BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBO...BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBOA)can alleviate ischemic burden;however,its security and eff ectiveness prior to operative hemorrhage control remains unknown.Hence,we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS:Twenty Landrace pigs were randomized into control(no aortic occlusion)(n=5),intervention with complete REBOA(cREBOA)(n=5),continuous pREBOA(C-pREBOA)(n=5),and sequential pREBOA(S-pREBOA)(n=5)groups.In the cREBOA and C-pREBOA groups,the balloon was inflated for 60 min.The hemodynamic and laboratory values were compared at various observation time points.Tissue samples immediately after animal euthanasia from the myocardium,liver,kidneys,and duodenum were collected for histological assessment using hematoxylin and eosin staining.RESULTS:Compared with the control group,the survival rate of the REBOA groups was prominently improved(all P<0.05).The total volume of blood loss was markedly lower in the cREBOA group(493.14±127.31 mL)compared with other groups(P<0.01).The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups(P<0.05).At 120 min,the S-pREBOA group showed higher alanine aminotransferase(P<0.05)but lower blood urea nitrogen compared with the cREBOA group(P<0.05).CONCLUSION:In this trauma model with liver injury,a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure,despite persistent hemorrhage.Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures,and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.展开更多
Hemorrhagic shock is a life-threatening disease often encountered in emergency departments(EDs).Hemorrhagic shock caused by extensive bleeding from multiple sites is often associated with high mortality and morbidity....Hemorrhagic shock is a life-threatening disease often encountered in emergency departments(EDs).Hemorrhagic shock caused by extensive bleeding from multiple sites is often associated with high mortality and morbidity.In recent years,resuscitative endovascular balloon occlusion of the aorta(REBOA)has been widely used in traumatic hemorrhagic shock and is considered to be an effective resuscitation measure.[1]Some studies reported that REBOA was also effective for non-traumatic hemorrhage.[2,3]In this study,we report a case of hemorrhagic shock caused by acute upper gastrointestinal bleeding that was successfully treated and received REBOA to obtain a transition time.This report may provide feasible options for emergency physicians,gastroenterologists,or surgeons to more actively treat refractory gastrointestinal bleeding.展开更多
Objective Shock heart syndrome(SHS)is associated with lethal arrhythmias(ventricular tachycardia/ventricular fibrillation,VT/VF).We investigated whether liposome-encapsulated human hemoglobin vesicles(HbVs)has compara...Objective Shock heart syndrome(SHS)is associated with lethal arrhythmias(ventricular tachycardia/ventricular fibrillation,VT/VF).We investigated whether liposome-encapsulated human hemoglobin vesicles(HbVs)has comparable persistent efficacy to washed red blood cells(wRBCs)for improving arrhythmogenesis in the subacute to chronic phase of SHS.Methods Optical mapping analysis(OMP),electrophysiological study(EPS),and pathological examinations were performed on blood samples from Sprague-Dawley rats following induction of hemorrhagic shock.After hemorrhagic shock,the rats were immediately resuscitated by transfusing 5%albumin(ALB),HbV,or wRBCs.All rats survived for 1 week.OMP and EPS were performed on Langendorff-perfused hearts.Spontaneous arrhythmias and heart rate variability(HRV)were evaluated using awake 24-h telemetry,cardiac function by echocardiography,and pathological examination of Connexin43.Results OMP showed significantly impaired action potential duration dispersion(APDd)in the left ventricle(LV)in the ALB group whereas APDd was substantially preserved in the HbV and wRBCs groups.Sustained VT/VF was easily provoked by EPS in the ALB group.No VT/VF was induced in the HbV and wRBCs groups.HRV,spontaneous arrhythmias,and cardiac function were preserved in the HbV and wRBCs groups.Pathology showed myocardial cell damage and Connexin43 degradation in the ALB group,all of which were attenuated in the HbV and wRBCs groups.Conclusion LV remodeling after hemorrhagic shock caused VT/VF in the presence of impaired APDd.Similar to wRBCs,HbV persistently prevented VT/VF by inhibiting persistent electrical remodeling,preserving myocardial structures,and ameliorating arrhythmogenic modifying factors in the subacute to chronic phase of hemorrhagic shock-induced SHS.展开更多
AIM:To investigate whether electroacupuncture(EA)at Zusanli(ST36)prevents intestinal barrier and remote organ dysfunction following prolonged hemorrhagic shock through a vagus anti-inflammatory mechanism.METHODS:Sprag...AIM:To investigate whether electroacupuncture(EA)at Zusanli(ST36)prevents intestinal barrier and remote organ dysfunction following prolonged hemorrhagic shock through a vagus anti-inflammatory mechanism.METHODS:Sprague-Dawley rats were subjected to about 45%of total blood volume loss followed by delayed fluid replacement(DFR)with Ringer lactate 3h after hemorrhage.In a first study,rats were randomly divided into six groups:(1)EAN:EA at non-channel acupoints followed by DFR;(2)EA:EA at ST36 after hemorrhage followed by DFR;(3)VGX/EA:vagotomy(VGX)before EA at ST36 and DFR;(4)VGX/EAN:VGX before EAN and DFR;(5)α-bungarotoxin(α-BGT)/EA:intraperitoneal injection ofα-BGT before hemorrhage,followed by EA at ST36 and DFR;and(6)α-BGT/EAN group:α-BGT injection before hemorrhage followed by EAN and DFR.Survival and mean arterial pressure(MAP)were monitored over the next 12 h.In a second study,with the same grouping and treatment,cytokine levels in plasma and intestine,organ parameters,gut injury score,gut permeability to 4 kDa FITC-dextran,and expression and distribution of tight junction protein ZO-1 were evaluated.RESULTS:MAP was significantly lowered after blood loss;EA at ST36 improved the blood pressure at corresponding time points 3 and 12 h after hemorrhage.EA at ST36 reduced tumor necrosis factor-αand interleukin(IL)-6 levels in both plasma and intestine homogenates after blood loss and DFR,while vagotomy or intraperitoneal injection ofα-BGT before EA at ST36reversed its anti-inflammatory effects,and EA at ST36did not influence IL-10 levels in plasma and intestine.EA at ST36 alleviated the injury of intestinal villus,the gut injury score being significantly lower than that of EAN group(1.85±0.33 vs 3.78±0.59,P<0.05).EA at ST36 decreased intestinal permeability to FITCdextran compared with EAN group(856.95 ng/mL±90.65 ng/mL vs 2305.62 ng/mL±278.32 ng/mL,P<0.05).EA at ST36 significantly preserved ZO-1 protein expression and localization at 12 h after hemorrhage.However,EA at non-channel acupoints had no such effect,and abdominal vagotomy andα-BGT treatment could weaken or eliminate the effects of EA at ST36.Besides,EA at ST36 decreased blood aminotransferase,MB isoenzyme of creatine kinase and creatinine vs EAN group at corresponding time points.At the end of 12-h experiment,the survival rate of the EA group was significantly higher than that of the other groups.CONCLUSION:EA at ST36 attenuates the systemic inflammatory response,protects intestinal barrier integrity,improves organ function and survival rate after hemorrhagic shock via activating the cholinergic antiinflammatory mechanism.展开更多
AIM To compare the effects of extract F of red-rooted Salvia (EFRRS) on mucosal lesions of gastric corpus and antrum induced by hemorrhagic shock and reperfusion in rats.``METHODS The rats were subject to hemorrhagic ...AIM To compare the effects of extract F of red-rooted Salvia (EFRRS) on mucosal lesions of gastric corpus and antrum induced by hemorrhagic shock and reperfusion in rats.``METHODS The rats were subject to hemorrhagic shock and followed by reperfusion, and were divided randomly into two groups. Group 1 received saline, and group 2received EFRRS intravenously. The index of gastric mucosal lesions (IGML) was expressed as the percentage of lesional area in the corpus or antrum. The degree of gastric mucosal lesions (DGML) was catalogued grade 0,1. 2 and 3. The concentrations of prostaglandins (lags)were measured by radioimmunoassay. The concentration of MDA was measured according to the procedures of Asakawa. The activity of SOD was measured by the biochemical way. The growth rates or inhibitory rates of above-mentioned parametes were calculated.``RESULTS As compared with IGML (%), grade 3 damage (%) and MDA content (nmol/g tissue) of gastric antrum which were respectively 7.96 ± 0.59, 34.86± 4.96 and 156.98± 16.12. those of gastric corpus which were respectively 23.18 ± 6.82, 58.44 ± 9.07 and 230.56 ± 19.37increased markedly (P<0.01), whereas the grade 0damage, grade 1 damage, the concentrations of PGE2 and PGI2(pg/ mg tissue), the ratio of PGI2/ TXA2 and the activity of SOD (U/ g tissue) of corpus which were respectively 3.01 _- 1.01, 8.35 + 1.95, 540.48 _+ 182.78,714.38 ± 123.74, 17.38 ± 5.93 and 134.29 ± 13.35 were markedly lower than those of antrum which were respectively 13.92 ± 2.25, 26.78 ± 6.06, 2218.56 ± 433.12,2531.76 ± 492.35, 43.46 ± 8.51 and 187.45 ± 17.67( P<0.01 ) after hemorrhagic shock and reperfusion. After intravenous EFRRS, the growth rates (%) of grade 0damage, grade 1 damage, the concentrations of PGE2 and PGI2, the ratio of PGI2/TXA2 and the activity of SOD of corpus which were respectively 632.56, 308.62, 40.75,74.75, 92.29 and 122.25 were higher than those in antrum which were respectively 104,89, 58.40, 11.12, 56.58,30.65 and 82.64, whereas the inhibitory rates (%) ofIGML, grade 3 damage and MDA content of gastric corpus were 82.93, 65.32 and 59.09, being higher than those of gastric antrum which were 76.64, 53.18 and 42.37.``CONCLUSION After hemorrhagic shock-reperfusion, the gastric mucosal lesions in the corpus were more severe than those in the antrum, which were related not only to the different distribution of endogenous PGs in the mucosa, but also to the different ability of anti-oxidation of the mucosa. The protective effect of EFRRS on the gastric mucosa in the corpus was more evident than that in the antrum, which was related to higher growth degree of PGs contents and anti-oxitative ability in gastric corpus after administration of EFRRS.展开更多
