| Objective:Traumatic hemorrhagic shock is the main causes leading to death of casualties. The early fluid resuscitation in pre-hospital phrase is one of the main treatments to the severe traumatic uncontrolled hemorrhagic shock. The rat model with severe traumatic uncontrolled hemorrhagic shock was built by drawing blood and cutting tails to observe the effects of different fluid resuscitation means on the amount of hemoglobin(Hgb),hematocrit(Hct),alanine aminotransterase ( ALT ),blood loss,fluid resuscitation,glucocorticoid(GC) and glucocorticoid receptor(GR) , and the survival time and survival probability of the rats with uncontrolled hemorrhagic shock in every monitoring times. And it is further investigated the relationship between the level of GC/GR and the prognosis in rats with severe uncontrolled hemorrhagic shock after different means of fluid resuscitation and provided the theory basis for the pre-hospital emergency treatment of the traumatic uncontrolled hemorrhagic shock.Methods:The rat model with severe traumatic uncontrolled hemorrhagic shock was established by Capone's ways of drawing blood and cutting tails. The whole experimental process was divided into four phrases by imitating the clinical life-surpport chain of emergency medical service(EMS) for trauma, which were 30min of traumatic blood loss stage(0～30min),60min of simulated"pre-hospital"emergency stage (30min～90min),420min of simulated"hospital"treatment stage (90min～510min)and observing recovery stage ( 510min～72h). The 30min,90min,150min,270min,510min was regarded as monitoring point, separately. The healthy model rats, whatever they were female or male, weighing 265±20g and fulfilling the criteria of resuscitation with mean arterial pressure(MAP) were randomly divided into four groups by the different fluid resuscitation means: the sham surgery group(SS group),no fluid resuscitation group(NF group),aggressive fluid resuscitation group(AR group) and limited fluid resuscitation group(LR group). The naturally died rats and the rats that did not fulfill the criteria of blood pressure during the process of the rats model established and resuscitation were kept out of the study during the experiment. Four rats were killed at every time point in every group to detect the amount of Hgb,Hct,ALT,GC by automatic detector , respectively. The level of GR in hepatic tissue was detected by enzyme-linked immunosorbent assay (ELISA). The hepatic tissue's pathologic change was observed after hematoxylin and eosin (HE) dyeing. And blood loss,fluid resuscitation of every group of rats were calculated.In addition, 40 rats were randomly devided into 4 groups: SS, NF, AR and LR, which were dealt as above, respectively. And their survival time and survival probability were observed. All of 120 rats were brought into the study.All datas were dealed with SPSS13.0. Results of measurement data were stated as mean±S.D. Statistical analysis for comparing mean values from the 4 groups was made by one-way analysis of variance (ANOVA)(Multiple comparison test and ANOVA). Mortality was compared using the Ch-square with Fisher's exact test. Differences were considered significant at P<0.05. Results:1.the basic data of each group of ratsThe body weight,MAP,GC,ALT,Hgb and Hct of every group rats were not statistical difference(P>0.05)(Table 1).2. the volume of continuous blood loss of each group ratsThe volume of rat's tail continuous blood loss of AR group was more than that of NF and LR group in traumatic emergency stage(pre-hospital phrase) (P<0.01) , and there was no significant difference between NF and LR group(Table 3).3. the resuscitation volume of each group ratsThe rat's resuscitation volume of NF group was more than that of AR(P<0.05)and LR group with statistical difference(P<0.01), and the rat's resuscitation volume of AR group was more than that of LR group too(P<0.01)(Table 4).4. the level of Hgb and Hct of each group ratsAfter traumatic hemorrhagic shock, the level of Hgb and Hct of AR and LR group rats decreased with the lowest point of (50±7)g/L (,12.25±1.50)% and(62±10)g/L,(17.50±1.29)% at 90min monitoring point,respectively. There was little change in the Hgb(98±4g/L)and Hct(29.25±1.89% )level of NF group rats. The Hgb and Hct level of AR group rats was lower than that of LR group(P<0.05)and NF group(P<0.01). It