Effects Of Different Target Blood Pressure Resuscitation On Peripheral Blood Inflammatory Factors And Hemodynamics In Patients With Traumatic Hemorrhagic Shock

Objective:To investigate the level of blood pressure that should be maintained by restrictive fluid resuscitation in patients with traumatic hemorrhagic shock.Methods:The clinical data of 45 patients with traumatic hemorrhagic shock admitted to the First Affiliated Hospital of Bengbu Medical College from January 2016 to October2018 were collected.According to the difference of mean arterial pressure(MAP)after resuscitation,20 cases of low MAP(60mmHg?MAP<65mmHg),medium MAP(65mmHg?MAP<70mmHg)and high MAP(70mmHg?MAP<75mmHg)were randomly selected according to the admission order.The study subjects were grouped in turn.The restrictive fluid resuscitation phase was divided into three phases: T0 phase(before fluid resuscitation),T1 phase(liquid resuscitation 30 min),and T2 phase(liquid resuscitation 60 min).The most suitable resuscitation blood pressure level was further speculated by monitoring the inflammatory markers and hemodynamics in different periods of serum in each group of patients.Results:1.Before fluid resuscitation,there was no significant difference in hemodynamics and initial expression of serum cytokines among the three groups(P>0.05).2.Three groups of patients were resuscitated for 30 min to achieve the target blood pressure level and maintain 30 min;.With the prolongation of fluid resuscitation time,the central venous pressure(CVP),cardiac output(CO)and cardiac output index(CI)increased slowly in the three groups,and reached a steady state about 30 min resuscitation,especially in the high MAP group and middle MAP group.But there was no significant difference between high MAP group and middle MAP group.3.Fluid resuscitation for 30 min,compared with the low MAP group and the high MAP group,the middle MAP group was superior to the other two groups in inhibiting the expression of pro-inflammatory factors(TNF-?,IL-6)and promoting anti-inflammatory factors(IL-10).(TNF-? mRNA:0.21±0.13 vs.0.52±0.50?0.57±0.35,IL-6 mRNA:0.35±0.3 vs.0.72±0.39?0.59±0.42,IL-10 mRNA:1.25±0.81 vs.0.61±0.46?0.82±0.53,P<0.05),but there was no significant difference in promoting the expression of anti-inflammatory factor(IL-4)(IL-4mRNA:1.10±0.67 vs.0.87±0.39?0.86±0.44,P>0.05).4.Fluid resuscitation at 60 min,compared with the low MAP group and the high MAP group,the middle MAP group inhibited pro-inflammatory factors(TNF-?,IL-6)and promoted the expression of anti-inflammatory factors(IL-10)better than the other two groups(TNF-? mRNA:0.72±0.35 vs.1.05±0.54?1.03±0.49,IL-6 mRNA:0.57±0.50 vs.1.27±0.72?1.01±0.64,IL-10 mRNA:1.41±0.90 vs.0.81±0.48?0.94±0.61,P<0.05).Compared with the high MAP group,the middle MAP group was significant differences in promoting the expression of anti-inflammatory factor(IL-4)and regulatory factor(IFN-?)(IL-4 mRNA:1.32±0.62 vs.0.91±0.60,IFN-? mRNA:1.07±0.50 vs.0.73±0.49,P<0.05).5.Correlation analysis showed that there was a strong linear correlation between MAP and mRNA expression of TNF-?,IL-6 and IL-10 in middle MAP group(r = 0.638,0.553,0.562,P < 0.01),but had no correlation with IL-4(r = 0.361,P = 0.059);Fitting linear regression analysis showed an increase of 1 mmHg per MAP.The expression of IL-6 mRNA increased by 0.021 [95% confidence interval(95% CI)=0.017-0.024,P<0.001],and IL-10 mRNA increased by 0.049(95% CI=0.041-0.058,P<0.001)and TNF-? mRNA increased by 0.027(95% CI=0.023-0.031,P<0.001).Conclusion:1.After fluid resuscitation in traumatic hemorrhagic shock patients,MAP maintained at 65 mmHg < MAP < 70 mmHg could inhibit the release of pro-inflammatory cytokines IL-6 and TNF-?,and promote the release of anti-inflammatory cytokines IL-4 and IL-10.2.After fluid resuscitation in traumatic hemorrhagic shock patients,when MAP was maintained at 65 mmHg < MAP < 70 mmHg,it could basically meet tissue perfusion requirements and maintain hemodynamic stability.