Objective: To explore the protection and molecular mechanism of histone deacetylase inhibitors(HDACIs) on the spleen of rats with hemorrhagic shock. Methods: A total of 60 SPF male SD rats were selected for the modeli...Objective: To explore the protection and molecular mechanism of histone deacetylase inhibitors(HDACIs) on the spleen of rats with hemorrhagic shock. Methods: A total of 60 SPF male SD rats were selected for the modeling of severe hemorrhagic shock using the method of arterial and venous cannulation with the time-divided bleeding. The measurement of mean arterial blood pressure and blood lactic acid was used to verify the modeling. The modeled rats were randomly divided into shock group, shock+suberoylanilide hydroxamic acid(SAHA) group, shock+autogenous transfusion group, and shock+SAHA+autogenous transfusion group. Three hours after the treatment, the spleen of rats was collected and TUNEL method was employed to detect the apoptosis of spleen cells in each group. Afterwards, real-time PCR and western blot were employed to detect the expression of BCL-2, BAX, and caspass3 in the spleen of rats in each group. Results: A total of 55 rats had successful modeling of severe hemorrhagic shock, with success rate of 92%. Cell apoptosis in the severe hemorrhagic model group was the most serious. After the intervention of HDACIs and the autogenous transfusion, the tissue injury was a bit recovered. Cell apoptosis was least in the shock+SAHA+autogenous transfusion group(P<0.05). After the intervention of HDACIs and the autogenous transfusion, the relative expression of BCL-2 was significantly increased(P<0.05), with highest relative expression of BCL-2 in shock+SAHA+autogenous transfusion group(P<0.05). After the intervention of HDACIs and the autogenous transfusion, the relative expression of BAX was significantly decreased(P<0.05), with lowest relative expression of BAX in the intervention group of single HDACIs. The change in the expression of caspass3 was similar to BAX, namely the relative expression of caspass3 was significantly decreased after the intervention of HDACIs and the autogenous transfusion(P<0.05). Conclusions: HDACIs and autogenous transfusion can all protect the spleen injury because of the severe hemorrhagic shock. Its molecular mechanism may be related to the regulation on the expression of BCL-2/BAX and caspass3, which may affect the apoptosis process of cells.展开更多
BACKGROUND:Hypothermia is associated with poor outcome in trauma patients;however,hemorrhagic shock(HS)model with anesthetized swine was different from that of clinical reality.To identify the effects of environmental...BACKGROUND:Hypothermia is associated with poor outcome in trauma patients;however,hemorrhagic shock(HS)model with anesthetized swine was different from that of clinical reality.To identify the effects of environmental hypothermia on HS,we investigated hemodynamics and oxygen dynamics in an unanesthetized swine model of HS under simulating hypothermia environment.METHODS:Totally 16 Bama pigs were randomly divided into ambient temperature group(group A)and low temperature group(group B),8 pigs in each group.Venous blood(30 mL/kg)was continuously withdrawn for more than 15 minutes in conscious swine to establish a hemorrhagic shock model.Pulmonary arterial temperature(Tp),heart rate(HR),mean arterial pressure(MAP),pulmonary arterial pressure(PAP),pulmonary arterial wedge pressure(PAWP),central venous pressure(CVP),cardiac output(CO),hemoglobin(Hb),saturation of mixed venous blood(SvO_2)and blood gas analysis were recorded at the baseline and different hemorrhagic shock time(HST).The whole body oxygen delivery indices,DO_2l and VO_2l,and the O_2 extraction ratio(O_2ER)were calculated.RESULTS:Core body temperature in group A decreased slightly after the hemorrhagic shock model was established,and environmental hypothermia decreased in core body temperature.The mortality rate was significantly higher in group B(50%)than in group A(0%).DO_2l and VO_2l decreased significantly after hemorrhage.No difference was found in hemodynamics,DO_2l and VO_2l between group A and group B,but the difference in pH,lactic acid and O_2ER was significant between the two groups.CONCLUSION:Environmental hypothermia aggravated the disorder of oxygen metabolism after hemorrhagic shock,which was associated with poor prognosis.展开更多
AIM: To characterize differences of arterial(ABG) and venous(VBG) blood gas analysis in a rabbit model of hemorrhagic shock. METHODS: Following baseline arterial and venous blood gas analysis, fifty anesthetized, vent...AIM: To characterize differences of arterial(ABG) and venous(VBG) blood gas analysis in a rabbit model of hemorrhagic shock. METHODS: Following baseline arterial and venous blood gas analysis, fifty anesthetized, ventilated New Zealand white rabbits were hemorrhaged to and maintained at a mean arterial pressure of 40 mm Hg until a state of shock was obtained, as defined by arterial p H ≤ 7.2 and base deficit ≤-15 mmol/L. Simultaneous ABG and VBG were obtained at 3 minute intervals. Comparisons of p H, base deficit, p CO2, and arteriovenous(a-v) differences were then made between ABG and VBG at baseline and shock states. Statistical analysis was applied where appropriate with a significance of P < 0.05. RESULTS: All 50 animals were hemorrhaged to shockstatus and euthanized; no unexpected loss occurred. Significant differences were noted between baseline and shock states in blood gases for the following parameters: p H was significantly decreased in both arterial(7.39 ± 0.12 to 7.14 ± 0.18) and venous blood gases(7.35 ± 0.15 to 6.98 ± 0.26, P < 0.05), base deficit was significantly increased for arterial(-0.9 ± 3.9 m Eq/L vs-17.8 ± 2.2 m Eq/L) and venous blood gasses(-0.8 ± 3.8 m Eq/L vs-15.3 ± 4.1 m Eq/L, P < 0.05). p CO2 trends(baseline to shock) demonstrated a decrease in arterial blood(40.0 ± 9.1 mm Hg vs 28.9 ± 7.1 mm Hg) but an increase in venous blood(46.0 ± 10.1 mm Hg vs 62.8 ± 15.3 mm Hg), although these trends were non-significant. For calculated arteriovenous differences between baseline and shock states, only the p CO2 difference was shown to be significant during shock.CONCLUSION: In this rabbit model, significant differences exist in blood gas measurements for arterial and venous blood after hemorrhagic shock. A widened p CO2 a-v difference during hemorrhage, reflective of poor tissue oxygenation, may be a better indicator of impending shock.展开更多
AIM: To investigate the effects of biliary tract external drainage(BTED) on intestinal barrier injury in rats with hemorrhagic shock(HS). METHODS: BTED was performed via cannula insertion into the bile duct of rats. H...AIM: To investigate the effects of biliary tract external drainage(BTED) on intestinal barrier injury in rats with hemorrhagic shock(HS). METHODS: BTED was performed via cannula insertion into the bile duct of rats. HS was induced by drawing blood from the femoral artery at a rate of 1 m L/min until a mean arterial pressure(MAP) of 40 ± 5 mm Hg was achieved. That MAP was maintained for 60 min. A total of 99 Sprague-Dawley rats were randomized into a sham group, an HS group and an HS + BTED group. Nine rats in the sham group were sacrificed 0.5 h after surgery. Nine rats in each of the HS and HS + BTED groups were sacrificed 0.5 h, 1 h, 2 h, 4 h and 6 h after resuscitation. Plasma tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), and lipopolysaccharide(LPS) levels were analyzed using enzyme-linked immunosorbent assay. Plasma D-lactate levels were analyzed using colorimetry. The expression levels of occludin and claudin-1 in the ileum were analyzed using Western blot and immunohistochemistry. Histology of the ileumwas evaluated by hematoxylin and eosin staining. RESULTS: Plasma TNF-α levels in the HS + BTED group decreased significantly compared with the HS group at 1 h and 6 h after resuscitation(P < 0.05). Plasma IL-6 levels in the HS + BTED group decreased significantly compared with the HS group at 0.5 h, 1 h and 2 h after resuscitation(P < 0.05). Plasma D-lactate and LPS levels in the HS + BTED group decreased significantly compared with the HS group at 6 h after resuscitation(P < 0.05). The expression levels of occludin in the HS + BTED group increased significantly compared with the HS group at 4 h and 6 h after resuscitation(P < 0.05). The expression levels of claudin-1 in the HS + BTED group increased significantly compared with the HS group at 6 h after resuscitation(P < 0.05). Phenomena of putrescence and desquamation of epithelial cells in the ileal mucosa were attenuated in the HS + BTED group. Ileal histopathologic scores in the HS + BTED group decreased significantly compared with the HS group at 2 h, 4 h and 6 h after resuscitation(P < 0.05). CONCLUSION: BTED protects against intestinal barrier injury in HS rats.展开更多
