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
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
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
Objective To observe the intestinal mucosal injury and the change of TNF-αcontent in rabbits with hemorrhagic shock/reperfusion(HS-R)and the effects of ganoderma Lcidum polysaccharide(GLP)on them.Methods 30rabbits we...Objective To observe the intestinal mucosal injury and the change of TNF-αcontent in rabbits with hemorrhagic shock/reperfusion(HS-R)and the effects of ganoderma Lcidum polysaccharide(GLP)on them.Methods 30rabbits were made into hemorrhagic shock,then reperfused with different liquids.These rabbits were divided by random number table into three groups:sham operation group(Sham group),reperfusion with normal saline group(NS group),reperfusion with 1%GLP group(LS group).Bacterial translocation of blood and TNF-αcontent in serum were respectively observed at the time before shock,40 min after shock,40 min and 90 min after.TNF-αcontent in intestinal mucosa and the degree of intestinal mucosal injury were examined at 90 min post-resuscitation.Results 1 With the extension of reperfusion time,the positive rate of blood bacteria increased gradually in NS group,which was significantly higher than that of Sham group and LS group(P<0.05),meanwhile the degree of intestinal mucosal injury in NS group was more severe than that of Sham group and LS group too(P<0.05).2TNF-αcontent in serum of NS group and LS group were increased obviously compared with that before shock and in Sham group(P<0.05).TNF-αcontent in serum was further increased after reperfusion with NS,which was distinctly higher than that in LS group.TNF-αcontent in intestinal mucosa of NS group was significantly higher than that in LS group and Sham group too(P<0.05).Conclusion GLP can protect intestinal mucosa against HS-R injury,and its effects may relate with the change of TNF-αin hemorrhagic shock rabbits.展开更多
Background Anesthesia induction is challenging in patients with hemodynamic instability.Esketamine has hypnotic,analgesic,and sympathomimetic effects and is the only anesthetic that can increase sympathetic tension.Th...Background Anesthesia induction is challenging in patients with hemodynamic instability.Esketamine has hypnotic,analgesic,and sympathomimetic effects and is the only anesthetic that can increase sympathetic tension.Therefore,it may be more suitable for patients with hypovolemic shock.Case summary A 40-year-old female patient presented to the emergency department with new-onset abdominal pain and vaginal bleeding for 2 hours.Menstruation of the patient was regular,her self-reported urine pregnancy test was positive half a month earlier,and she had been diagnosed at another hospital 12 days earlier based on a positive blood human chorionic gonadotropin test.Gynecological ultrasonography demonstrated no pregnancy sac in utero,confirming ectopic pregnancy.Emergency laparoscopy for ectopic pregnancy should be performed immediately.We administered esketamine for induction.Conclusion Esketamine-based total intravenous anesthesia results in mild hypotension in ectopic pregnancies with hemorrhagic shock.展开更多
Objective:To investigate the effects of Shenfu Injection(SFI)on endothelial damage in a porcine model of hemorrhagic shock(HS).Methods:After being bled to a mean arterial pressure of40±3 mm Hg and held for 60 min...Objective:To investigate the effects of Shenfu Injection(SFI)on endothelial damage in a porcine model of hemorrhagic shock(HS).Methods:After being bled to a mean arterial pressure of40±3 mm Hg and held for 60 min,32 pigs were treated with a venous injection of either shed blood(transfusion group),shed blood and saline(saline group),shed blood and SFI(SEI group)or without resuscitation(sham group).Venous blood samples were collected and analyzed at baseline and 0,1,2,4,and 6 h after HS.Tumor necrosis factor-α(TNF-α),serum interleuking(IL)-6,and IL-10 levels were measured by enzymelinked immunosorbent assay(ELISA);expressions of vascular cell adhesion molecule-1(VCAM-1),intercellular adhesion molecule 1(ICAM-1),von Willebrand factor(vWF),plasminogen activator inhibitor-1(PAI-1)and Bcl-2,Bax,and caspase-3 proteins were determined by Western blot.Results:The serum level of TNF-αin the SFI group was significantly lower than in the other groups at 0,1,and 2 h after HS,while the level of IL-6 was lower at 4 and 6 h compared with the saline group(P<0.01 or P<0.05).The concentration of serum IL-10 was significantly higher in the SFI group than in the other groups at 0,1,4,and 6 h after HS(P<0.01).Western blot and immunohistochemistry of vascular tissue showed that the expression of caspase-3 was downregulated,and that of Bcl-2 and Bax was upregulated in the SFI group compared to other groups(P<0.05).Conclusion:SFI attenuated endothelial injury in the porcine model of HS by inhibiting cell apoptosis,suppressing the formation of proinflammatory cytokines,and reducing endothelial activation.展开更多
The vascular reactivity and calcium sensitivity were decreased following hemorrhagic shock.Arginine vasopressin(AVP)was beneficial to endotoxic,infec-tious/septic and hemorrhagic shock.Our previous studies found that ...The vascular reactivity and calcium sensitivity were decreased following hemorrhagic shock.Arginine vasopressin(AVP)was beneficial to endotoxic,infec-tious/septic and hemorrhagic shock.Our previous studies found that Rho kinase played an important role in the occurrence of calcium desensitization following shock.It was reported that AVP was with stimulation effect of Rho kinase.So we hypothesized that AVP might have bene-ficial effect on shock via activation of Rho kinase to regu-late the calcium sensitivity and vascular reactivity.Hemorrhagic shock(40 mmHg for 2 h)Wistar rats in vivo were adopted to observe the effects of small dose of AVP on hemodynamics,24-h survival rate,the pressor effect of norepinephrine(NE)and the contractility of superior mesenteric artery(SMA).Isolated SMAs from hemorrha-gic shock rats were adopted to observe the effects of AVP on vascular reactivity and calcium sensitivity and its rela-tionship to