Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Hubei 430071, China.
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Exp Biol Med (Maywood). 2020 Apr;245(7):644-653. doi: 10.1177/1535370220909332. Epub 2020 Mar 12.
To investigate the effects of direct peritoneal resuscitation with pyruvate-peritoneal dialysis solution (Pyr-PDS) of different concentrations combined with intravenous resuscitation on acid–base imbalance and intestinal ischemia reperfusion injury in rats with hemorrhagic shock. Sixty rats were randomly assigned to group SHAM, group intravenous resuscitation, and four direct peritoneal resuscitation groups combined with intravenous resuscitation: group NS, LA, PY1, and PY2, that is, normal saline, lactate-PDS (Lac-PDS), lower concentration Pyr-PDS (Pyr-PDS1), and higher concentration Pyr-PDS (Pyr-PDS2), respectively. Two hours after hemorrhagic shock and resuscitation, the pH, oxygen partial pressure, carbon dioxide partial pressure (PCO), base excess, and bicarbonate ion concentration (HCO) of the arterial blood were measured. The intestinal mucosal damage index and intercellular adhesion molecule 1 (ICAM-1), tumor necrosis factor-α, interleukin-6, zonula occludens-1, claudin-1, and occludin levels in intestinal issues were detected. Two hours after resuscitation, group PY2 had higher mean arterial pressure, pH, oxygen partial pressure, and base excess and lower PCO of arterial blood than group PY1 (<0.05). Tumor necrosis factor-α and interleukin-6 levels in group PY2 were significantly lower than those in group PY1 (<0.05). Zonula occludens-1, claudin-1, and occludin expression levels were significantly higher in group PY2 than in group PY1 (<0.05). Direct peritoneal resuscitation with Pyr-PDS2 combined with intravenous resuscitation enhanced the hemodynamics, improved the acid–base balance, and alleviated intestinal ischemia reperfusion injury from hemorrhagic shock and resuscitation in rats. The mechanisms might include correction of acidosis, inhibition of inflammatory response, enhancement of systemic immune status, regulation of intestinal epithelial permeability, and maintenance of intestinal mucosal barrier function.
Hemorrhagic shock is a life-threatening condition after trauma or during surgery. Acid–base imbalance and intestinal ischemia reperfusion injury are two significant causes in the pathogenetic process and multiple organ dysfunction. As a result, it is urgent and necessary to find an effective method of resuscitation in order to reverse the acid–base imbalance and protect organ function. This current study confirmed the protection against hypoxic acidosis and intestinal ischemia reperfusion injury by peritoneal resuscitation with pyruvate combined with intravenous resuscitation in rats with hemorrhagic shock. And the peritoneal dialysis solution with pyruvate of high concentration plays a crucial role in the process. It provided a new idea and possible direction of fluid resuscitation for alleviating organ injuries, protecting organ functions, and improving clinical prognosis after hemorrhagic shock and resuscitation.
研究不同浓度丙酮酸-腹膜透析液（Pyr-PDS）联合静脉复苏对失血性休克大鼠酸碱失衡和肠缺血再灌注损伤的影响。
60 只大鼠随机分为 SHAM 组、静脉复苏组和四组联合静脉复苏的直接腹膜复苏组：NS 组、LA 组、PY1 组和 PY2 组，即生理盐水、乳酸-PDS（Lac-PDS）、低浓度 Pyr-PDS（Pyr-PDS1）和高浓度 Pyr-PDS（Pyr-PDS2）。失血性休克和复苏 2 小时后，检测动脉血 pH 值、氧分压、二氧化碳分压（PCO）、碱剩余和碳酸氢根离子浓度（HCO）。检测肠黏膜损伤指数和细胞间黏附分子 1（ICAM-1）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、肠组织中紧密连接蛋白-1（ZO-1）、闭合蛋白-1（Claudin-1）和封闭蛋白（occludin）的水平。
复苏 2 小时后，PY2 组平均动脉压、pH 值、氧分压和碱剩余高于 PY1 组，PCO 低于 PY1 组（<0.05）。PY2 组 TNF-α和 IL-6 水平明显低于 PY1 组（<0.05）。PY2 组 ZO-1、Claudin-1 和 occludin 的表达水平明显高于 PY1 组（<0.05）。
与静脉复苏联合使用 Pyr-PDS2 的直接腹膜复苏可增强血流动力学，改善酸碱平衡，减轻失血性休克和复苏后大鼠的肠缺血再灌注损伤。其机制可能包括纠正酸中毒、抑制炎症反应、增强全身免疫状态、调节肠上皮通透性和维持肠黏膜屏障功能。
失血性休克是创伤或手术期间危及生命的一种情况。酸碱失衡和肠缺血再灌注损伤是其发病机制和多器官功能障碍的两个重要原因。因此，寻找有效的复苏方法以逆转酸碱失衡和保护器官功能是非常紧迫和必要的。本研究证实了丙酮酸联合静脉复苏对失血性休克大鼠缺氧酸中毒和肠缺血再灌注损伤的保护作用，且高浓度丙酮酸腹膜透析液在这一过程中发挥了关键作用。为减轻失血性休克和复苏后器官损伤、保护器官功能、改善临床预后提供了新的液体复苏思路和可能的方向。