increased in hospital phrase, but the level of LR group was still higher than that of AR group(P<0.05). Furthermore, the level of Hct of AR group was lower than 20%, but the level of LR group was higher than 20% during the ency treatment stage (Table 5～6, chart 3).5.the injury of livers of each group ratsThe value of every group rats'ALT began to increase after traumatic hemorrhagic shock. The value of ALT in NF,AR,LR group rat's was contiously increased with experimental time prolonged after dealt with different fluid resuscitation in traumatic emergency phrase, with highest degree in NF group and lowest degree in LR group. The level of NF group was significantly higher than that of AR and LR group at 150min monitoring point(P<0.05), but there was no obviously difference in AR and LR group. At 270min and 510min monitoring point, the level of ALT of NF group rats was significant higher than that of AR group(P<0.05)and LR group(P<0.01), and the level of NF group was lower than that of AR group (P<0.05)(Table 7, chart 4). The hepatic tissue's pathologic change was not obvious before 150min of the experiment , folowed by pathologic change of hydropic degeneration and fatty degeneration (table7,chart4～7). The hepatic tissue's pathologic change of NF and AR group's rat was severer than that of LR group during the whole process(chart 5～8).6.the rat's survival time and survival probabilityThe rat's survival time of LR group was significant longer than that of NF and AR group(P<0.01), the rat's median survival time of NF group was the shortest in 3 groups. The NF,AR,LR group rat's median survival time was 4.84±1.126h,9.14±3.25h,52.52±8.97h,respectively. None of the 10 rats survived more than 72h in NF and AR group, but 6 rats in LR group, comparisons between LR group and NF,AR group were statistically- significant(P<0.01);Compared with AR group, the rat's survival probability of NF group in every monitoring time point was not statistical difference(P> 0.05 ) . The rat's survival probability of LR group was not statistically-significant difference, comparing with AR group, but was higher than that of NF group in 150min monitoring time point (P<0.05). And it was higher than that of NF and AR group at 270min monitoring time point(P<0.05). The rat's survival probability of LR group was 80%, which was higher than that of NF group(30%) at 510min monitoring time point (P<0.05); however, which was no statistical difference, comparing with that of NF group. The rat's survival probability of 72h of LR group was significant higher than that of NFand AR group(P<0.01)(table8～9, chart9～10).7. the GC value of each group ratsThe value of NF,AR,LR group rat's GC peaked after traumatic hemorrhagic shock,which was higher than that of SS group(P<0.05). After dealt with different fluid resuscitation in traumatic emergency phrase, the GC value of NF group continiously increased, which was higher than that of LR and AR group. The value of GC in NF,AR,LR group decreased firstly in hospital phrase, but they began to increase at 510min monitoring point. At this time, the value of LR group rat's GC was significant lower than that of NF and AR group (table 10, chart 11).8. the rat hepatic tissue's GR value of each groupThe value of NF,AR,LR group rat hepatic tissue's GR was always lower than that of SS group(P<0.05) after traumatic hemorrhagic shock. The value of every group rat's GR decreased continiously after dealed with different fluid resuscitation in traumatic emergency phrase, but the value of LR group rat's GR was significant higher than that of NF and AR group (table 11,chart 12).Conclusion:Comparing with no fluid resuscitation and aggressive fluid resuscitation, the earlier limited fluid resuscitation can reduce blood loss of rat tails and volume of post-fluid resuscitation, and reduce hemodilution;and it is effective to protect hepatic function, to improve survival probability, to reduce mortality probability; furthermore, it is actively effective to increase the value of hepatic tissue's GR. It is suggested that early limited fluid resuscitation can improve prognosis and deduce complications after traumatic uncontrolled hemorrhagic shock, which is probably related to the reduction of degree of decreasing GR and tolerance of GC.
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