Rho kinase with an isolated organ perfusion system.The results show that AVP at the concentration of 0.1 U/kg and 0.4 U/kg significantly improved the hemo-dynamic parameters and the 24-h survival rate of hemor-rhagic shock rats.Meanwhile,these dosages of AVP significantly increased the pressor effect of NE and the contractile response of SMA to NE.Y-27632(3 mg/kg),a Rho kinase specific inhibitor,abolished the beneficial effects of AVP.In vitro,the calcium sensitivity and vas-cular reactivity of SMA to calcium and NE were signifi-cantly decreased following hemorrhagic shock.AVP at the concentration of 0.5 nmol/L and 5 nmol/L signifi-cantly increased the calcium sensitivity and vascular react-ivity.These effects of AVP were abolished by Y-27632(10 mmol/L).Taken together,the results suggest that AVP at 0.1 U/kg and 0.4 U/kg is beneficial to hemorrha-gic shock by improving the vascular reactivity,which involves activation of Rho kinase.展开更多
Haemorrhagic shock (HS) is a subset of hypovolaemic shock in which there is minimal to massive loss of blood either internally or externally in trauma or injured patients. Data from the World Health Organization (WHO)...Haemorrhagic shock (HS) is a subset of hypovolaemic shock in which there is minimal to massive loss of blood either internally or externally in trauma or injured patients. Data from the World Health Organization (WHO) affirm that injuries account for over 5 million fatalities globally every year, and by 2030, injury mortality is predicted to rise severely. Public health research typically uses the KAP models, which may be divided into three parts: acquiring accurate knowledge, forming an attitude, and adopting behavior, to analyze people’s health behaviors and explain changes in them. This review is about the nurses’ perspectives of the concept of Knowledge, Attitude, and Practice (KAP) Model of hemorrhagic shock in trauma patients and assesses clinical practice tools used by nurses to keep an eye on patients who have the condition. Nurses’ knowledge of indications of shock is either high or very high. The knowledge of nurses was related to their training before working in accident and emergency units. The nurses’ attitude is considered significant, commendable, appropriate, and pertinent to the provision of care for a patient experiencing hemorrhagic shock. And the nurse’s practice of early patient identification, prompt and continuous monitoring, control of the bleeding source, maintenance of hemostasis, and the correction of significant blood loss that can occur quickly to cause death, are the strengths of management. .展开更多
Hydatid disease or echinococcosis is a zoonotic parasitic disease. The lungs are the second most commonly affected organ after the liver. Intrathoracic and extrapulmonary hydatid disease can affect the pleura, mediast...Hydatid disease or echinococcosis is a zoonotic parasitic disease. The lungs are the second most commonly affected organ after the liver. Intrathoracic and extrapulmonary hydatid disease can affect the pleura, mediastinum, heart, diaphragm, and chest wall. The unusual location or complications of thoracic hydatid disease can present both a diagnostic problem and a therapeutic and surgical problem. We present results of a case of multilocular thoracic hydatid disease complicated by aortic wall erosion and cystic fistula in a 23-year-old patient who developed acute respiratory distress syndrome (ARDS) on the 4<sup>th</sup> day after emergency pneumonectomy. The surgery was carried out under the conditions of the auxiliary artificial circulation. This case represented a serious clinical situation with the highest risk to life. The need for immediate respiratory support was due to the development of severe respiratory failure, and the presence of direct and indirect harmful factors of ARDS. The correct choice of modes and techniques of mechanical ventilation resulted in significant and sustained improvement in gas exchange parameters without hemodynamic disorders with a further favorable outcome.展开更多
BACKGROUND Splenic artery aneurysm(SAA)and pseudoaneurysm are rare vessel’s lesions.Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma.True SAA is the most common aneurysm of visceral vessels...BACKGROUND Splenic artery aneurysm(SAA)and pseudoaneurysm are rare vessel’s lesions.Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma.True SAA is the most common aneurysm of visceral vessels.In contrast to pseudoaneurysm,SAA is usually asymptomatic until the rupture,with high mortality rate.The clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability,usually into the free peritoneal space and more rarely into the gastrointestinal tract.CASE SUMMARY We describe the case of a 35-year-old male patient,with negative past medical history,who presented to the emergency department for massive upper gastrointestinal bleeding,severe anemia and hypotension.An esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface,with a visible vessel,but no active bleeding.Endoscopic injection therapy with cyanoacrylate glue was performed.Urgent contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect:The radiological examination showed a giant SAA which was adherent to posterior stomach wall,and some smaller aneurysms of the left gastric and ileocolic artery.Because of the high risk of a two-stage rupture of the giant SAA with dramatic outcome,the patient underwent immediate open surgery with aneurysmectomy,splenectomy and distal pancreatectomy with a good postoperative outcome.CONCLUSION The management of a ruptured giant SAA into the stomach can be successful with surgical approach.展开更多
