

[Effects of different means of fluid resuscitation on apoptosis of visceral organs in rats with hemorrhagic shock].

OBJECTIVE: To observe the effects of different means of fluid resuscitation on apoptosis of visceral organs in rats with hemorrhagic shock. METHODS: The tails of 8 male SD rats were cut to cause active bleeding. Blood was collected from the carotid arteries of another 24 male SD rats and heparinized, then the 24 rats were randomly divided into 3 equal groups: no fluid resuscitation group (NF group, carotid blood was collected as described above, the tail was cut and the blood from the tail was collected in container with heparin 30 min after, and hemostasis and heparin blood transfusion were performed 60 min after cutting of the tail), controlled fluid resuscitation group [NS40 group: isosmotic saline was infused during the period of 30 to 60 min after the tail cutting to maintain the mean arterial pressure (MAP) at about 40 mm Hg and then hemostasis and heparin blood transfusion were performed 60 min after cutting of the tail], and great quantity fluid rapid resuscitation group [NS80 group: a great quantity of isosmotic saline was infused during the period of 30 to 60 min after the tail cutting to maintain the MAP at about 80 mm Hg and then hemostasis and heparin blood transfusion were performed 60 min after cutting of the tail]. Blood specimens were collected at the time points 0, 120, and 150 min to undergo blood routine examination. Another blood specimens were collected at the time points 0, 30, 60, and 90 min to undergo lactic acid examination. The surviving rats were killed and their livers, kidneys, lungs, and small intestines were taken out to undergo pathology. Cell apoptosis was examined by flow cytometry and TUNEL. RESULTS: The survival rates of the NS40 and NS80 groups were significantly higher than that of the NF group (both P < 0.05). The blood lactic acid levels of the NS40 and NS80 groups at the time points 60 and 90 min were all significantly lower than those of the NF and control groups (all P < 0.05). Apoptosis in the liver, kidney, and small intestine mucosa of the NS80 group was significantly marked than in the NF and NS40 groups (all P < 0.01). CONCLUSION: Controlled fluid resuscitation obviously reduces the early death rate of rats with severe hemorrhagic shock and apoptosis in the liver, kidney, and small intestine mucosa thereof and may benefit the prognosis.