BACKGROUND Esophageal submucosal hematoma is a rare condition.Although the exact etiology remains uncertain,vessel fragility with external factors is believed to have led to submucosal bleeding and hematoma formation;...BACKGROUND Esophageal submucosal hematoma is a rare condition.Although the exact etiology remains uncertain,vessel fragility with external factors is believed to have led to submucosal bleeding and hematoma formation;the vessel was ruptured by a sudden increase in pressure due to nausea,and the hematoma was enlarged by antiplatelet or anticoagulant therapy.Serious conditions are rare,with a better prognosis.We present the first known case of submucosal esophageal hematoma-subsequent hemorrhagic shock due to Mallory-Weiss syndrome.CASE SUMMARY A 73-year-old female underwent endovascular treatment for an unruptured cerebral aneurysm.The patient received aspirin and clopidogrel before surgery and heparin during surgery,and was well during the surgery.Several hours after returning to the ICU,she complained of chest discomfort,vomited 500 m L of fresh blood,and entered hemorrhagic shock.Esophageal submucosal hematoma with Mallory-Weiss syndrome was diagnosed through an endoscopic examination and computed tomography.In addition to a massive fluid and erythrocyte transfusion,we performed a temporary compression for hemostasis with a Sengstaken-Blakemore(S-B)tube.Afterwards,she became hemodynamically stable.On postoperative day 1,we performed an upper gastrointestinal endoscopy and confirmed no expansion of the hematoma nor any recurring bleeding;therefore,we removed the S-B tube and clipped the gastric mucosal laceration at the esophagogastric junction.We started oral intake on postoperative day 10.The patient made steady progress,and was discharged on postoperative day 33.CONCLUSION We present the first known case of submucosal esophageal hematoma subsequent hemorrhagic shock due to Mallory-Weiss syndrome.展开更多
AIM: To determine the time course of intestinal permeability changes to proteolytically-derived bowel peptides in experimental hemorrhagic shock. METHODS: We injected fluorescently-conjugated casein protein into the s...AIM: To determine the time course of intestinal permeability changes to proteolytically-derived bowel peptides in experimental hemorrhagic shock. METHODS: We injected fluorescently-conjugated casein protein into the small bowel of anesthetized Wistar rats prior to induction of experimental hemorrhagic shock. These molecules, which fluoresce when proteolytically cleaved, were used as markers for the ability of proteolytically cleaved intestinal products to access the central circulation. Blood was serially sampled to quantify the relative change in concentration of proteolytically-cleaved particles in the systemic circulation. To provide spatial resolution of their location, particles in the mesenteric microvasculature were imaged using in vivo intravital fluorescent microscopy. The experiments were then repeated using an alternate measurement technique, fluorescein isothiocyanate(FITC)-labeled dextrans 20, to semi-quantitatively verify the ability of bowel-derived low-molecular weight molecules(< 20 k D) to access the central circulation.RESULTS: Results demonstrate a significant increase in systemic permeability to gut-derived peptides within 20 min after induction of hemorrhage(1.11 ± 0.19 vs 0.86 ± 0.07, P < 0.05) compared to control animals. Reperfusion resulted in a second, sustained increase in systemic permeability to gut-derived peptides in hemorrhaged animals compared to controls(1.2 ± 0.18 vs 0.97 ± 0.1, P < 0.05). Intravital microscopy of the mesentery also showed marked accumulation of fluorescent particles in the microcirculation of hemorrhaged animals compared to controls. These results were replicated using FITC dextrans 20 [10.85 ± 6.52 vs 3.38 ± 1.11 fluorescent intensity units(× 105, P < 0.05, hemorrhagic shock vs controls)], confirming that small bowel ischemia in response to experimental hemorrhagic shock results in marked and early increases in gut membrane permeability. CONCLUSION: Increased small bowel permeability in hemorrhagic shock may allow for systemic absorption of otherwise retained proteolytically-generated peptides, with consequent hemodynamic instability and remote organ failure.展开更多
AIM To evaluate the effects of mineralocorticoid receptor(MR) antagonists on mortality and inflammatory responses after hemorrhagic shock(HS) in rats.METHODS One hundred and two male Sprague–Dawley rats were randomly...AIM To evaluate the effects of mineralocorticoid receptor(MR) antagonists on mortality and inflammatory responses after hemorrhagic shock(HS) in rats.METHODS One hundred and two male Sprague–Dawley rats were randomly assigned to one of the following three groups: Control, spironolactone (SPL), and eplerenone(EP) groups. HS was induced by the removal of blood. One half of rats were evaluated to determine mortality, hemodynamics, plasma tumor necrosis factor-alpha(TNF-α) concentrations, and arterial blood gas at 8 h afterHS recovery. In the remainder of rats, the expression levels of genes encoding cytokines were evaluated in liver tissue samples at 1 h after HS recovery. RESULTS The survival rates 8 h after HS recovery were 71%, 94%, and 82% in the control, SPL, and EP groups, respectively. There were no significant differences in survival rates among the three groups (P = 0.219). Furthermore, there were no significant differences in gene expression levels in the liver or plasma TNF-α concentrations among the three groups(P = 0.888).CONCLUSION Pretreatment with MR antagonists did not improve mortality or cytokine responses in the liver after HS recovery in rats.展开更多
BACKGROUND: Portal hypertension ( PHT) with upper gastrointestinal hemorrhage as its chief complication is a very common disease with great harm to humans. The effects of infusion volume, speed, and type on hemody- na...BACKGROUND: Portal hypertension ( PHT) with upper gastrointestinal hemorrhage as its chief complication is a very common disease with great harm to humans. The effects of infusion volume, speed, and type on hemody- namics in case of cirrhosis, PHT esophageal variceal bleed- ing, and their mechanism should be clarified. This study was designed to assess the effects of different infusion vo- lumes on hemodynamics of PHT canines after hemorrhagic shock (HS). METHODS: PHT canine models were made by chronic embolization via coarctating half of the main portal vein with silk suture. Two weeks later, the models were subjec- ted to hemorrhagic shock by quick femoral artery venesec- tion. The canines were divided into two groups to resusci- tate : one to receive a large volume of infusion (n =6) (large volume infusion group) and the other to receive a small vo- lume of infusion (n =6) (small volume infusion group). Hemodynamic indexes of PHT canines after HS and infu- sion were observed closely. RESULTS: The PHT canines showed a series of hemody- namical changes in hemorrhagic shock stage, which aggra- vated hemodynamical disorder in PHT. After quick infu- sion, mean arterial pressure (MAP), inferior vena cava pressure (IVCP), portal venous pressure ( PVP), portal vein pressure gradient ( PVPG), portal vein blood flow ( PVBF), hepatic artery blood flow ( HABF) and hepatic blood flow (HBF) increased significantly. These indexes in the large volume infusion group were higher than those in the small volume infusion group. Portal vascular resistance (PVR), splanchnic vascular resistance ( SVR), hepatic arte- rial resistance ( HAR) decreased significantly, but PVP, PVPG, PVBF, HABF and HBF showed a rebounding in- crease above the baseline values in the large volume infu- sion group. The changes of PVP, PVPG, PVBF, HABF and HBF were in parallel with those of MAP and inferior vena cava pressure (IVCP), without a rebounding increase in the small volume infusion group. In the large volume in- fusion group PVPG increased earlier and more significantly than did PVP; moreover PVPG exceeded the baseline by 13% , making the possibility of rebleeding great. In the small volume infusion group, PVPG was lower than the baseline by more than 22% , indicating a small possibility of rebleeding. SVR and HAR were lower in the large volume infusion group. PVP, PVPG, PVBF, HABF and HBF were positively correlated with accumulated volume of vein infusion. PVR showed a positive correlation with accumu- lated volume of vein infusion in the small volume infusion group. HAR was negatively correlated with accumulated volume of vein infusion in the large volume infusion group. CONCLUSIONS: PHT canines after HS, resuscitated by vein infusion, may show a rebounding increase of PVP, PVPG, PVBF, HABF and HBF above the baseline values in the large volume infusion group but not in the small vol- ume infusion group. A large volume infusion causes PVP, PVPG, PVBF, HABF and HBF to increase higher than does a small volume infusion.展开更多
Forty rots were randomized into 2 groups and naloxone or saline were injected to therats after they were inflicted with hemorrhagic shock at sea level and at a simulated altitude of4000m respectively to observe the ef...Forty rots were randomized into 2 groups and naloxone or saline were injected to therats after they were inflicted with hemorrhagic shock at sea level and at a simulated altitude of4000m respectively to observe the effects of naloxone on left ventricular systolic pressure(LVSP),left ventricular diastolic pressure(LVDP),the maximal changing rate of LVSP(dp/dt max),heartrate(HR),and survival time of the animals.Plasma β-endorphin(β-EP)was determined beforeand after hemorrhage to observe the relationship between β-EP and hemorrhagic shock.It wasfound that the circulatory parameters of hemorrhagic shock changed more markedly at high alti-tude than at sea level,naloxone could restore these parameters and prolong the survival time inboth the animals of the sea level and high altitude groups,and plasma β-EP level was elevatedafter hemorrhage especially in those animals at high altitude.These findings indicate:(1)Hemorrhagic shock at high altitude is usually accompanied with severe clinical manifestations,rapid progression,and high mortality.(2)β-EP seems to participate in the pathologicalmanifestafions of hemorrhagic shock at high altitude,and its depressive action on myocardialcontraction may be one of the factors inducing hemorrhagic shock.(3)Naloxone possesses defi-nite property to comet hemorrhagic shock at high altitude.展开更多