Background: The successful treatment of military combat casualties with penetrating injuries is significantly dependent on the time needed to get the patient to an adequate treatment facility. Profound hypothermia ind...Background: The successful treatment of military combat casualties with penetrating injuries is significantly dependent on the time needed to get the patient to an adequate treatment facility. Profound hypothermia induced suspended animation for delayed resuscitation(SADR) is a novel approach for inducing cardiac arrest and buying additional time for such injuries. However, the time used to safely administer circulatory arrest(CA) is controversial. The goal of this study was to evaluate the safety of hypothermia-induced SADR over 90 and 120 min time intervals.Methods: Sixteen male BAMA minipigs were randomized into two groups: CA90 group(90 min, n =8) and CA120 group(120 min, n =8). Cannulation of the right common carotid arteries and internal jugular veins was performed to establish cardiopulmonary bypass for each animal. Through the perfusion of cold organ preservation solution(OPS), cardioplegia and profound hypothermia(15℃) were induced. After CA, cardiopumonary bypass(CPB) was restarted, and the animals were gradually re-warmed and resuscitated. The animals were assisted with ventilators until spontaneous breathing was achieved. The index of hemodynamic perioperative serum chemistry values [alanine transaminase(ALT), aspartate aminotransferase(AST), creatinine(CR), lactic dehydrogenase(LDH) and troponin T(TnT)] and survival were observed from pre-operation to 7 days post-operation.Results: Fifteen animals were enrolled in the experiment, while 1 animal in CA120 group died from surgical error. All 8 animals in CA90 group recovered, with only 1 animal displaying mild disability. However, in CA120 group, only 2 animals survived with severe disability, and the other 5 animals died after 2 days post-operation. In CA90 group, the perioperative serum chemistry values increased at 1 day post-operation(ALT 84.43±18.65 U/L; AST 88.99±23.19 U/L; Cr 87.90±24.49μmol/L; LDH 1894.13±322.26 U/L; TnT 0.849±0.135 ng/ml) but decreased to normal or almost normal levels at 7 days post-operation(ALT 52.48±9.04 U/L; AST 75.23±21.46 U/L; Cr 82.69±18.41μmol/L; LDH 944.67±834.32 U/L; TnT 0.336±0.076 ng/ml).Conclusion: Profound hypothermia-induced SADR is an effective method for inducing cardiac arrest. Our results indicate that inducing CA for 90 min(at 15℃) is safer than doing so for 120 min. Our results indicate that 120 min of CA at 15℃ is dangerous and can result in high mortality and severe neurological complications. Further experimentation is needed to determine whether 120 min of CA at temperatures lower than 15℃ can lead to safe recovery.展开更多
BACKGROUND:S100B protein in patients with cardiac arrest,hemorrhagic shock and other causes of global cerebral ischemic injury will be dramatically increased.Ischemic brain injury may elevate the level of serum S100 B...BACKGROUND:S100B protein in patients with cardiac arrest,hemorrhagic shock and other causes of global cerebral ischemic injury will be dramatically increased.Ischemic brain injury may elevate the level of serum S100 B protein and the severity of brain damage.METHODS:This article is a critical and descriptive review on S100 B protein in serum after ischemic brain injury.We searched Pubmed database with key words or terms such as "S100B protein", "cardiac arrest", "hemorrhagic shock" and "ischemia reperfusion injury" appeared in the last five years.RESULTS:S100B protein in patients with cardiac arrest,hemorrhagic shock and other causes of ischemic brain injury will be dramatically increased.Ischemic brain injury elevated the level of serum S100 B protein,and the severity of brain damage.CONCLUSION:The level of S100 B protein in serum is elevated after ischemic brain injury,but its mechanism is unclear.展开更多
BACKGROUND: Although coagulopathy can be very common in severe traumatic shock patients, the exact incidence and mechanism remain unclear. In this study, a traumatic shock rabbit model with special abdomen injuries wa...BACKGROUND: Although coagulopathy can be very common in severe traumatic shock patients, the exact incidence and mechanism remain unclear. In this study, a traumatic shock rabbit model with special abdomen injuries was developed and evaluated by examining indicators of clotting and fi brinolysis.METHODS: Forty New Zealand white rabbits were randomly divided into four groups: group 1(sham), group 2(hemorrhage), group 3(hemorrhage-liver injury), and group 4(hemorrhage-liver injury/intestinal injury-peritonitis). Coagulation was detected by thromboelastography before trauma(T0), at 1 hour(T1) and 4 hours(T2) after trauma.RESULTS: Rabbits that suffered from hemorrhage alone did not differ in coagulation capacity compared with the sham group. The clot initiations(R times) of group 3 at T1 and T2 were both shorter than those of groups 1, 2, and 4(P<0.05). In group 4, clot strength was decreased at T1 and T2 compared with those in groups 1, 2, and 3(P<0.05), whereas the R time and clot polymerization were increased at T2(P<0.05). The clotting angle signifi cantly decreased in group 4 compared with groups 2 and 3 at T2(P<0.05).CONCLUSION: This study suggests that different abdominal traumatic shock show diverse coagulopathy in the early phase. Isolated hemorrhagic shock shows no obvious effect on coagulation. In contrast, blunt hepatic injury with hemorrhage shows hypercoagulability, whereas blunt hepatic injury with hemorrhage coupled with peritonitis caused by a ruptured intestine shows a tendency toward hypocoagulability.展开更多
BACKGROUND Regular abdominal massage can be used to treat digestive symptoms such as bloating and constipation and is reported to reduce abdominal discomfort,improve digestive function,and increase the quality of life...BACKGROUND Regular abdominal massage can be used to treat digestive symptoms such as bloating and constipation and is reported to reduce abdominal discomfort,improve digestive function,and increase the quality of life,without serious adverse effects.Isolated pancreatic injury is rare,and most often occurs during severe trauma such as steering wheel impact injury.To our knowledge,pancreatic injury caused by massage has not yet been reported in the literature.CASE SUMMARY A 57-year-old woman was referred to our hospital for acute abdominal pain and transient syncope.On examination,she had low hemoglobin concentration and a high white blood cell count and neutrophil percentage.Plain computed tomography of the abdomen revealed a substantial hemorrhage in the abdominal cavity.A large amount of