Saraçoğlu Kemal Tolga, Saraçoğlu Ayten, Yıldırım Mehmet, Demirtaş Cumaali, Akça Metehan, Serdoğan Ferda, Ergün İlyas Samet, Tetik Şermin, Pençe Sadrettin
Department of Anaesthesiology, ICU & Perioperative Medicine, Hazm Mebaireek General Hospital HMC, Doha, Qatar.
Qatar University College of Medicine, Doha, Qatar.
Turk J Anaesthesiol Reanim. 2023 Oct 24;51(5):380-387. doi: 10.4274/TJAR.2023.231262.
The type of fluid that should be used in uncontrollable hemorrhages remains an area of research. This study was designed to compare the effects of resuscitation with Ringer's lactate (RL) solution versus a normal saline (NS) solution on hemodynamics, renal tissue histopathology, coagulation, and apoptosis in a rat model of hemorrhagic shock.
The study employed groups designated as the control, hemorrhage, NS, and RL groups. Heart rate, mean arterial pressure, and respiratory rate were monitored. Annexin A5 values were assayed, rotational thromboelastometry analysis was performed, and excised kidney tissue samples were histopathologically analyzed.
Blood pressure levels were found to be significantly higher in the control group than those measured in the other groups. While the clotting time (CT) and clot formation time (CFT) in the hemorrhage group were significantly longer than those in the control and RL groups, the CT and CFT measured in the control group were significantly shorter compared to the RL group. The mean Annexin A5 level was in the hemorrhage group, which was significantly higher compared to the other groups. In the renal histopathological evaluation, the scores of proximal tubular injury, distal renal tubular injury, and interstitial renal tubular injury were found to be significantly lower in the control group compared to the other groups.
This study demonstrated that NS or RL can be used safely to improve the hemodynamic symptoms resulting from hemorrhagic shock as a means to reduce apoptosis, and to decrease findings in favor of coagulopathy in bedside coagulation tests during the early stages of hemorrhagic shock until the time of starting a blood transfusion.
在不可控出血中应使用何种液体仍是一个研究领域。本研究旨在比较在失血性休克大鼠模型中，用乳酸林格氏液（RL）溶液与生理盐水（NS）溶液进行复苏对血流动力学、肾组织组织病理学、凝血和细胞凋亡的影响。
该研究采用了对照组、出血组、NS组和RL组。监测心率、平均动脉压和呼吸频率。检测膜联蛋白A5值，进行旋转血栓弹力图分析，并对切除的肾组织样本进行组织病理学分析。
发现对照组的血压水平显著高于其他组测量值。出血组的凝血时间（CT）和血栓形成时间（CFT）显著长于对照组和RL组，而对照组测量的CT和CFT与RL组相比显著缩短。出血组的平均膜联蛋白A5水平显著高于其他组。在肾脏组织病理学评估中，发现对照组近端肾小管损伤、远端肾小管损伤和肾小管间质损伤的评分显著低于其他组。
本研究表明，在失血性休克早期直至开始输血时，NS或RL可安全用于改善失血性休克引起的血流动力学症状，作为减少细胞凋亡的手段，并减少床旁凝血试验中有利于凝血病的结果。
