Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Intensive Care Unit, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.
J Surg Res. 2014 Apr;187(2):587-95. doi: 10.1016/j.jss.2013.10.061. Epub 2013 Nov 7.
Large-volume, rapid crystalloid infusion may increase endothelial cell damage and induce shear stress, potentially leading to multiple-organ dysfunction syndrome. Limited guideline data for fluid administration are currently available, especially for the aging population. The aim of the present study was to compare the degree of organ damage in conscious aging rats when different resuscitation speeds were used during the treatment of hemorrhagic shock (HS).
Eighteen aging male Wistar-Kyoto rats were randomly divided into the following three groups: the control group, 30-min rapid resuscitation group, and 12-h slow resuscitation group. To mimic HS, 40% of the total blood volume was withdrawn. Fluid resuscitation (1:3) was given at 30 min after the blood withdrawal. Blood biochemical parameters including glucose, lactic acid, and lactate dehydrogenase (LDH) were measured along with the levels of serum and bronchoalveolar lavage fluid, tumor necrosis factor alpha (TNF-α), and interleukin 10 by enzyme-linked immunosorbent assay. The lungs were examined for pathologic changes, and the injury score at 24 h after HS was calculated.
Compared with slow-rate resuscitation, initially rapid and immediate resuscitation significantly increased the serum levels of glucose, LDH, and proinflammatory cytokines (TNF-α and interleukin 10), and bronchoalveolar lavage fluid levels of white blood cells, TNF-α, and LDH as well as produced pathologic changes in the organ. The lung injury scores were higher after induced HS in aging rats.
The slow and continuous (12 h) fluid resuscitation rate ameliorated HS-induced organ damage in conscious aging rats.
大量快速输注晶体液可能会增加内皮细胞损伤并诱导切应力，从而可能导致多器官功能障碍综合征。目前，关于输液管理的指南数据有限，特别是针对老年人群。本研究旨在比较不同复苏速度在治疗失血性休克（HS）期间对清醒老年大鼠器官损伤程度的影响。
将 18 只雄性 Wistar-Kyoto 老年大鼠随机分为以下三组：对照组、30 分钟快速复苏组和 12 小时缓慢复苏组。通过抽取 40%的总血容量来模拟 HS。在抽血后 30 分钟进行液体复苏（1:3）。通过酶联免疫吸附试验测量血糖、乳酸和乳酸脱氢酶（LDH）等血液生化参数，以及血清和支气管肺泡灌洗液中肿瘤坏死因子-α（TNF-α）和白细胞介素 10 的水平。检查肺部的病理变化，并计算 HS 后 24 小时的损伤评分。
与缓慢复苏相比，最初快速且即时的复苏显著增加了血清中葡萄糖、LDH 和促炎细胞因子（TNF-α和白细胞介素 10）的水平，以及支气管肺泡灌洗液中白细胞、TNF-α和 LDH 的水平，并导致器官发生病理变化。在诱导 HS 后，老年大鼠的肺损伤评分更高。
缓慢而持续（12 小时）的液体复苏速度可改善清醒老年大鼠 HS 诱导的器官损伤。