exudate in the pancreatic area was considered a hematoma.Preoperative diagnosis was difficult.Her hemoglobin and blood pressure did not rise even after blood.We suspected progressive bleeding in the abdominal cavity and urgently performed exploratory laparotomy.During the operation,the pancreas was confirmed to be ruptured;hence,spleen-preserving pancreatic body and tail resection were performed.A pancreatic fistula was found on the 15th d after the operation,and the patient was discharged with a drainage tube on the 24th d after active treatment.Subsequently,it was discovered that the patient had undergone a vigorous abdominal massage the day before the abdominal pain began.To our knowledge,this is the first report of isolated pancreatic injury and massive abdominal hemorrhage caused by abdominal massage.CONCLUSION Our findings indicate that any action that increases intra-abdominal pressure may cause internal organ damage.We also review similar cases reported in the literature.展开更多
Objective:To summarize the first aid and nursing of the operating room due to serious complications caused by postpartum massive bleeding.Methods:One case of emergency hemorrhage was ineffective in emergency hysterect...Objective:To summarize the first aid and nursing of the operating room due to serious complications caused by postpartum massive bleeding.Methods:One case of emergency hemorrhage was ineffective in emergency hysterectomy.Results:The uterus was successfully removed and the bleeding was successfully stopped.It was transferred to the ICU under general anesthesia.Conclusion:For pregnant women with postpartum massive bleeding and hemorrhagic shock and diffuse intravascular coagulation(DIC),targeted surgical treatment and complete operating room emergency care are of great significance to save maternal lives.展开更多
Summarize the surgical cooperation of a massive retroperitoneal tumor. The main surgical cooperation points include: clos e observation of the patient's vital signs and condition changes, strengthen ing the preven...Summarize the surgical cooperation of a massive retroperitoneal tumor. The main surgical cooperation points include: clos e observation of the patient's vital signs and condition changes, strengthen ing the prevention of potential complications, mak ing full preoperative preparation, master ing the coordination points of hand washing, itinerant nurses, and effective massive bleeding treatment plan, etc. Through perfect surgical cooperation and nursing, the patient's condition was stable and discharged smoothly.展开更多
Objective: To investigate the effects of CO2 pneumo-peritoneum on blood flow volume of abdominal organs of rabbits with controlled hemorrhagic shock model and liver impact injuries.Methods: After controlled hemorrhagi...Objective: To investigate the effects of CO2 pneumo-peritoneum on blood flow volume of abdominal organs of rabbits with controlled hemorrhagic shock model and liver impact injuries.Methods: After controlled hemorrhagic shock and liver impact injuries, the rabbit model was established. Eighteen rabbits subjected to hemorrhagic shock and liver impact inju-ries were divided into 3 groups randomly according to the volume of lost blood: light hemorrhagic shock (blood loss volume was 10%, 6 ml/kg), moderate hemorrhagic shock (20%, 12 ml/kg) and severe hemorrhagic shock (40%, 22 ml/kg). Intraabdominal pressures of CO2 pneumoperitoneum was 10 mmHg. Color-labeled microspheres were used to mea-sure the blood flow volume of the liver, kidney and stomach before pneumoperitoneum at 30 minutes and 2 hours after pneumoperitoneum and 30 minutes after deflation. And the mortality and hepatic traumatic condition of rabbits were recorded.Results: Of the 18 rabbits, there were 9 with liver impact injuries at Grade Ⅰ, 8 at Grade Ⅱ and Ⅰ at Grade Ⅲ (according to AIS-2005). The mortality rate in light hemorrhagic shock group was 33.33%, and that in moderate or severe hemor-rhagic shock group was 100% within 30 minutes and 2 hours after pneumoperitoneum, respectively. The blood flow vol-ume in the organs detected decreased at 30 minutes under pneumoperitoneum in light and moderate hemorrhagic shock groups. At the same time, the blood flow volume of the liver in moderate hemorrhagic shock group decreased more sig-nificantly than that in light hemorrhagic shock group.Conclusions: The blood flow volume of abdominal organs in rabbits is decreased obviously under CO2 pneumoperitoneum, with fairly high mortality rate. It is be-lieved that CO2 pneumoperitoneum should cautiously be used in abdominal injury accompanied with hemorrhagic shock, especially under non-resuscitation conditions.展开更多
The therapeutic strategies of hemorrhagic shock mainly include bleeding control and fluid resuscitation. However, current resuscitation fluids may further aggravate the inflammation of low intestine and bacterial tran...The therapeutic strategies of hemorrhagic shock mainly include bleeding control and fluid resuscitation. However, current resuscitation fluids may further aggravate the inflammation of low intestine and bacterial translocation that causes organ dysfunction. This review discusses the possible mechanisms about the inflammation of lower intestine and bacterial translocation, and the effect of different fluids resuscitation on the inflammation of low intestine and bacterial translocation. However, it still has not perfectly fluid resuscitation used in hemorrhagic shock nowadays.展开更多
Drag reducing polymers (DRPs) provide large drag reductions in turbulent flow at nanomolar concentrations of linear macropolymers,as polyethylene glycol, aloe vera polymer. DRPs have been shown to significantly enhanc...Drag reducing polymers (DRPs) provide large drag reductions in turbulent flow at nanomolar concentrations of linear macropolymers,as polyethylene glycol, aloe vera polymer. DRPs have been shown to significantly enhance hemodynamics and improve microcirculation, make the red blood cells work harder and increase blood pressure , improve survival in hemorrhagic shock.展开更多
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 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.
