Effects Of Oral Rehydration With The Pyruvate-Glucose-Electrolyte Solution On Resuscitation Of Hemorrhagic Shock In Rats With45%Blood Volume Loss

Objective：To investigate the effects of the pyruvate-glucose-electrolyte solution(PGES), compared with the bicarbonate-glucose-electrolyte solution (BGES) onhemodynamic parameters, gastrointestinal as well as other organs function andsurvival rate during intragastrical fluid resuscitation of lethal hemorrhagic shockinduced by45%blood volume loss in rats, so as to evaluate the thereputic effectsand possible mechanisms of PGES on early oral resuscitation of hemorrhagic shock,and to provide experimental evidence for appling in the on-site treatment ofhemorrhagic shock when the intravenous treatment is unavailable.Method：one hundred adult male SD rats with intubation of stomach, femoralartery and vein were randomly divided into four groups（each n=25）: hemorrhagicshock without fluid resuscitation (NR group), hemorrhagic shock resuscitated withthe oral PGES (PGES group), hemorrhagic shock resuscitated with the oral BGES(BGES group) and rats without hemorrhage were served as a surgical control (NHgroup). Rats were bled of about45%TBV from the femoral artery over an interval of15minutes to induce a lethal model of hemorrhagic shock. For NR and NH group, theanimals received no fluid replacement or any other treatment.After0.5h from theendpoint of hemorrhagic shock, resuscitated animals received the PGES or BGEStreatment with2times volume of shed blood through the gastric catheter over6hours.The mean arterial blood pressure and hepatic, renal, intestinal mucosal blood flowwere measured before or at0h、1h、2h、4h post hemorrhage.Blood samples in eachgroup were collected from the abdominal aortic before or at0h、1h、2h、4h posthemorrhage to detect serum alanine aminotransferase (ALT), creatinine (Cr), creatinephosphate kinase isoenzyme (CK-MB) and intestinal fatty acid binding protein(iFABP). The rats were euthanized at1h、4h to detect all levels of MDA, XOD, MPOin kidney、liver and intestinal tissues。Gastric emptying rate and the total amount ofintestinal absorption within6hours after hemorrhage were determined in oralresuscitation groups；Another (76) rats randomly divided into four groups：Group NR（n=18），Group PGES（n=24)，Group BGES（n=24），Group NH（n=10） were observed for their24-hour survival rates.Result：Gastric emptying rate and the total amount of intestinal absorptionwithin6hours post hemorrhagic shock in PGES group were significantly higher thanthose in BGES group (P<0.05or P<0.01);The levels of MAP and tissue blood flows（hepatic, renal and intestinal mucosal）in rats subjected to hemorrhage droppedsharply to the lowest points after45%TBV loss, which grew to a higher level inBGES and PGES groups than in NR group at1h,2h and4h post hemorrhage,respectively (P<0.01),and these parameters in PGES group were significantly higherthan that in BGES group (P<0.01). The serum levels of ALT,CK-MB,Cr and iFABPin NR group and two oral resuscitation groups at1h,2h and4h post hemorrhage weresignificantly higher than those before hemorrhage, respectively (P<0.01). Theseparameters at2h,4h post hemorrhage were significantly lower in PGES and BGESgroups than in NR group (P<0.01); and these parameters were also significantly lowerin PGES group than in BGES group at2h and4h post hemorrhage, respectively (P<0.05). All levels of MDA,XOD and MPO of liver、kidney and intestinal tissues in allhemorrhagic shock group at1h,4h post hemorrhage were significantly higher thanthose in the NH group, respectively (P<0.01);These parameters at4h post hemorrhagewere significantly lower in the PGES group than in the BGES group and the NRgroup (P <0.01or P <0.05).The24-hour survival rates of PGES and BGES groupswere both significantly higher than the rate of NR group (45.8%vs.4.2%, P <0.01;20.8%vs4.2%, P <0.05); and the survival rate of PGES group was also significantlyhigher than that of BGES group (45.8%vs.20.8%, P <0.05).Conclusion：This study successfully copied an animal model of oral fluidresuscitation in rats with lethal hemorrhagic shock and the study have shown that oralresuscitation with PGES in rats with severe hemorrhagic shock can significantlyimprove the early hemodynamics and tissues blood perfusion, reduce the organdamage, alleviate lipid oxidative injury and acidosis, so as to improve the survivalrate. Present results demonstrated that the pyruvate-enriched ORS (PGES) was moreeffective in preserving the organ function and prolonging the animal survival inresuscitation of lethal hemorrhagic shock, compared with the bicarbonate-containingORS (BGES)， and provide an experimental basis for improving the previous WHO-recommended HCO3-ORS formulation appling in the on-site and prehospitaltreatment of hemorrhagic shock under the conditions when the intravenous infusiontreatment is unavailable.