The effects of 7.5％ NaCl-6％ dextran 70 in small dosage on the cardiovascular func-tion and the survival rate in hemorrhagic shock at a simnlated altitude of 4000 m were observedin dogs.The animals were bled from the...The effects of 7.5％ NaCl-6％ dextran 70 in small dosage on the cardiovascular func-tion and the survival rate in hemorrhagic shock at a simnlated altitude of 4000 m were observedin dogs.The animals were bled from the femoral artery for 8 rain to reduce the mean arterialpressure to 5.73±0.1kPa,which was maintained for an hour.Then the dogs were intravenouslyinjected with 4ml/kg 0.9％ NaCL(NS group,n=7),7.5％ NaCl(HS group,n=6)and 7.5％Naa-6％ dextran 70(HSD group,n=6)respectively.In the 2-hour-period after injection,5out of 7 dogs of NS group died but only 1 out of the 6 of both the HS and HSD groupsdied.Significant increase of mean arterial pressure,left ventricular pressure,±dp/dt max of leftventricle,cardiac output,cardiac index and cardiac minute work index was observed in both theHS and HSD groups.Improvement of the cardiovascular function was even more marked inHSD group than in HS group,thougth the difference between the 2 groups was statisticallyinsignificant.There was a tendency for the pulmonary vascular resistance to decrease in HS andHSD groups as compared with the NS group.The percentage of plasma expansion of HSDgroup was larger than that of HS group(P【0.05)and of NS group(P【0.01),but nosignificant difference existed between the HS and NS groups.It is believed that intravenous injection of hypertonic saline alone or in combination with dextran is effective for the treatment ofhemorrhagic shock at high altitude and the combination of 7.5％ NaCl and 6％ dextran 70seems even more effective.展开更多
In order to investigate whether hemorrhgic shock (HS) can enhance an individual’s sensitivity to endotoxin and the mechanism of this sensitization if it occurs, the changes of arterial blood pressure, plasma level of...In order to investigate whether hemorrhgic shock (HS) can enhance an individual’s sensitivity to endotoxin and the mechanism of this sensitization if it occurs, the changes of arterial blood pressure, plasma level of lactate and β-glucuronidase (β-G) and mortality rate were observed in rabbits of HS, lipopolysaccharide (LPS) and HS＋LPS groups. In addition. the expression of CD14 was determined in peritoneal macrophages in mice with HS.It was found that after the Infusion of LPS in HS＋LPS group, arterial blood pressure was significantly decreased while plasma lactate and β-G increased. The changes of these 3 parameters in HS＋LPS group were significantlydifferent from those of HS or LPS group at all time points. All the rabbits in HS＋LPS group died and those of HSand LPS groups survived. The expression of CD14 elevated in the peritoneal macrophages of mice during HS andsubsequent resuscitation. It is concluded that HS can markedly increase an individual’s sensitivity to endotoxin.which might be due to the upregulation of CD14 expression after HS.展开更多
A 67-year-old man visited our hospital with a history of continuous hematochezia leading to hemorrhagic shock.An abdominal computed tomography scan re-vealed a large mass in the ascending colon invading the duodenum a...A 67-year-old man visited our hospital with a history of continuous hematochezia leading to hemorrhagic shock.An abdominal computed tomography scan re-vealed a large mass in the ascending colon invading the duodenum and pancreatic head as well as extra-vasation of blood from the gastroduodenal artery(GDA) into the colon.Colonoscopy revealed an irregular ulcerative lesion and stenosis in the ascending colon.Therefore,right hemicolectomy combined with pylorus-preser ving pancreaticoduodenectomy was performed.Histologically,the tumor was classified as a moderately differentiated adenocarcinoma.Moreover,cancer cells were mainly located in the colon but had also invaded the duode-num and pancreas and involved the GDA.Immunohistochemically,the tumor cells were positive for cytokeratin(CK)20 and carcinoembryonic antigen(CEA)but not forCK7 and carbohydrate antigen(CA)19-9.The patient died 23 d after the surgery because he had another episode of arterial bleeding from the anastomosis site.Although En bloc resection of the tumor with pancreatico duodenectomy and colectomy performed for locally advanced colon cancer can ensure long-term survival,patients undergoing these procedures should be carefully monitored,particularly when the tumor involves the main artery.展开更多
Objective: To detect the changes of coagulation function in patients with early hemorrhagic shock by thromboelastography (TEG). Methods: TEG was performed in 50 patients with early hemorrhagic shock and surgical indic...Objective: To detect the changes of coagulation function in patients with early hemorrhagic shock by thromboelastography (TEG). Methods: TEG was performed in 50 patients with early hemorrhagic shock and surgical indications. The TEG parameters were compared with 50 healthy people. The coagulation and fibrinolysis in patients with early hemorrhagic shock were observed. Results: In terms of coagulation parameters, the R value decreased, the α angle increased, and the K value and MA value did not change significantly in patients with early hemorrhagic shock. Fibrinolytic aspects: EPL, LY30 observations have no significant changes compared to normal values. Conclusion: The plasma coagulation factor activity is increased in patients with early hemorrhagic shock;the fibrin level is increased;the blood is in a hypercoagulable state;and the fibrinolysis function is not changed. The timely detection of TEG can be used for coagulation function monitoring and blood transfusion therapy in patients with surgical hemorrhagic shock. It provides an important basis for preventing the formation of deep vein thrombosis.展开更多
BACKGROUND Neurofibromatosis type 1(NF-1)is a common autosomal dominant genetic disorder.It is characterized by café-au-lait spots and cutaneous neurofibromas.Although NF-1 typically involves the skin,nerves,bone...BACKGROUND Neurofibromatosis type 1(NF-1)is a common autosomal dominant genetic disorder.It is characterized by café-au-lait spots and cutaneous neurofibromas.Although NF-1 typically involves the skin,nerves,bones,and eyes,vascular manifestation in the form of devastating hemorrhage can occur rarely.CASE SUMMARY We present the case of a 47-year-old female with NF-1 who had a ruptured right lower limb arterial malformation.She presented with sudden right lower limb swelling for two hours and symptoms of hemorrhagic shock on admission.The physical examination revealed a right lower limb presenting as elephantiasis and visible dark-brown pigmentation over a large area.Computed tomography angiography showed right lower limb arteriovenous malformation.Therefore,the patient underwent emergency right lower limb digital subtraction angiography(DSA)and vascular embolization after blood transfusions.However,after DSA,vascular embolization,and repeated blood transfusions,the anemia and right lower limb swelling and tenderness did not improve.As a result,the patient underwent right lower extremity above-knee amputation.After amputation,the patient's hemoglobin level improved significantly without blood transfusion,and she was discharged from the hospital after the incision healed.Postoperative pathological examination suggested neurogenic tumors.No other complications had occurred 1-year follow-up.CONCLUSION Vascular malformation and rupture are fatal complications of NF-1.Embolization may not provide complete relief,the patient might need to undergo neurofibroma resection or amputation.展开更多
基金supported by military logistics scientific research project(AHJ16J004)。
文摘BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBOA)can alleviate ischemic burden;however,its security and eff ectiveness prior to operative hemorrhage control remains unknown.Hence,we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS:Twenty Landrace pigs were randomized into control(no aortic occlusion)(n=5),intervention with complete REBOA(cREBOA)(n=5),continuous pREBOA(C-pREBOA)(n=5),and sequential pREBOA(S-pREBOA)(n=5)groups.In the cREBOA and C-pREBOA groups,the balloon was inflated for 60 min.The hemodynamic and laboratory values were compared at various observation time points.Tissue samples immediately after animal euthanasia from the myocardium,liver,kidneys,and duodenum were collected for histological assessment using hematoxylin and eosin staining.RESULTS:Compared with the control group,the survival rate of the REBOA groups was prominently improved(all P<0.05).The total volume of blood loss was markedly lower in the cREBOA group(493.14±127.31 mL)compared with other groups(P<0.01).The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups(P<0.05).At 120 min,the S-pREBOA group showed higher alanine aminotransferase(P<0.05)but lower blood urea nitrogen compared with the cREBOA group(P<0.05).CONCLUSION:In this trauma model with liver injury,a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure,despite persistent hemorrhage.Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures,and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.