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.
基金Natural Science Research Project of Henan Province Education Department(NO.2006310021)
文摘Objective To observe the intestinal mucosal injury and the change of TNF-αcontent in rabbits with hemorrhagic shock/reperfusion(HS-R)and the effects of ganoderma Lcidum polysaccharide(GLP)on them.Methods 30rabbits were made into hemorrhagic shock,then reperfused with different liquids.These rabbits were divided by random number table into three groups:sham operation group(Sham group),reperfusion with normal saline group(NS group),reperfusion with 1%GLP group(LS group).Bacterial translocation of blood and TNF-αcontent in serum were respectively observed at the time before shock,40 min after shock,40 min and 90 min after.TNF-αcontent in intestinal mucosa and the degree of intestinal mucosal injury were examined at 90 min post-resuscitation.Results 1 With the extension of reperfusion time,the positive rate of blood bacteria increased gradually in NS group,which was significantly higher than that of Sham group and LS group(P<0.05),meanwhile the degree of intestinal mucosal injury in NS group was more severe than that of Sham group and LS group too(P<0.05).2TNF-αcontent in serum of NS group and LS group were increased obviously compared with that before shock and in Sham group(P<0.05).TNF-αcontent in serum was further increased after reperfusion with NS,which was distinctly higher than that in LS group.TNF-αcontent in intestinal mucosa of NS group was significantly higher than that in LS group and Sham group too(P<0.05).Conclusion GLP can protect intestinal mucosa against HS-R injury,and its effects may relate with the change of TNF-αin hemorrhagic shock rabbits.
基金This study was supported by Youth Funding of the Affiliated Hospital of Qingdao University.
文摘Background Anesthesia induction is challenging in patients with hemodynamic instability.Esketamine has hypnotic,analgesic,and sympathomimetic effects and is the only anesthetic that can increase sympathetic tension.Therefore,it may be more suitable for patients with hypovolemic shock.Case summary A 40-year-old female patient presented to the emergency department with new-onset abdominal pain and vaginal bleeding for 2 hours.Menstruation of the patient was regular,her self-reported urine pregnancy test was positive half a month earlier,and she had been diagnosed at another hospital 12 days earlier based on a positive blood human chorionic gonadotropin test.Gynecological ultrasonography demonstrated no pregnancy sac in utero,confirming ectopic pregnancy.Emergency laparoscopy for ectopic pregnancy should be performed immediately.We administered esketamine for induction.Conclusion Esketamine-based total intravenous anesthesia results in mild hypotension in ectopic pregnancies with hemorrhagic shock.
基金Supported by the National Natural Science Foundation of China(No.81372025)the 2015 Annual Special Cultivation and Development Project for the Technology Innovation of Beijing(No.Z151100001615056)。
文摘Objective:To investigate the effects of Shenfu Injection(SFI)on endothelial damage in a porcine model of hemorrhagic shock(HS).Methods:After being bled to a mean arterial pressure of40±3 mm Hg and held for 60 min,32 pigs were treated with a venous injection of either shed blood(transfusion group),shed blood and saline(saline group),shed blood and SFI(SEI group)or without resuscitation(sham group).Venous blood samples were collected and analyzed at baseline and 0,1,2,4,and 6 h after HS.Tumor necrosis factor-α(TNF-α),serum interleuking(IL)-6,and IL-10 levels were measured by enzymelinked immunosorbent assay(ELISA);expressions of vascular cell adhesion molecule-1(VCAM-1),intercellular adhesion molecule 1(ICAM-1),von Willebrand factor(vWF),plasminogen activator inhibitor-1(PAI-1)and Bcl-2,Bax,and caspase-3 proteins were determined by Western blot.Results:The serum level of TNF-αin the SFI group was significantly lower than in the other groups at 0,1,and 2 h after HS,while the level of IL-6 was lower at 4 and 6 h compared with the saline group(P<0.01 or P<0.05).The concentration of serum IL-10 was significantly higher in the SFI group than in the other groups at 0,1,4,and 6 h after HS(P<0.01).Western blot and immunohistochemistry of vascular tissue showed that the expression of caspase-3 was downregulated,and that of Bcl-2 and Bax was upregulated in the SFI group compared to other groups(P<0.05).Conclusion:SFI attenuated endothelial injury in the porcine model of HS by inhibiting cell apoptosis,suppressing the formation of proinflammatory cytokines,and reducing endothelial activation.
