Experimental Studies On The Initial Limited Fluid Resuscitation For Uncontrolled Hemorrhagic Shock In Trauma

Traumatic hemorrhagic shock is one of the main causes leading to death of casualties. Sixty percent patients with serious trauma died from hemorrhagic shock in daily lives as well as in wars. The traditional guideline of treatment for hemorrhagic shock included aggressive, rapid, and large fluid infusion, which meant to restore effective circulation blood volume and maintain the blood pressure at a normal or near normal level. However, this might aggravate bleeding if there is uncontrolled hemorrhagic shock existed, such as splanchnic bleeding. Thus, a new hypothesis of initial limited fluid resuscitation for uncontrolled hemorrhagic shock in trauma is generated recently. A number of studies have been conducted to establish the physiological mechanism and the functional influence on immunization. Few study has focused on the system evaluation for the earlier effects of limited fluid resuscitation as well as its impact on vital organs. The purposes of this study are (1) to investigate the early effects of limited fluid resuscitation for uncontrolled hemorrhagic shock. (2) to explore the influence of limited fluid resuscitation on heart, brain, and kidney, and (3) to find an acceptable blood pressure level, at which the infusion of tissues might be improved and meanwhile, the increase of splanchnic bleeding might be avoided.Research MethodsA rat-modified Capone's methods was employed to build an uncontrolled hemorrhagic shock model. Sixty Sprague-Dawley rats were randomly sent into six groups: NC group, normal control group; NF group, shock non-resuscitation; NS40,NS60 group (limited fluid resuscitation); NS80, NS100 group (large-volume fluid resuscitation). The blood loss, infusion volume, survival time, survival rate, base deficit (BD), platelet (PLT), hematocrit (Hct), lactic acid (LA) and the functional changes of the heart, brain, kidney were measured to test the effects of initial limited fluid resuscitation for uncontrolled hemorrhagic shock in trauma.Chief results1. Findings showed that, comparing with large-volume fluid resuscitation at early traumatic hemorrhagic shock, limited fluid resuscitation have following merits: avoid hemodilution, decrease blood loss and acute ascites, improve the perfusion and oxygen-delivery for tissues, improve cell metabolism, and decrease acidosis. Limited fluid resuscitation also prolonged survival time and short-term survival rate as well as 72 hours survival rate.2. Ascitic fluid was found in large-volume resuscitation groups, but was not found in limited fluid resuscitation groups, say, NS40 and NS60 groups. Serious pathological impairment of vital organs such as heart, brain, and kidney were found in large-volume fluid resuscitation groups. More pathological changes were found in NS40 than in NS60 group, although both of the groups have less serious pathological changes comparing with large-volume resuscitation groups.3. Regarding the 72-hour-survival rats, there was no significantly functional impairment of vital organs. But the outcome of OPC and NDS evaluation were abnormal in NS40 group after 72 hours. The values of ALI\ LDH> CK^ Q\ Ur were significantly higher in NS40 than in NS60 and NC groups. In NS60 group, OPC and NDS marks was almost normal in nine rats which survival to 72 hours. The value of ALT> LDt^ G\ Ur was almost normal except for CK, which is higher than normal.Conclusion1. The earlier effects of limited fluid resuscitation is better than rapid and large...