基金supported by a grant from Health Commission of Zhejiang Province“optimization study on partial balloon occlusion of the aorta in traumatic hemorrhagic shock patients(2023KY774)”.
文摘Hemorrhagic shock is a life-threatening disease often encountered in emergency departments(EDs).Hemorrhagic shock caused by extensive bleeding from multiple sites is often associated with high mortality and morbidity.In recent years,resuscitative endovascular balloon occlusion of the aorta(REBOA)has been widely used in traumatic hemorrhagic shock and is considered to be an effective resuscitation measure.[1]Some studies reported that REBOA was also effective for non-traumatic hemorrhage.[2,3]In this study,we report a case of hemorrhagic shock caused by acute upper gastrointestinal bleeding that was successfully treated and received REBOA to obtain a transition time.This report may provide feasible options for emergency physicians,gastroenterologists,or surgeons to more actively treat refractory gastrointestinal bleeding.
基金supported in part by the Project Promoting Clinical Trials for Development of New Drugs and Medical Devices from the Japan Agency for Medical Research and Development(AMED),Japan.
文摘Objective Shock heart syndrome(SHS)is associated with lethal arrhythmias(ventricular tachycardia/ventricular fibrillation,VT/VF).We investigated whether liposome-encapsulated human hemoglobin vesicles(HbVs)has comparable persistent efficacy to washed red blood cells(wRBCs)for improving arrhythmogenesis in the subacute to chronic phase of SHS.Methods Optical mapping analysis(OMP),electrophysiological study(EPS),and pathological examinations were performed on blood samples from Sprague-Dawley rats following induction of hemorrhagic shock.After hemorrhagic shock,the rats were immediately resuscitated by transfusing 5%albumin(ALB),HbV,or wRBCs.All rats survived for 1 week.OMP and EPS were performed on Langendorff-perfused hearts.Spontaneous arrhythmias and heart rate variability(HRV)were evaluated using awake 24-h telemetry,cardiac function by echocardiography,and pathological examination of Connexin43.Results OMP showed significantly impaired action potential duration dispersion(APDd)in the left ventricle(LV)in the ALB group whereas APDd was substantially preserved in the HbV and wRBCs groups.Sustained VT/VF was easily provoked by EPS in the ALB group.No VT/VF was induced in the HbV and wRBCs groups.HRV,spontaneous arrhythmias,and cardiac function were preserved in the HbV and wRBCs groups.Pathology showed myocardial cell damage and Connexin43 degradation in the ALB group,all of which were attenuated in the HbV and wRBCs groups.Conclusion LV remodeling after hemorrhagic shock caused VT/VF in the presence of impaired APDd.Similar to wRBCs,HbV persistently prevented VT/VF by inhibiting persistent electrical remodeling,preserving myocardial structures,and ameliorating arrhythmogenic modifying factors in the subacute to chronic phase of hemorrhagic shock-induced SHS.
基金Supported by The National Basic Research Program of China,973 Program,Grant No.2012CB518101
文摘AIM:To investigate whether electroacupuncture(EA)at Zusanli(ST36)prevents intestinal barrier and remote organ dysfunction following prolonged hemorrhagic shock through a vagus anti-inflammatory mechanism.METHODS:Sprague-Dawley rats were subjected to about 45%of total blood volume loss followed by delayed fluid replacement(DFR)with Ringer lactate 3h after hemorrhage.In a first study,rats were randomly divided into six groups:(1)EAN:EA at non-channel acupoints followed by DFR;(2)EA:EA at ST36 after hemorrhage followed by DFR;(3)VGX/EA:vagotomy(VGX)before EA at ST36 and DFR;(4)VGX/EAN:VGX before EAN and DFR;(5)α-bungarotoxin(α-BGT)/EA:intraperitoneal injection ofα-BGT before hemorrhage,followed by EA at ST36 and DFR;and(6)α-BGT/EAN group:α-BGT injection before hemorrhage followed by EAN and DFR.Survival and mean arterial pressure(MAP)were monitored over the next 12 h.In a second study,with the same grouping and treatment,cytokine levels in plasma and intestine,organ parameters,gut injury score,gut permeability to 4 kDa FITC-dextran,and expression and distribution of tight junction protein ZO-1 were evaluated.RESULTS:MAP was significantly lowered after blood loss;EA at ST36 improved the blood pressure at corresponding time points 3 and 12 h after hemorrhage.EA at ST36 reduced tumor necrosis factor-αand interleukin(IL)-6 levels in both plasma and intestine homogenates after blood loss and DFR,while vagotomy or intraperitoneal injection ofα-BGT before EA at ST36reversed its anti-inflammatory effects,and EA at ST36did not influence IL-10 levels in plasma and intestine.EA at ST36 alleviated the injury of intestinal villus,the gut injury score being significantly lower than that of EAN group(1.85±0.33 vs 3.78±0.59,P<0.05).EA at ST36 decreased intestinal permeability to FITCdextran compared with EAN group(856.95 ng/mL±90.65 ng/mL vs 2305.62 ng/mL±278.32 ng/mL,P<0.05).EA at ST36 significantly preserved ZO-1 protein expression and localization at 12 h after hemorrhage.However,EA at non-channel acupoints had no such effect,and abdominal vagotomy andα-BGT treatment could weaken or eliminate the effects of EA at ST36.Besides,EA at ST36 decreased blood aminotransferase,MB isoenzyme of creatine kinase and creatinine vs EAN group at corresponding time points.At the end of 12-h experiment,the survival rate of the EA group was significantly higher than that of the other groups.CONCLUSION:EA at ST36 attenuates the systemic inflammatory response,protects intestinal barrier integrity,improves organ function and survival rate after hemorrhagic shock via activating the cholinergic antiinflammatory mechanism.