基金supported by the National Natural Science Foundation of China(Grant Nos.30600228 and 30625037)the National Basic Research Program of China(2005CB522601)the Innovation Group Plan of Ministry of Education(IRT0712).
文摘The vascular reactivity and calcium sensitivity were decreased following hemorrhagic shock.Arginine vasopressin(AVP)was beneficial to endotoxic,infec-tious/septic and hemorrhagic shock.Our previous studies found that Rho kinase played an important role in the occurrence of calcium desensitization following shock.It was reported that AVP was with stimulation effect of Rho kinase.So we hypothesized that AVP might have bene-ficial effect on shock via activation of Rho kinase to regu-late the calcium sensitivity and vascular reactivity.Hemorrhagic shock(40 mmHg for 2 h)Wistar rats in vivo were adopted to observe the effects of small dose of AVP on hemodynamics,24-h survival rate,the pressor effect of norepinephrine(NE)and the contractility of superior mesenteric artery(SMA).Isolated SMAs from hemorrha-gic shock rats were adopted to observe the effects of AVP on vascular reactivity and calcium sensitivity and its rela-tionship to Rho kinase with an isolated organ perfusion system.The results show that AVP at the concentration of 0.1 U/kg and 0.4 U/kg significantly improved the hemo-dynamic parameters and the 24-h survival rate of hemor-rhagic shock rats.Meanwhile,these dosages of AVP significantly increased the pressor effect of NE and the contractile response of SMA to NE.Y-27632(3 mg/kg),a Rho kinase specific inhibitor,abolished the beneficial effects of AVP.In vitro,the calcium sensitivity and vas-cular reactivity of SMA to calcium and NE were signifi-cantly decreased following hemorrhagic shock.AVP at the concentration of 0.5 nmol/L and 5 nmol/L signifi-cantly increased the calcium sensitivity and vascular react-ivity.These effects of AVP were abolished by Y-27632(10 mmol/L).Taken together,the results suggest that AVP at 0.1 U/kg and 0.4 U/kg is beneficial to hemorrha-gic shock by improving the vascular reactivity,which involves activation of Rho kinase.
文摘Haemorrhagic shock (HS) is a subset of hypovolaemic shock in which there is minimal to massive loss of blood either internally or externally in trauma or injured patients. Data from the World Health Organization (WHO) affirm that injuries account for over 5 million fatalities globally every year, and by 2030, injury mortality is predicted to rise severely. Public health research typically uses the KAP models, which may be divided into three parts: acquiring accurate knowledge, forming an attitude, and adopting behavior, to analyze people’s health behaviors and explain changes in them. This review is about the nurses’ perspectives of the concept of Knowledge, Attitude, and Practice (KAP) Model of hemorrhagic shock in trauma patients and assesses clinical practice tools used by nurses to keep an eye on patients who have the condition. Nurses’ knowledge of indications of shock is either high or very high. The knowledge of nurses was related to their training before working in accident and emergency units. The nurses’ attitude is considered significant, commendable, appropriate, and pertinent to the provision of care for a patient experiencing hemorrhagic shock. And the nurse’s practice of early patient identification, prompt and continuous monitoring, control of the bleeding source, maintenance of hemostasis, and the correction of significant blood loss that can occur quickly to cause death, are the strengths of management. .
文摘Hydatid disease or echinococcosis is a zoonotic parasitic disease. The lungs are the second most commonly affected organ after the liver. Intrathoracic and extrapulmonary hydatid disease can affect the pleura, mediastinum, heart, diaphragm, and chest wall. The unusual location or complications of thoracic hydatid disease can present both a diagnostic problem and a therapeutic and surgical problem. We present results of a case of multilocular thoracic hydatid disease complicated by aortic wall erosion and cystic fistula in a 23-year-old patient who developed acute respiratory distress syndrome (ARDS) on the 4<sup>th</sup> day after emergency pneumonectomy. The surgery was carried out under the conditions of the auxiliary artificial circulation. This case represented a serious clinical situation with the highest risk to life. The need for immediate respiratory support was due to the development of severe respiratory failure, and the presence of direct and indirect harmful factors of ARDS. The correct choice of modes and techniques of mechanical ventilation resulted in significant and sustained improvement in gas exchange parameters without hemodynamic disorders with a further favorable outcome.
文摘BACKGROUND Splenic artery aneurysm(SAA)and pseudoaneurysm are rare vessel’s lesions.Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma.True SAA is the most common aneurysm of visceral vessels.In contrast to pseudoaneurysm,SAA is usually asymptomatic until the rupture,with high mortality rate.The clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability,usually into the free peritoneal space and more rarely into the gastrointestinal tract.CASE SUMMARY We describe the case of a 35-year-old male patient,with negative past medical history,who presented to the emergency department for massive upper gastrointestinal bleeding,severe anemia and hypotension.An esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface,with a visible vessel,but no active bleeding.Endoscopic injection therapy with cyanoacrylate glue was performed.Urgent contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect:The radiological examination showed a giant SAA which was adherent to posterior stomach wall,and some smaller aneurysms of the left gastric and ileocolic artery.Because of the high risk of a two-stage rupture of the giant SAA with dramatic outcome,the patient underwent immediate open surgery with aneurysmectomy,splenectomy and distal pancreatectomy with a good postoperative outcome.CONCLUSION The management of a ruptured giant SAA into the stomach can be successful with surgical approach.
