Protective Effects Of Early Peritoneal Dialysis Combined Volume Resuscitation In Rabbit Crush Syndrome

Background Crush injury(CI),occurring as a consequence of traumatic events,including accidents and natural disasters,has been investigated from many angles to date.Its systematic manifestation was named as crush syndrome(CS),which is common in earthquakes.Objectives In this study,we aim to establish a new rabbit CS model and to investigate the effects of early peritoneal dialysis combined volume rescucitation in crush injury.Methods(1)Rabbit crash injury model.Forty-five rabbits were randomly devided into three groups:Sham group(n =15);Compression group 1(CP1,5 kg/kg,n = 15);Compression group 2(CP2,10 kg/kg,n = 15);In the CP1 and CP2 groups,rabbits were compressed on both hindlimbs for 6 hours.Fluid resuscitation were started at 1 hour before compreesion release and lasted for 4 hours.Blood samples were collected for the measurements of AST,ALT,CK,MB,CK-MB,BUN and CRN.Blood gazes and blood routine analysis were also carried out.Histological analysis of kidney and injured muscle were conducted at the end of study.Detection of proinflammatory and anti-inflammatory cytokines has been done at different time points after compression.A 72-h survival observation was conducted.(2)Using rabbit crush injury model to investigate the effects of peritoneal dialysis combined volume resuscitation in crush injury.Sixty rabbits were randomly devided into four groups:Compression group(CP,n = 15);Volume resuscitation group(VR,n = 10);Early peritoneal dialyasis group(PD,n = 15);Early peritoneal dialysis combined volume resuscitation group(PD + VR,n =15).Blood samples were collected at different time points after resuscitation for the measurements of AST,ALT,CK,MB,CK-MB,BUN and CRN.Urine samples were collected for the detection of NGAL and β2-MG.At the same time,dialysis fluid also collected for the measurements of BUN,CRN and MB.Histological analysis and survival ovbservation were also conducted at the end of experiments.Results(1)Compression with 10 kg/kg BW on the hindlimbs induced sharply decrease in MAP.Blood analysis showed significant metabolic acisosis and hyperkalemia after compression(p<0.05,resp.).In addition,serum AST,ALT,BUN and CRN were significantly increased in the CP2 group compared to the CP1 and Sham group(p<0.05,resp.).ELISA results suggested that inflammatory cytokines were significantly increased in the compression groups compared to the Sham group(p<0.05,resp.).In detail,TNF-α,IL-4 and IL-10 peaked at 12 h after compression while IL-1β peaked at 6 h after compression release.Histological analysis showed apparent muscle edema and inflammation infiltration.Furthermore,the survival rate in the CP2 group was significantly decreased compared to the CP1 and Sham group(p<0.05,resp.).(2)Compared to the CP group,the survival rate was significantly increased in the VR,PD and PD + VR groups(p<0.05,resp.).In addition,the survival rate in the PD + VR group(80%)was significantly higher than the PD(50%)and VR(60%)(p<0.05,resp.).Moreover,serum K+,CK.CK-MB,MB,AST,BUN and CRN were significantly higher in the PD + VR group than the other groups(p<0.05,resp.).Urine analysis of NAGL and β2-MG showed decreased acute kindey injury in the PD + VR group compared to other groups.Conclusion(1)We successfully established a rabbit crush injury model.Crush injury induced systemic inflammatory response.Both proinflammatory and antiinflammatory cytokines were significantly increased after crush injury.(2)Early peritoneal dialysis combined volume resuscitation successfully maintained blood pressure and attenuated hyperkalemia and metabolic acidosis after compression release.In addition,peritoneal dialysis effectively clear blood MB and CK.Finally,early peritoneal dialysis combined volume resuscitation increased survival rate of CI rabbits.However,further study is required to confirm the safty of early peritoneal dialysis in crush injury.