基金Supported by the National Natural Science Foundation of China.No.3870890
文摘AIM To compare the effects of extract F of red-rooted Salvia (EFRRS) on mucosal lesions of gastric corpus and antrum induced by hemorrhagic shock and reperfusion in rats.``METHODS The rats were subject to hemorrhagic shock and followed by reperfusion, and were divided randomly into two groups. Group 1 received saline, and group 2received EFRRS intravenously. The index of gastric mucosal lesions (IGML) was expressed as the percentage of lesional area in the corpus or antrum. The degree of gastric mucosal lesions (DGML) was catalogued grade 0,1. 2 and 3. The concentrations of prostaglandins (lags)were measured by radioimmunoassay. The concentration of MDA was measured according to the procedures of Asakawa. The activity of SOD was measured by the biochemical way. The growth rates or inhibitory rates of above-mentioned parametes were calculated.``RESULTS As compared with IGML (%), grade 3 damage (%) and MDA content (nmol/g tissue) of gastric antrum which were respectively 7.96 ± 0.59, 34.86± 4.96 and 156.98± 16.12. those of gastric corpus which were respectively 23.18 ± 6.82, 58.44 ± 9.07 and 230.56 ± 19.37increased markedly (P<0.01), whereas the grade 0damage, grade 1 damage, the concentrations of PGE2 and PGI2(pg/ mg tissue), the ratio of PGI2/ TXA2 and the activity of SOD (U/ g tissue) of corpus which were respectively 3.01 _- 1.01, 8.35 + 1.95, 540.48 _+ 182.78,714.38 ± 123.74, 17.38 ± 5.93 and 134.29 ± 13.35 were markedly lower than those of antrum which were respectively 13.92 ± 2.25, 26.78 ± 6.06, 2218.56 ± 433.12,2531.76 ± 492.35, 43.46 ± 8.51 and 187.45 ± 17.67( P<0.01 ) after hemorrhagic shock and reperfusion. After intravenous EFRRS, the growth rates (%) of grade 0damage, grade 1 damage, the concentrations of PGE2 and PGI2, the ratio of PGI2/TXA2 and the activity of SOD of corpus which were respectively 632.56, 308.62, 40.75,74.75, 92.29 and 122.25 were higher than those in antrum which were respectively 104,89, 58.40, 11.12, 56.58,30.65 and 82.64, whereas the inhibitory rates (%) ofIGML, grade 3 damage and MDA content of gastric corpus were 82.93, 65.32 and 59.09, being higher than those of gastric antrum which were 76.64, 53.18 and 42.37.``CONCLUSION After hemorrhagic shock-reperfusion, the gastric mucosal lesions in the corpus were more severe than those in the antrum, which were related not only to the different distribution of endogenous PGs in the mucosa, but also to the different ability of anti-oxidation of the mucosa. The protective effect of EFRRS on the gastric mucosa in the corpus was more evident than that in the antrum, which was related to higher growth degree of PGs contents and anti-oxitative ability in gastric corpus after administration of EFRRS.
基金supported by the National Natural Science Foundation of China(No.81160230)the Natural Science Foundation of Jiangxi Province of China(No.20114BAB205003)
文摘Objective: To explore the protection and molecular mechanism of histone deacetylase inhibitors(HDACIs) on the spleen of rats with hemorrhagic shock. Methods: A total of 60 SPF male SD rats were selected for the modeling of severe hemorrhagic shock using the method of arterial and venous cannulation with the time-divided bleeding. The measurement of mean arterial blood pressure and blood lactic acid was used to verify the modeling. The modeled rats were randomly divided into shock group, shock+suberoylanilide hydroxamic acid(SAHA) group, shock+autogenous transfusion group, and shock+SAHA+autogenous transfusion group. Three hours after the treatment, the spleen of rats was collected and TUNEL method was employed to detect the apoptosis of spleen cells in each group. Afterwards, real-time PCR and western blot were employed to detect the expression of BCL-2, BAX, and caspass3 in the spleen of rats in each group. Results: A total of 55 rats had successful modeling of severe hemorrhagic shock, with success rate of 92%. Cell apoptosis in the severe hemorrhagic model group was the most serious. After the intervention of HDACIs and the autogenous transfusion, the tissue injury was a bit recovered. Cell apoptosis was least in the shock+SAHA+autogenous transfusion group(P<0.05). After the intervention of HDACIs and the autogenous transfusion, the relative expression of BCL-2 was significantly increased(P<0.05), with highest relative expression of BCL-2 in shock+SAHA+autogenous transfusion group(P<0.05). After the intervention of HDACIs and the autogenous transfusion, the relative expression of BAX was significantly decreased(P<0.05), with lowest relative expression of BAX in the intervention group of single HDACIs. The change in the expression of caspass3 was similar to BAX, namely the relative expression of caspass3 was significantly decreased after the intervention of HDACIs and the autogenous transfusion(P<0.05). Conclusions: HDACIs and autogenous transfusion can all protect the spleen injury because of the severe hemorrhagic shock. Its molecular mechanism may be related to the regulation on the expression of BCL-2/BAX and caspass3, which may affect the apoptosis process of cells.
基金supported by a grant from 11th Five-Year Plan Medical Science Scientific Research Fund of the Chinese People's Liberation Army(08G002)
文摘BACKGROUND:Hypothermia is associated with poor outcome in trauma patients;however,hemorrhagic shock(HS)model with anesthetized swine was different from that of clinical reality.To identify the effects of environmental hypothermia on HS,we investigated hemodynamics and oxygen dynamics in an unanesthetized swine model of HS under simulating hypothermia environment.METHODS:Totally 16 Bama pigs were randomly divided into ambient temperature group(group A)and low temperature group(group B),8 pigs in each group.Venous blood(30 mL/kg)was continuously withdrawn for more than 15 minutes in conscious swine to establish a hemorrhagic shock model.Pulmonary arterial temperature(Tp),heart rate(HR),mean arterial pressure(MAP),pulmonary arterial pressure(PAP),pulmonary arterial wedge pressure(PAWP),central venous pressure(CVP),cardiac output(CO),hemoglobin(Hb),saturation of mixed venous blood(SvO_2)and blood gas analysis were recorded at the baseline and different hemorrhagic shock time(HST).The whole body oxygen delivery indices,DO_2l and VO_2l,and the O_2 extraction ratio(O_2ER)were calculated.RESULTS:Core body temperature in group A decreased slightly after the hemorrhagic shock model was established,and environmental hypothermia decreased in core body temperature.The mortality rate was significantly higher in group B(50%)than in group A(0%).DO_2l and VO_2l decreased significantly after hemorrhage.No difference was found in hemodynamics,DO_2l and VO_2l between group A and group B,but the difference in pH,lactic acid and O_2ER was significant between the two groups.CONCLUSION:Environmental hypothermia aggravated the disorder of oxygen metabolism after hemorrhagic shock,which was associated with poor prognosis.
基金Carolinas Health Care System,Department of Surgery,Charlotte,North Carolina,United States
文摘AIM: To characterize differences of arterial(ABG) and venous(VBG) blood gas analysis in a rabbit model of hemorrhagic shock. METHODS: Following baseline arterial and venous blood gas analysis, fifty anesthetized, ventilated New Zealand white rabbits were hemorrhaged to and maintained at a mean arterial pressure of 40 mm Hg until a state of shock was obtained, as defined by arterial p H ≤ 7.2 and base deficit ≤-15 mmol/L. Simultaneous ABG and VBG were obtained at 3 minute intervals. Comparisons of p H, base deficit, p CO2, and arteriovenous(a-v) differences were then made between ABG and VBG at baseline and shock states. Statistical analysis was applied where appropriate with a significance of P < 0.05. RESULTS: All 50 animals were hemorrhaged to shockstatus and euthanized; no unexpected loss occurred. Significant differences were noted between baseline and shock states in blood gases for the following parameters: p H was significantly decreased in both arterial(7.39 ± 0.12 to 7.14 ± 0.18) and venous blood gases(7.35 ± 0.15 to 6.98 ± 0.26, P < 0.05), base deficit was significantly increased for arterial(-0.9 ± 3.9 m Eq/L vs-17.8 ± 2.2 m Eq/L) and venous blood gasses(-0.8 ± 3.8 m Eq/L vs-15.3 ± 4.1 m Eq/L, P < 0.05). p CO2 trends(baseline to shock) demonstrated a decrease in arterial blood(40.0 ± 9.1 mm Hg vs 28.9 ± 7.1 mm Hg) but an increase in venous blood(46.0 ± 10.1 mm Hg vs 62.8 ± 15.3 mm Hg), although these trends were non-significant. For calculated arteriovenous differences between baseline and shock states, only the p CO2 difference was shown to be significant during shock.CONCLUSION: In this rabbit model, significant differences exist in blood gas measurements for arterial and venous blood after hemorrhagic shock. A widened p CO2 a-v difference during hemorrhage, reflective of poor tissue oxygenation, may be a better indicator of impending shock.