基金supported by the Major Project for Equipment Development of PLA in 2013(ASY135001)the National High Technology Research and Development Program of China(2015AA020312)
文摘Background: The successful treatment of military combat casualties with penetrating injuries is significantly dependent on the time needed to get the patient to an adequate treatment facility. Profound hypothermia induced suspended animation for delayed resuscitation(SADR) is a novel approach for inducing cardiac arrest and buying additional time for such injuries. However, the time used to safely administer circulatory arrest(CA) is controversial. The goal of this study was to evaluate the safety of hypothermia-induced SADR over 90 and 120 min time intervals.Methods: Sixteen male BAMA minipigs were randomized into two groups: CA90 group(90 min, n =8) and CA120 group(120 min, n =8). Cannulation of the right common carotid arteries and internal jugular veins was performed to establish cardiopulmonary bypass for each animal. Through the perfusion of cold organ preservation solution(OPS), cardioplegia and profound hypothermia(15℃) were induced. After CA, cardiopumonary bypass(CPB) was restarted, and the animals were gradually re-warmed and resuscitated. The animals were assisted with ventilators until spontaneous breathing was achieved. The index of hemodynamic perioperative serum chemistry values [alanine transaminase(ALT), aspartate aminotransferase(AST), creatinine(CR), lactic dehydrogenase(LDH) and troponin T(TnT)] and survival were observed from pre-operation to 7 days post-operation.Results: Fifteen animals were enrolled in the experiment, while 1 animal in CA120 group died from surgical error. All 8 animals in CA90 group recovered, with only 1 animal displaying mild disability. However, in CA120 group, only 2 animals survived with severe disability, and the other 5 animals died after 2 days post-operation. In CA90 group, the perioperative serum chemistry values increased at 1 day post-operation(ALT 84.43±18.65 U/L; AST 88.99±23.19 U/L; Cr 87.90±24.49μmol/L; LDH 1894.13±322.26 U/L; TnT 0.849±0.135 ng/ml) but decreased to normal or almost normal levels at 7 days post-operation(ALT 52.48±9.04 U/L; AST 75.23±21.46 U/L; Cr 82.69±18.41μmol/L; LDH 944.67±834.32 U/L; TnT 0.336±0.076 ng/ml).Conclusion: Profound hypothermia-induced SADR is an effective method for inducing cardiac arrest. Our results indicate that inducing CA for 90 min(at 15℃) is safer than doing so for 120 min. Our results indicate that 120 min of CA at 15℃ is dangerous and can result in high mortality and severe neurological complications. Further experimentation is needed to determine whether 120 min of CA at temperatures lower than 15℃ can lead to safe recovery.
基金supported by a grant from 122 Project of Nanjing Military Command focusing on training(JQZD200905)
文摘BACKGROUND:S100B protein in patients with cardiac arrest,hemorrhagic shock and other causes of global cerebral ischemic injury will be dramatically increased.Ischemic brain injury may elevate the level of serum S100 B protein and the severity of brain damage.METHODS:This article is a critical and descriptive review on S100 B protein in serum after ischemic brain injury.We searched Pubmed database with key words or terms such as "S100B protein", "cardiac arrest", "hemorrhagic shock" and "ischemia reperfusion injury" appeared in the last five years.RESULTS:S100B protein in patients with cardiac arrest,hemorrhagic shock and other causes of ischemic brain injury will be dramatically increased.Ischemic brain injury elevated the level of serum S100 B protein,and the severity of brain damage.CONCLUSION:The level of S100 B protein in serum is elevated after ischemic brain injury,but its mechanism is unclear.
基金funded by Guangxi Natural Science Foundation(N o.2015GXNSFAA139195)Guang xi Emergency Medicine and Medical Rescue Talent Upland Foundation(No.GXJZ201403)
文摘BACKGROUND: Although coagulopathy can be very common in severe traumatic shock patients, the exact incidence and mechanism remain unclear. In this study, a traumatic shock rabbit model with special abdomen injuries was developed and evaluated by examining indicators of clotting and fi brinolysis.METHODS: Forty New Zealand white rabbits were randomly divided into four groups: group 1(sham), group 2(hemorrhage), group 3(hemorrhage-liver injury), and group 4(hemorrhage-liver injury/intestinal injury-peritonitis). Coagulation was detected by thromboelastography before trauma(T0), at 1 hour(T1) and 4 hours(T2) after trauma.RESULTS: Rabbits that suffered from hemorrhage alone did not differ in coagulation capacity compared with the sham group. The clot initiations(R times) of group 3 at T1 and T2 were both shorter than those of groups 1, 2, and 4(P<0.05). In group 4, clot strength was decreased at T1 and T2 compared with those in groups 1, 2, and 3(P<0.05), whereas the R time and clot polymerization were increased at T2(P<0.05). The clotting angle signifi cantly decreased in group 4 compared with groups 2 and 3 at T2(P<0.05).CONCLUSION: This study suggests that different abdominal traumatic shock show diverse coagulopathy in the early phase. Isolated hemorrhagic shock shows no obvious effect on coagulation. In contrast, blunt hepatic injury with hemorrhage shows hypercoagulability, whereas blunt hepatic injury with hemorrhage coupled with peritonitis caused by a ruptured intestine shows a tendency toward hypocoagulability.
