Effect Of Different Concentration Of Hemoglobin On Lung Function In Hemorrhagic Shock Rabbits

Objective: To observe the different haemoglobin concentration influence on hemorrhagic shock rabbits lung function,explore the ideal hemoglobin concentration on severe hemorrhagic shock resuscitation,and to guide clinical rational use.Methods: To elective healthy fifty male New Zealand rabbits,weighing1.9-2.4kg,were randomly divided into 5 groups(n=10 each),using a random number table:control group(group C),the shock resuscitation of the non transfusion group(group F),the shock resuscitation with transfusion group(group R),after resuscitation the hemoglobin concentration(Hb)was controlled at the aim Hb: R1 group 60 ?Hb<80 g/L?R2 group 80?Hb<100 g/L?R3 group 100g? Hb<120g/L,each group with 10 rabbits.Femoral artery of group C was separated and measured femoral artery pressure,but don't simulate shock;group S was subjected to fluid resuscitation after shock,but with no transfusion;group R was subjected to fluid resuscitation after shock,and infusion of stored concentrated red cells for two weeks,to reache the set concentration.The arterial blood gases(including potential of hydrogen,arterial oxygen tension,arterial carbon dioxide tension and lactic acid)were detected before hemorrhagic shock(T0),after hemorrhagic shock(T1),resuscitation 0 min(T2),resuscitation 1 hour(T3),resuscitation 2 hour(T4),resuscitation 3 hour(T5).The content of inflammatory cytokines(including detected at each time point in the serum by ELISA method.The whole record of blood loss,Infusion volume and blood transfusion.At the end of the experiment,the wet dry ratio,pathological changes and apoptosis of the lung tissue were observed,lung tissue myeloperoxidase detection(MPO),nitric oxide(NO)and protein content(BCA)were tested.Results:(1)(1)Five groups of rabbits basis MAP was no significant difference(P > 0.05).Compared with the base level MAP,MAP of group F and group R were significantly decreased after shock(P<0.05).Group R2 and R3 returned to the basic levels after resuscitation,Group R1 and F were still lower than that of group C(P<0.05).(2)Compared with T0,p H level significantly decreased in group R and F at T1(P<0.05).Compared with group C,p H in group R2 and R3 returned to normal level at T2,Group R1 and group F still decreased(P<0.05),Group R1 and F also returned to normal level at T3.Compared with T0,p H level significantly decreased in group R and F at T1(P<0.05).All groups returned to normal level at T2.Compared with group C,the level of Pa CO2 at group R1?R3 and F were decreased at T3?T4 and T5,there were statistically significant differences(P<0.05).Compared with T0,Pa O2 level of group R and F significantly increased in group R and F at T1(P<0.05).Group R was higher than group F at T2(P<0.05).Compared with T0,the level of Lac at group R and F were significantly increased at T1(P < 0.05).After resuscitation,the level of Lac in group R and F were significantly decreased,compared with the other groups,the Lac value of F group was the highest,and group R2 m was the lowest,the difference was statistically significant(P<0.05).The level of Lac in group R2 returned to normal level at T5.(3)The level of plasma IL-6,IL-8 and TNF-? was significantly increased in group R and group F after shock,the concentrations of inflammatory factors in group R2 were significantly lower than those in group F and R1 at T2~T5,group F and R1 were significantly higher than group C(P<0.05),There was no significant difference between group R2 and group R3(P>0.05).(4)Compared with group C,the levels of MPO,NO and BCA in lung tissue of rabbits in group R and group F were significantly increased(P<0.05).The contents of MPO,NO and BCA in group R2 were significantly lower than those in group F and R1,these in group R3 were significantly lower than those in group F and group R1(P<0.05),There was no significant difference between group R2 and group R3(P>0.05).(5)In group C,the alveolar structure was complete,and there was no neutrophil infiltration in alveolar space and interval;in the F group,the alveolar space was widened,and the number of granulocytes in the alveolar cavity was increased obviously,some of them were expanded and fused,and the pulmonary interstitial edema was obvious;compared with group F and group R1,the alveolar structure of R2 group was more complete,there was less effusion in alveolar space,and the interstitial edema was lighter.The wet dry ratio of lung tissue in group R2 was lower than group F and group R1(P<0.05),There was no significant difference between group R2 and group R3(P>0.05).(6)TUNEL method was used to detect the apoptosis of lung tissue in each group of rabbits.The apoptosis rate of F group was obvious,and the apoptosis rate was significantly higher than that of other groups.The apoptosis rate of group R2 was less than that of group F and other transfusion groups.Conclusion: Different levels of blood transfusion can lead to different degrees of lung injury after hemorrhagic shock resuscitation;when the hemoglobin concentration was 80~120 g/L,the blood perfusion and oxygen supply could be restored effectively;after hemorrhagic shock resuscitation,the Hb concentration in80~100 g/L can reduce the amount of blood transfusion,and reduce the occurrence of adverse reactions after transfusion.