基金Supported by National Natural Science Foundation of ChinaNo.81171789
文摘AIM: To investigate the effects of biliary tract external drainage(BTED) on intestinal barrier injury in rats with hemorrhagic shock(HS). METHODS: BTED was performed via cannula insertion into the bile duct of rats. HS was induced by drawing blood from the femoral artery at a rate of 1 m L/min until a mean arterial pressure(MAP) of 40 ± 5 mm Hg was achieved. That MAP was maintained for 60 min. A total of 99 Sprague-Dawley rats were randomized into a sham group, an HS group and an HS + BTED group. Nine rats in the sham group were sacrificed 0.5 h after surgery. Nine rats in each of the HS and HS + BTED groups were sacrificed 0.5 h, 1 h, 2 h, 4 h and 6 h after resuscitation. Plasma tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), and lipopolysaccharide(LPS) levels were analyzed using enzyme-linked immunosorbent assay. Plasma D-lactate levels were analyzed using colorimetry. The expression levels of occludin and claudin-1 in the ileum were analyzed using Western blot and immunohistochemistry. Histology of the ileumwas evaluated by hematoxylin and eosin staining. RESULTS: Plasma TNF-α levels in the HS + BTED group decreased significantly compared with the HS group at 1 h and 6 h after resuscitation(P < 0.05). Plasma IL-6 levels in the HS + BTED group decreased significantly compared with the HS group at 0.5 h, 1 h and 2 h after resuscitation(P < 0.05). Plasma D-lactate and LPS levels in the HS + BTED group decreased significantly compared with the HS group at 6 h after resuscitation(P < 0.05). The expression levels of occludin in the HS + BTED group increased significantly compared with the HS group at 4 h and 6 h after resuscitation(P < 0.05). The expression levels of claudin-1 in the HS + BTED group increased significantly compared with the HS group at 6 h after resuscitation(P < 0.05). Phenomena of putrescence and desquamation of epithelial cells in the ileal mucosa were attenuated in the HS + BTED group. Ileal histopathologic scores in the HS + BTED group decreased significantly compared with the HS group at 2 h, 4 h and 6 h after resuscitation(P < 0.05). CONCLUSION: BTED protects against intestinal barrier injury in HS rats.
文摘BACKGROUND Esophageal submucosal hematoma is a rare condition.Although the exact etiology remains uncertain,vessel fragility with external factors is believed to have led to submucosal bleeding and hematoma formation;the vessel was ruptured by a sudden increase in pressure due to nausea,and the hematoma was enlarged by antiplatelet or anticoagulant therapy.Serious conditions are rare,with a better prognosis.We present the first known case of submucosal esophageal hematoma-subsequent hemorrhagic shock due to Mallory-Weiss syndrome.CASE SUMMARY A 73-year-old female underwent endovascular treatment for an unruptured cerebral aneurysm.The patient received aspirin and clopidogrel before surgery and heparin during surgery,and was well during the surgery.Several hours after returning to the ICU,she complained of chest discomfort,vomited 500 m L of fresh blood,and entered hemorrhagic shock.Esophageal submucosal hematoma with Mallory-Weiss syndrome was diagnosed through an endoscopic examination and computed tomography.In addition to a massive fluid and erythrocyte transfusion,we performed a temporary compression for hemostasis with a Sengstaken-Blakemore(S-B)tube.Afterwards,she became hemodynamically stable.On postoperative day 1,we performed an upper gastrointestinal endoscopy and confirmed no expansion of the hematoma nor any recurring bleeding;therefore,we removed the S-B tube and clipped the gastric mucosal laceration at the esophagogastric junction.We started oral intake on postoperative day 10.The patient made steady progress,and was discharged on postoperative day 33.CONCLUSION We present the first known case of submucosal esophageal hematoma subsequent hemorrhagic shock due to Mallory-Weiss syndrome.
基金Supported by Career Development Award(CDA2)1IK2BX-001277-01A1 from the Department of Veterans Affairs,Veterans Health Administration,Office of Research and Developmentthe Foundation for Anesthesia Education and Research and the American Society of Critical Care Anesthesiologists and NIH GM085072-06
文摘AIM: To determine the time course of intestinal permeability changes to proteolytically-derived bowel peptides in experimental hemorrhagic shock. METHODS: We injected fluorescently-conjugated casein protein into the small bowel of anesthetized Wistar rats prior to induction of experimental hemorrhagic shock. These molecules, which fluoresce when proteolytically cleaved, were used as markers for the ability of proteolytically cleaved intestinal products to access the central circulation. Blood was serially sampled to quantify the relative change in concentration of proteolytically-cleaved particles in the systemic circulation. To provide spatial resolution of their location, particles in the mesenteric microvasculature were imaged using in vivo intravital fluorescent microscopy. The experiments were then repeated using an alternate measurement technique, fluorescein isothiocyanate(FITC)-labeled dextrans 20, to semi-quantitatively verify the ability of bowel-derived low-molecular weight molecules(< 20 k D) to access the central circulation.RESULTS: Results demonstrate a significant increase in systemic permeability to gut-derived peptides within 20 min after induction of hemorrhage(1.11 ± 0.19 vs 0.86 ± 0.07, P < 0.05) compared to control animals. Reperfusion resulted in a second, sustained increase in systemic permeability to gut-derived peptides in hemorrhaged animals compared to controls(1.2 ± 0.18 vs 0.97 ± 0.1, P < 0.05). Intravital microscopy of the mesentery also showed marked accumulation of fluorescent particles in the microcirculation of hemorrhaged animals compared to controls. These results were replicated using FITC dextrans 20 [10.85 ± 6.52 vs 3.38 ± 1.11 fluorescent intensity units(× 105, P < 0.05, hemorrhagic shock vs controls)], confirming that small bowel ischemia in response to experimental hemorrhagic shock results in marked and early increases in gut membrane permeability. CONCLUSION: Increased small bowel permeability in hemorrhagic shock may allow for systemic absorption of otherwise retained proteolytically-generated peptides, with consequent hemodynamic instability and remote organ failure.
文摘AIM To evaluate the effects of mineralocorticoid receptor(MR) antagonists on mortality and inflammatory responses after hemorrhagic shock(HS) in rats.METHODS One hundred and two male Sprague–Dawley rats were randomly assigned to one of the following three groups: Control, spironolactone (SPL), and eplerenone(EP) groups. HS was induced by the removal of blood. One half of rats were evaluated to determine mortality, hemodynamics, plasma tumor necrosis factor-alpha(TNF-α) concentrations, and arterial blood gas at 8 h afterHS recovery. In the remainder of rats, the expression levels of genes encoding cytokines were evaluated in liver tissue samples at 1 h after HS recovery. RESULTS The survival rates 8 h after HS recovery were 71%, 94%, and 82% in the control, SPL, and EP groups, respectively. There were no significant differences in survival rates among the three groups (P = 0.219). Furthermore, there were no significant differences in gene expression levels in the liver or plasma TNF-α concentrations among the three groups(P = 0.888).CONCLUSION Pretreatment with MR antagonists did not improve mortality or cytokine responses in the liver after HS recovery in rats.