文摘BACKGROUND Regular abdominal massage can be used to treat digestive symptoms such as bloating and constipation and is reported to reduce abdominal discomfort,improve digestive function,and increase the quality of life,without serious adverse effects.Isolated pancreatic injury is rare,and most often occurs during severe trauma such as steering wheel impact injury.To our knowledge,pancreatic injury caused by massage has not yet been reported in the literature.CASE SUMMARY A 57-year-old woman was referred to our hospital for acute abdominal pain and transient syncope.On examination,she had low hemoglobin concentration and a high white blood cell count and neutrophil percentage.Plain computed tomography of the abdomen revealed a substantial hemorrhage in the abdominal cavity.A large amount of exudate in the pancreatic area was considered a hematoma.Preoperative diagnosis was difficult.Her hemoglobin and blood pressure did not rise even after blood.We suspected progressive bleeding in the abdominal cavity and urgently performed exploratory laparotomy.During the operation,the pancreas was confirmed to be ruptured;hence,spleen-preserving pancreatic body and tail resection were performed.A pancreatic fistula was found on the 15th d after the operation,and the patient was discharged with a drainage tube on the 24th d after active treatment.Subsequently,it was discovered that the patient had undergone a vigorous abdominal massage the day before the abdominal pain began.To our knowledge,this is the first report of isolated pancreatic injury and massive abdominal hemorrhage caused by abdominal massage.CONCLUSION Our findings indicate that any action that increases intra-abdominal pressure may cause internal organ damage.We also review similar cases reported in the literature.
文摘Objective:To summarize the first aid and nursing of the operating room due to serious complications caused by postpartum massive bleeding.Methods:One case of emergency hemorrhage was ineffective in emergency hysterectomy.Results:The uterus was successfully removed and the bleeding was successfully stopped.It was transferred to the ICU under general anesthesia.Conclusion:For pregnant women with postpartum massive bleeding and hemorrhagic shock and diffuse intravascular coagulation(DIC),targeted surgical treatment and complete operating room emergency care are of great significance to save maternal lives.
文摘Summarize the surgical cooperation of a massive retroperitoneal tumor. The main surgical cooperation points include: clos e observation of the patient's vital signs and condition changes, strengthen ing the prevention of potential complications, mak ing full preoperative preparation, master ing the coordination points of hand washing, itinerant nurses, and effective massive bleeding treatment plan, etc. Through perfect surgical cooperation and nursing, the patient's condition was stable and discharged smoothly.
文摘Objective: To investigate the effects of CO2 pneumo-peritoneum on blood flow volume of abdominal organs of rabbits with controlled hemorrhagic shock model and liver impact injuries.Methods: After controlled hemorrhagic shock and liver impact injuries, the rabbit model was established. Eighteen rabbits subjected to hemorrhagic shock and liver impact inju-ries were divided into 3 groups randomly according to the volume of lost blood: light hemorrhagic shock (blood loss volume was 10%, 6 ml/kg), moderate hemorrhagic shock (20%, 12 ml/kg) and severe hemorrhagic shock (40%, 22 ml/kg). Intraabdominal pressures of CO2 pneumoperitoneum was 10 mmHg. Color-labeled microspheres were used to mea-sure the blood flow volume of the liver, kidney and stomach before pneumoperitoneum at 30 minutes and 2 hours after pneumoperitoneum and 30 minutes after deflation. And the mortality and hepatic traumatic condition of rabbits were recorded.Results: Of the 18 rabbits, there were 9 with liver impact injuries at Grade Ⅰ, 8 at Grade Ⅱ and Ⅰ at Grade Ⅲ (according to AIS-2005). The mortality rate in light hemorrhagic shock group was 33.33%, and that in moderate or severe hemor-rhagic shock group was 100% within 30 minutes and 2 hours after pneumoperitoneum, respectively. The blood flow vol-ume in the organs detected decreased at 30 minutes under pneumoperitoneum in light and moderate hemorrhagic shock groups. At the same time, the blood flow volume of the liver in moderate hemorrhagic shock group decreased more sig-nificantly than that in light hemorrhagic shock group.Conclusions: The blood flow volume of abdominal organs in rabbits is decreased obviously under CO2 pneumoperitoneum, with fairly high mortality rate. It is be-lieved that CO2 pneumoperitoneum should cautiously be used in abdominal injury accompanied with hemorrhagic shock, especially under non-resuscitation conditions.
文摘The therapeutic strategies of hemorrhagic shock mainly include bleeding control and fluid resuscitation. However, current resuscitation fluids may further aggravate the inflammation of low intestine and bacterial translocation that causes organ dysfunction. This review discusses the possible mechanisms about the inflammation of lower intestine and bacterial translocation, and the effect of different fluids resuscitation on the inflammation of low intestine and bacterial translocation. However, it still has not perfectly fluid resuscitation used in hemorrhagic shock nowadays.
文摘Drag reducing polymers (DRPs) provide large drag reductions in turbulent flow at nanomolar concentrations of linear macropolymers,as polyethylene glycol, aloe vera polymer. DRPs have been shown to significantly enhance hemodynamics and improve microcirculation, make the red blood cells work harder and increase blood pressure , improve survival in hemorrhagic shock.
