|
Objective: hemorrhagic shock is the the trauma leading cause of death, the early prehospital fluid resuscitation is one of the main measures of the treatment of traumatic hemorrhagic shock. The experiment by the method of manufacture of blood and tails trauma uncontrolled hemorrhagic shock rat model, observation of early fluid resuscitation rat model at each time point hemoglobin content, hematocrit, serum ALT levels and tail of secondary hemorrhage follow-up to the amount of fluid volume, survival time, survival, and GC / GR expression changes, early fluid resuscitation of trauma uncontrolled hemorrhagic shock in rats GC / GR level expression and its relationship with the prognosis for trauma uncontrolled hemorrhagic shock in the prehospital provide a theoretical basis. Methods: In this study, reference Capone blood tails prepared trauma with uncontrolled hemorrhagic shock rat model. And simulate the clinical process of trauma care in the emergency medical services system, divided into four stages: traumatic hemorrhagic period (30min), pre-hospital emergency period (30min ~ 90min), hospital treatment period (90min ~ 510min), observation period (510min ~ 72h), and select 30min, 90min, 150min, 270min, 510min as the observation point. Healthy SD rats as subjects, body weight 265 ± 20g, male or female, were randomly divided into four groups and give appropriate treatment. As follows: mean arterial pressure (MAP) as a standard fluid resuscitation divided into sham group (SS group), not infusion group (NF), a large number of fluid resuscitation group (AR group) and the limit, depending on the fluid resuscitation sexual fluid resuscitation group (LR group), each point in time each group were sacrificed four rats and to detect rat hemoglobin content, hematocrit, serum ALT, GC level; liver homogenates was detected by ELISA in liver tissue the GR content; using HE staining pathological changes of the liver tissue of rats; computing tail secondary hemorrhage, subsequent infusion volume. Selected in the same manner, 40 SD rats were randomly divided into the SS, NF, AR, LR, four groups of 10, each processing method as above, independent observation of survival time and survival rate of each group of rats. During the experiment rats discounting natural death, and the blood pressure of the molding and the recovery process is not up to a total of 120 SD rats were included in the experimental study. All data are used SPSS13.0 statistical software for processing. The measurement data are presented as mean ± standard differential (? X ± s) said four groups mean pairwise comparisons using one-way ANOVA, t-test was used to compare between the two groups. Mortality compared using the x2 test. P lt; 0.05, there is a statistically significant difference. Results: 1, the experimental rats basic information analysis: the body weight of rats in each group, mean arterial pressure (MAP), GC, ALT of Hgb, Hct group showed no statistical significance (P gt; 0.05), as shown in Table 1. 2, the amount of secondary hemorrhage rat tail: the pre-hospital emergency period, the AR rats tail secondary amount of bleeding is higher than the NF group and LR group (P lt; 0.01), no significant difference in the NF group and LR group, see Table 3.3, the rats follow-up treatment of fluid volume: NF group required fluid volume, significantly more than the AR group (P lt; 0.05) and LR group (P lt; 0.01); AR group was significantly more than the LR group (P lt; 0.01), are shown in Table 4.4, rats Hgb and Hct levels: traumatic hemorrhagic shock after traumatic hemorrhagic period and pre-hospital care of AR and LR group rats Hgb and Hct were lower phase lowest 90min respectively (50 ± 7) g / L, (12.25 ± 1.50)% and (62 ± 10) g / L, (17.50 ± 1.29)% AR group than in the NF group (P lt; 0.01) and LR group ( P lt; 0.05). NF group did not change significantly, of Hgb and Hct were (98 ± 4) g / L, (29.25 ± 1.89)%. In-hospital treatment, the three groups of rats Hgb and Hct have rebounded, but the NF group, and decreased rapidly after only a short period of time increased; the LR group still higher than the AR group (P lt; 0.05), and the AR rats the Hct has been below 20%, LR rats Hct higher than 20%, see Table 5-6, Figure 3.5, liver damage in rats: rats in each group after shock, serum ALT starts to rise. Trauma period is given in different ways fluid resuscitation, along with the time extension of NF, AR, LR serum ALT were increased. NF group increased the most obvious the LR group change is small. AR group and LR group level 150min time points less than the NF group (P lt; 0.05), while no significant difference in the AR group and LR. 270min, 510min phase point NF group ALT than the AR group (P lt; 0.05) and LR group (P lt; 0.01) high, and the LR group than in the AR group (P lt; 0.05), are shown in Table 7, Figure 4 . Liver histopathology injury: early liver damage is not obvious, at 150min phase point began to pathological changes of the light microscope, mainly edema and fatty degeneration of the liver cells. NF and AR group in the course of the experiment more damage than the LR group (Figure 5-8). 6, rat survival time and survival: the shortest NF rats survival time, median survival time was 4.84 ± 1.126h 72 hour survival 1/10; the LR rats survived longest median survival time of 52.52 ± 8.97h, 72 hour survival 6/10; AR group, the median survival time was 9.14 ± 3.25h, 72 hour survival 0/10. LR rats survived longer than the NF group and LR group (P lt; 0.01), no significant difference between the NF group and AR group. NF survival of rats phase points at all when compared with the AR group, no significant difference (P gt; 0.05). 150min when the LR rats viability AR group no statistically significant difference (P gt; 0.05), but the LR group than in the NF group (P lt; 0.05); 270min of NF survival rate of AR rats LR group (P lt; 0.05); With the extension of time, NF group and AR group 510min phase points and 72h survival rates were 30%, 0% and 40%, 0%, lower than the LR group 510min time point survival rate was 80% compared with the NF group was statistically significant (P lt; 0.05) compared with the AR group had no significant difference. 72h survival rate was significantly higher than the NF and AR group (P lt; 0.01), are shown in Table 8 to 9, 9 to 10.7, the level of serum GC: traumatic hemorrhagic shock period, NF, AR and LR group The rat blood GC level up to the highest, are higher than the SS group (P lt; 0.01). The period of pre-hospital emergency fluid resuscitation administered to rats in different ways, the NF group GC level continues to rise higher than the AR and LR group (P lt; 0.05). Nosocomial treatment period, the three groups of rats GC water average decreased first phase point in the experiment 510min slightly elevated, but the AR and LR group is still lower than that of NF group (P LT; 0.05), Table 10, Figure 11.8. rat liver tissue GR: traumatic hemorrhagic shock, NF, AR and LR rats in each period the average hepatic tissue GR water below the SS group (P lt; 0.05). GR in rat liver tissue at different periods of the experiment, the shock trauma of liver tissue GR levels continue to decline, and subsequent treatment of early, three groups of rats GR level than before, with varying degrees of recovery LR group rat liver tissue fluid resuscitation GR level higher than the NF group and AR group (P lt; 0.05), no significant difference between the NF and AR groups. 510min when three groups of rat liver tissue GR level decreased compared with the SS group, a significant difference (P lt; 0.01). LR group reduced fewer than NF and AR group (P LT; 0.05), see Table 11, Figure 12. Conclusion: This study found that uncontrolled hemorrhagic shock rat model of trauma, the early prehospital fluid resuscitation can reduce the amount of bleeding and subsequent treatment of fluid volume to reduce the dilution of the blood, is conducive to the protection of liver function, can improve survival reduce mortality. Fluid resuscitation for the recovery of rat liver tissue GR levels played a positive role, suggesting prehospital traumatic hemorrhagic shock early fluid resuscitation can improve patient outcomes and reduce the extent of the body may be related to reduced GR alleviate related glucocorticoid tolerated.
|