文摘BACKGROUND: Portal hypertension ( PHT) with upper gastrointestinal hemorrhage as its chief complication is a very common disease with great harm to humans. The effects of infusion volume, speed, and type on hemody- namics in case of cirrhosis, PHT esophageal variceal bleed- ing, and their mechanism should be clarified. This study was designed to assess the effects of different infusion vo- lumes on hemodynamics of PHT canines after hemorrhagic shock (HS). METHODS: PHT canine models were made by chronic embolization via coarctating half of the main portal vein with silk suture. Two weeks later, the models were subjec- ted to hemorrhagic shock by quick femoral artery venesec- tion. The canines were divided into two groups to resusci- tate : one to receive a large volume of infusion (n =6) (large volume infusion group) and the other to receive a small vo- lume of infusion (n =6) (small volume infusion group). Hemodynamic indexes of PHT canines after HS and infu- sion were observed closely. RESULTS: The PHT canines showed a series of hemody- namical changes in hemorrhagic shock stage, which aggra- vated hemodynamical disorder in PHT. After quick infu- sion, mean arterial pressure (MAP), inferior vena cava pressure (IVCP), portal venous pressure ( PVP), portal vein pressure gradient ( PVPG), portal vein blood flow ( PVBF), hepatic artery blood flow ( HABF) and hepatic blood flow (HBF) increased significantly. These indexes in the large volume infusion group were higher than those in the small volume infusion group. Portal vascular resistance (PVR), splanchnic vascular resistance ( SVR), hepatic arte- rial resistance ( HAR) decreased significantly, but PVP, PVPG, PVBF, HABF and HBF showed a rebounding in- crease above the baseline values in the large volume infu- sion group. The changes of PVP, PVPG, PVBF, HABF and HBF were in parallel with those of MAP and inferior vena cava pressure (IVCP), without a rebounding increase in the small volume infusion group. In the large volume in- fusion group PVPG increased earlier and more significantly than did PVP; moreover PVPG exceeded the baseline by 13% , making the possibility of rebleeding great. In the small volume infusion group, PVPG was lower than the baseline by more than 22% , indicating a small possibility of rebleeding. SVR and HAR were lower in the large volume infusion group. PVP, PVPG, PVBF, HABF and HBF were positively correlated with accumulated volume of vein infusion. PVR showed a positive correlation with accumu- lated volume of vein infusion in the small volume infusion group. HAR was negatively correlated with accumulated volume of vein infusion in the large volume infusion group. CONCLUSIONS: PHT canines after HS, resuscitated by vein infusion, may show a rebounding increase of PVP, PVPG, PVBF, HABF and HBF above the baseline values in the large volume infusion group but not in the small vol- ume infusion group. A large volume infusion causes PVP, PVPG, PVBF, HABF and HBF to increase higher than does a small volume infusion.
文摘Forty rots were randomized into 2 groups and naloxone or saline were injected to therats after they were inflicted with hemorrhagic shock at sea level and at a simulated altitude of4000m respectively to observe the effects of naloxone on left ventricular systolic pressure(LVSP),left ventricular diastolic pressure(LVDP),the maximal changing rate of LVSP(dp/dt max),heartrate(HR),and survival time of the animals.Plasma β-endorphin(β-EP)was determined beforeand after hemorrhage to observe the relationship between β-EP and hemorrhagic shock.It wasfound that the circulatory parameters of hemorrhagic shock changed more markedly at high alti-tude than at sea level,naloxone could restore these parameters and prolong the survival time inboth the animals of the sea level and high altitude groups,and plasma β-EP level was elevatedafter hemorrhage especially in those animals at high altitude.These findings indicate:(1)Hemorrhagic shock at high altitude is usually accompanied with severe clinical manifestations,rapid progression,and high mortality.(2)β-EP seems to participate in the pathologicalmanifestafions of hemorrhagic shock at high altitude,and its depressive action on myocardialcontraction may be one of the factors inducing hemorrhagic shock.(3)Naloxone possesses defi-nite property to comet hemorrhagic shock at high altitude.
文摘The effects of 7.5％ NaCl-6％ dextran 70 in small dosage on the cardiovascular func-tion and the survival rate in hemorrhagic shock at a simnlated altitude of 4000 m were observedin dogs.The animals were bled from the femoral artery for 8 rain to reduce the mean arterialpressure to 5.73±0.1kPa,which was maintained for an hour.Then the dogs were intravenouslyinjected with 4ml/kg 0.9％ NaCL(NS group,n=7),7.5％ NaCl(HS group,n=6)and 7.5％Naa-6％ dextran 70(HSD group,n=6)respectively.In the 2-hour-period after injection,5out of 7 dogs of NS group died but only 1 out of the 6 of both the HS and HSD groupsdied.Significant increase of mean arterial pressure,left ventricular pressure,±dp/dt max of leftventricle,cardiac output,cardiac index and cardiac minute work index was observed in both theHS and HSD groups.Improvement of the cardiovascular function was even more marked inHSD group than in HS group,thougth the difference between the 2 groups was statisticallyinsignificant.There was a tendency for the pulmonary vascular resistance to decrease in HS andHSD groups as compared with the NS group.The percentage of plasma expansion of HSDgroup was larger than that of HS group(P【0.05)and of NS group(P【0.01),but nosignificant difference existed between the HS and NS groups.It is believed that intravenous injection of hypertonic saline alone or in combination with dextran is effective for the treatment ofhemorrhagic shock at high altitude and the combination of 7.5％ NaCl and 6％ dextran 70seems even more effective.
文摘In order to investigate whether hemorrhgic shock (HS) can enhance an individual’s sensitivity to endotoxin and the mechanism of this sensitization if it occurs, the changes of arterial blood pressure, plasma level of lactate and β-glucuronidase (β-G) and mortality rate were observed in rabbits of HS, lipopolysaccharide (LPS) and HS＋LPS groups. In addition. the expression of CD14 was determined in peritoneal macrophages in mice with HS.It was found that after the Infusion of LPS in HS＋LPS group, arterial blood pressure was significantly decreased while plasma lactate and β-G increased. The changes of these 3 parameters in HS＋LPS group were significantlydifferent from those of HS or LPS group at all time points. All the rabbits in HS＋LPS group died and those of HSand LPS groups survived. The expression of CD14 elevated in the peritoneal macrophages of mice during HS andsubsequent resuscitation. It is concluded that HS can markedly increase an individual’s sensitivity to endotoxin.which might be due to the upregulation of CD14 expression after HS.
文摘A 67-year-old man visited our hospital with a history of continuous hematochezia leading to hemorrhagic shock.An abdominal computed tomography scan re-vealed a large mass in the ascending colon invading the duodenum and pancreatic head as well as extra-vasation of blood from the gastroduodenal artery(GDA) into the colon.Colonoscopy revealed an irregular ulcerative lesion and stenosis in the ascending colon.Therefore,right hemicolectomy combined with pylorus-preser ving pancreaticoduodenectomy was performed.Histologically,the tumor was classified as a moderately differentiated adenocarcinoma.Moreover,cancer cells were mainly located in the colon but had also invaded the duode-num and pancreas and involved the GDA.Immunohistochemically,the tumor cells were positive for cytokeratin(CK)20 and carcinoembryonic antigen(CEA)but not forCK7 and carbohydrate antigen(CA)19-9.The patient died 23 d after the surgery because he had another episode of arterial bleeding from the anastomosis site.Although En bloc resection of the tumor with pancreatico duodenectomy and colectomy performed for locally advanced colon cancer can ensure long-term survival,patients undergoing these procedures should be carefully monitored,particularly when the tumor involves the main artery.
文摘Objective: To detect the changes of coagulation function in patients with early hemorrhagic shock by thromboelastography (TEG). Methods: TEG was performed in 50 patients with early hemorrhagic shock and surgical indications. The TEG parameters were compared with 50 healthy people. The coagulation and fibrinolysis in patients with early hemorrhagic shock were observed. Results: In terms of coagulation parameters, the R value decreased, the α angle increased, and the K value and MA value did not change significantly in patients with early hemorrhagic shock. Fibrinolytic aspects: EPL, LY30 observations have no significant changes compared to normal values. Conclusion: The plasma coagulation factor activity is increased in patients with early hemorrhagic shock;the fibrin level is increased;the blood is in a hypercoagulable state;and the fibrinolysis function is not changed. The timely detection of TEG can be used for coagulation function monitoring and blood transfusion therapy in patients with surgical hemorrhagic shock. It provides an important basis for preventing the formation of deep vein thrombosis.
文摘BACKGROUND Neurofibromatosis type 1(NF-1)is a common autosomal dominant genetic disorder.It is characterized by café-au-lait spots and cutaneous neurofibromas.Although NF-1 typically involves the skin,nerves,bones,and eyes,vascular manifestation in the form of devastating hemorrhage can occur rarely.CASE SUMMARY We present the case of a 47-year-old female with NF-1 who had a ruptured right lower limb arterial malformation.She presented with sudden right lower limb swelling for two hours and symptoms of hemorrhagic shock on admission.The physical examination revealed a right lower limb presenting as elephantiasis and visible dark-brown pigmentation over a large area.Computed tomography angiography showed right lower limb arteriovenous malformation.Therefore,the patient underwent emergency right lower limb digital subtraction angiography(DSA)and vascular embolization after blood transfusions.However,after DSA,vascular embolization,and repeated blood transfusions,the anemia and right lower limb swelling and tenderness did not improve.As a result,the patient underwent right lower extremity above-knee amputation.After amputation,the patient's hemoglobin level improved significantly without blood transfusion,and she was discharged from the hospital after the incision healed.Postoperative pathological examination suggested neurogenic tumors.No other complications had occurred 1-year follow-up.CONCLUSION Vascular malformation and rupture are fatal complications of NF-1.Embolization may not provide complete relief,the patient might need to undergo neurofibroma resection or amputation.
