Effects of different fluid restriction resuscitation on inflammatory factor and arteriovenous blood gas in patients with hemorrhage shock
Wang Ruyi1, Yang Yue2, Du Zhaohui1, Ji Zhong1, Qiu Zhaolei1, Wang Zhenjie1
1Department of Emergency Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China; 2Department of Emergency Operating Room, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
Abstract:Objective To investigate the effects of different fluids on resuscitation of peripheral blood inflammatory factors and arteriovenous blood gas in patients with traumatic hemorrhagic shock, and to provide a basis for screening relatively ideal resuscitation fluids.Methods A prospective controlled studie. Forty patients with hemorrhagic shock admitted to the emergency department of the First Affiliated Hospital of Bengbu Medical College between January 2016 and January 2019 were included in this study. Simple random grouping was used to divide all patients into observation group and control group, 20 cases in each group. The observation group was treated with acetated Ringer's solution and the control group was treated with lactated Ringer's solution. Restrictive fluid resuscitation was used in both groups. Peripheral vein, arterial, and central venous blood samples were taken before starting resuscitation, 30 minutes after resuscitation and 1 hour after resuscitation. Serum levels of interleukin(IL)-4, IL-6, interferon-γ(IFN-γ), tumor necrosis factor-α(TNF-α), arterial blood lactate, arterial oxygen saturation, central venous oxygen saturation, arterial partial pressure of oxygen, and venous partial pressure of oxygen were measured. The inflammatory factors of peripheral blood and arteriovenous blood gas were compared between the two groups to observe the resuscitation effect of the two fluids.Results There was no statistically significant difference in the general condition between the two groups (all P values>0.05). There were no statistically significant differences in the expression levels of inflammatory factors (IL-4, IL-6, IFN-γ, TNF-α) and arteriovenous blood gas between the two groups before the start of resuscitation (all P values>0.05). After 30 minutes and 1 hour of resuscitation, the expression levels of inflammatory factors in peripheral blood of the two groups of shock patient increased. There was no significant difference in the increase of IL-4 and IFN-γ between 30 minutes after resuscitation and 1 hour after resuscitation (all P values>0.05). The other indicators had statistical significance(all P values<0.05). An independent sample t-test was performed on the difference in the magnitude of the increase. Compared with lactated Ringer's solution, acetated Ringer's solution resuscitated hemorrhagic shock patients could reduce the release of inflammatory factors IL-6 and TNF-α and the difference was statistically significant(all P values<0.05). However, there was no significant difference in the changes of IL-4 and IFN-γ(all P values>0.05). The blood lactate value decreased in the observation group, while in the control group increased slightly, and the difference was statistically significant( P<0.05). However, there was no significant difference in arterial oxygen saturation, central venous oxygen saturation, arterial oxygen partial pressure, and venous oxygen partial pressure (all P values>0.05).Conclusions In resuscitates hemorrhagic shock patients,compared with lactated Ringer's solution,acetated Ringer's solution can better inhibit the expression of pro-inflammatory factors TNF-α and IL-6 in peripheral blood, and reduce blood lactate value, which can reduce the body inflammation and correction of acidosis. Acetated Ringer's solution is beneficial to fluid resuscitation in patients with hemorrhagic shock.
王如意,杨月,杜召辉,纪忠,邱兆磊,王振杰. 不同液体限制性复苏对失血性休克患者外周血炎症因子及动静脉血气的影响[J]. 中华解剖与临床杂志, 2019, 24(2): 182-187.
Wang Ruyi, Yang Yue, Du Zhaohui, Ji Zhong, Qiu Zhaolei, Wang Zhenjie. Effects of different fluid restriction resuscitation on inflammatory factor and arteriovenous blood gas in patients with hemorrhage shock. Chinese Journal of Anatomy and Clinics, 2019, 24(2): 182-187.
