| Objective And BackgroundWe define sepsis as a clinical syndrome defined by the presence of both infection and a systemic inflammatory response.septic shock is a severity stage in sepsis. Despite major advances in critical care,the mortality of sepsis is not decreased .According to U. S. epidemiology survey estimated that there are 751000 cases per year of severe sepsis in the United States with a mortality of 28. 6%. the mortality of septic shock is 62-75%. Recently, some research indicate, endothelial activation play an important role in the systemic inflammatory response syndrome(SIRS), septic shock and multiple organ failure(MOF). The present study investigate the effect of fluid resuscitation in order to study the changes of vasucular endothelial cells (VEC) in patients with septic shock.Materials and MethodsA total of 20 patients with septic shock were studied, diagnostic Criteria for septic shock refer to the standard of ACCP/SCCM 2001. Fluidresuscitation was adopted in patients with septic shock within 6 hours after diagonosis. Before resuscitation, record the heart rate(HR), mean arterial pressure (MAP), central venous pressure (CVP), lactic acid (LA), prothrombin time(PT), platelet(PLT) and ELISA was used to assess the P-selectin and intercellular adhesion molecule-1(ICAM-l) content. The expression of thrombomodulin(TM) was determined with Fluorescein(fitc)-conjugated mouse anti-human CD141 monoclonal antibody by flow cytometry. record above-mentioned data after resuscitation as well as 12 hours. The results were expressed as mean + standard deviation, statistical significance was determined by one-way analysis of varianc, followed by student-mewman-keuls method.All statistic tasks were accomplished with the software of SPSS12. 0. P-values <0. 05 was considered statistically significant.ResultsSet up three spots:before resusciatation (B), after resusciatation (A), 12hours after resusciatation (12H)and record all datas at every spot.Tablel. comparison of HemodynamicsB A 12 HHR (次/分) 119.65 ± 21.74 99.60 ±24.18* 93.92 ± 22.70*MAP (mmHg) 62.00±10.88 80.00±8.99* 81.57 ± 11.05*CVP (mmHg) 11.18 ± 3.20 16.29 ± 4.66* 14.25 ± 5.07LA (mmol/L) 4.32 ± 3.79 2.99 ± 2.19* 2.99 ± 2.45Note:compared with pre-resusciatation, *P<0. 05Table 2.the level of TM, FT, PLTB A 12 HTM (%) 81.48 ± 11.40 66. 18 ± 25.60 * 60.32 ± 22.08*PT (S) 19.29 ± 6.50 17.63 ± 4.11 14.98 ± 1.58PLT (*10VD 19.84±14.66 12.85 ± 7.76 11.06 ± 5.57Note:compared with pre-resusciatation, *P<0. 05Table 3. The level of adhesion moleculeB A 12 HP-selectin (pg/ul) 0.62 ± 0.36 0.30 ± 0.26* 0.36 ± 0.25*ICAM-1 (pg/ul) 2.08 ± 0.67 1.55 ± 0.42* 1.63 ± 0.43*Note:compared with pre-resusciatation, *P<0.05 Conclusions1. Fluid resuscitation decreases the expression of endothelial adhesion molecules, down-regulate leococyte-VEC interactions.2. Fluid resuscitation improve endothelium function in blood coagulation.3. Fluid resuscitation improve hemodynamics for patient with septic shock. |
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