Owattanapanich N, Chittawatanarat K, Benyakorn T, et al. Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis[J]. Scand J Trauma Resusc Emerg Med, 2018, 26(1): 107. DOI:10.1186/s13049-018-0572-4.
[2]
Arun S, Burawat J, Sukhorum W, et al. Changes of testicular phosphorylated proteins in response to restraint stress in male rats[J].J Zhejiang Univ Sci B, 2016, 17(1): 21-29. DOI:10.1631/jzus.b1500174.
[3]
Huber-Lang M, Gebhard F, Schmidt CQ, et al. Complement therapeutic strategies in trauma, hemorrhagic shock and systemic inflammation-closing Pandora's box?[J]. Semin Immunol, 2016, 28(3): 278-284. DOI:10.1016/j.smim.2016.04.005.
[4]
Duan C, Li T, Liu L. Efficacy of limited fluid resuscitation in patients with hemorrhagic shock: a meta-analysis[J]. Int J Clin Exp Med, 2015, 8(7): 11645-11656.
[5]
Cecconi M, de Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine[J]. Intensive Care Med, 2014, 40(12): 1795-1815. DOI:10.1007/s00134-014-3525-z.
[6]
Kusza K, Mielniczuk M, Krokowicz L, et al. Ringer's lactate solution enhances the inflammatory response during fluid resuscitation of experimentally induced haemorrhagic shock in rats[J]. Arch Med Sci, 2018, 14(3): 655-670. DOI:10.5114/aoms.2017.69771.
[7]
Chang R, Holcomb JB. Optimal fluid therapy for traumatic hemorrhagic shock[J]. Crit Care Clin, 2017, 33(1): 15-36. DOI:10.1016/j.ccc.2016.08.007.
[8]
Fox EE, Holcomb JB, Wade CE, et al. Earlier endpoints are required for hemorrhagic shock trials among severely injured patients[J]. Shock, 2017, 47(5): 567-573. DOI:10.1097/SHK.0000000000000788.
[9]
Lagny MG, Roediger L, Koch JN, et al. Hydroxyethyl starch 130/0.4 and the risk of acute kidney injury after cardiopulmonary bypass: a single-center retrospective study[J]. J Cardiothorac Vasc Anesth, 2016, 30(4): 869-875. DOI:10.1053/j.jvca.2015.10.010.
Huber-Lang M, Lambris JD, Ward PA. Innate immune responses to trauma[J]. Nat Immunol, 2018, 19(4): 327-341. DOI:10.1038/s41590-018-0064-8.
[12]
Lord JM, Midwinter MJ, Chen YF, et al. The systemic immune response to trauma: an overview of pathophysiology and treatment[J]. Lancet, 2014, 384(9952): 1455-1465. DOI:10.1016/S0140-6736(14)60687-5.
[13]
Caserta S, Mengozzi M, Kern F, et al. Severity of systemic inflammatory response syndrome affects the blood levels of circulating inflammatory-relevant MicroRNAs[J]. Front Immunol, 2017, 8: 1977. DOI:10.3389/fimmu.2017.01977.
[14]
Liu D, Yan Z, Minshall RD, et al. Activation of calpains mediates early lung neutrophilic inflammation in ventilator-induced lung injury[J]. Am J Physiol Lung Cell Mol Physiol, 2012, 302(4): L370-L379. DOI:10.1152/ajplung.00349.2011.
[15]
Lin KH, Liu CL, Kuo WW, et al. Early fluid resuscitation by lactated ringer's solution alleviate the cardiac apoptosis in rats with trauma-hemorrhagic shock[J].PLoS One,2016,11(10):e0165406.DOI:10.1371/journal.pone.0165406.
Rohrig R, Wegewitz C, Lendemans S, et al. Superiority of acetate compared with lactate in a rodent model of severe hemorrhagic shock[J]. J Surg Res, 2014, 186(1): 338-345. DOI:10.1016/j.jss.2013.09.005.