Combined early fluid resuscitation and hydrogen inhalation attenuates lung and intestine injury

AIM:To study the effects of combined early fluid resuscitation and hydrogen inhalation on septic shockinduced lung and intestine injuries.METHODS:Wistar male rats were randomly divided into four groups:control group(Group A,n = 15);septic shock group(Group B,n = 15);early fluid resuscitation-treated septic shock group(Group C,n = 15);and early fluid resuscitation and inhalation of 2% hydrogentreated septic shock group(Group D,n = 15).The activity of hydroxyl radicals,myeloperoxidase(MPO),superoxide dismutase(SOD),diamine oxidase(DAO),and the concentration of malonaldehyde(MDA) in the lung and intestinal tissue were assessed according to the corresponding kits.Hematoxylin and eosin staining was carried out to detect the pathology of the lung and intestine.The expression levels of interleukin(IL)-6,IL-8,and tumor necrosis factor(TNF)-α in lung and intestine tissue were detected by enzyme-linked immunosorbent assay method.The expression levels of Fas and Bcl2 in lung tissues were determined by immunohistochemistry and Western blotting.RESULTS:Septic shock elicited a significant increase in the levels of MDA(10.17 ± 1.12 nmol/mg protein vs 2.98 ± 0.64 nmol/mg protein) and MPO(6.79 ± 1.02 U/g wet tissue vs 1.69 ± 0.14 U/g wet tissue) in lung tissues.These effects were not significantly decreased by Group C pretreatment,but were significantly reduced by Group D pretreatment(MDA:4.45 ± 1.13 nmol/mg protein vs 9.56 ± 1.37 nmol/mg protein;MPO:2.58 ± 0.21 U/g wet tissue vs 6.02 ± 1.16 U/g wet tissue).The activity of SOD(250.32 ± 8.56 U/mg protein vs 365.78 ± 10.26 U/mg protein) in lung tissues was decreased after septic shock,and was not significantly increased by Group C pretreatment,but was significantly enhanced by Group D pretreatment(331.15 ± 9.64 U/mg protein vs 262.98 ± 5.47 U/mg protein).Histological evidence of lung hemorrhage,neutrophil infiltration and overexpression of IL-6,IL-8,and TNF-α was observed in lung tissues,all of which were attenuated by Group C and further alleviated by Group D pretreatment.Septic shock also elicited a significant increase in the levels of MDA,MPO and DAO(6.54 ± 0.68 kU/L vs 4.32 ± 0.33 kU/L) in intestinal tissues,all of which were further increased by Group C,but significantly reduced by Group D pretreatment.Increased Chiu scoring and overexpression of IL-6,IL-8 and TNF-α were observed in intestinal tissues,all of which were attenuated by Group C and further attenuated by Group D pretreatment.CONCLUSION:Combined early fluid resuscitation and hydrogen inhalation may protect the lung and intestine of the septic shock rats from the damage induced by oxidative stress and the inflammatory reaction.

Fluid resuscitation in acute pancreatitis

Acute pancreatitis remains a clinical challenge, despite an exponential increase in our knowledge of its complex pathophysiological changes. Early fluid therapy is the cornerstone of treatment and is universally recommended; however, there is a lack of consensus regarding the type, rate, amount and end points of fluid replacement. Further confusion is added with the newer studies reporting better results with controlled fluid therapy. This review focuses on the pathophysiology of fluid depletion in acute pancreatitis, as well as the rationale for fluid replacement, the type, optimal amount, rate of infusion and monitoring of such patients. The basic goal of fluid epletion should be to prevent or minimize the systemic response to inflammatory markers. For this review, various studies and reviews were critically evaluated, along with authors’ recommendations, for predicted severe or severe pancreatitis based on the available evidence.

Is aggressive intravenous fluid resuscitation beneficial in acute pancreatitis? A meta-analysis of randomized control trials and cohort studies

BACKGROUND There is conflincting evidence on the intravenous fluid(IVF)strategy for acute pancreatitis(AP).We perform a metaanalysis of the available evidence.AIM To investigate if aggressive IVF therapy in AP patients is beneficial to decrease mortality and improve outcomes.METHODS Metaanalysis of available randomized controlled trials and cohort studies comparing aggressive IVF vs non-aggressive IVF resuscitation.RESULTS There was no significant difference in mortality between the aggressive(n=1229)and non-aggressive IVF(n=1397)patients.Patients receiving aggressive IVF therapy had higher risk for acute kidney injury and acute respiratory distress syndrome.There also was no significant difference in the overall incidence of systemic inflammatory response syndrome,persistent organ failure,pancreatic necrosis when comparing both study groups.CONCLUSION Early aggressive IVF therapy did not improve mortality.Moreover,aggressive IVF therapy could potentially increase the risk for acute kidney injury and pulmonary edema leading to respiratory failure and mechanical ventilation.Studies are needed to investigate which subset of AP patients could benefit from aggressive IVF therapy.

Impact of different intravenous bolus rates on fluid and electrolyte balance and mortality in critically ill patients

The effect of intravenous bolus rates on patient outcomes is a complex and crucial aspect of critical care.Fluid challenges are commonly used in critically ill patients to manage their hemodynamic status,but there is limited information available on the specifics of when,how much,and at what rate fluids should be administered during these challenges.The aim of this review is to thoroughly examine the relationship between intravenous bolus rates,fluid-electrolyte balance,and mortality and to analyze key research findings and methodologies to understand these complex dynamics better.Fluid challenges are commonly employed in managing hemodynamic status in this population,yet there is limited information on the optimal timing,volume,and rate of fluid administration.Utilizing a narrative review approach,the analysis identified nine relevant studies that investigate these variables.The findings underscore the importance of a precise and individualized approach in clinical settings,highlighting the need to tailor intravenous bolus rates to each patient's specific needs to maximize outcomes.This review provides valuable insights that can inform and optimize clinical practices in critical care,emphasizing the necessity of meticulous and exact strategies in fluid administration.

Effect of preoperative limited fluid resuscitation to the patients with traumatic shock

Objective： To investigate the effect of preoperative limited fluid resuscitation on the patients with traumatic shock. Methods： Eighty-nine patients with multiple injuries complicating with shock were treated in Changhai Hospital Between January 2002 to October 2005 and were divided into 3 groups according to the preoperative levels of systolic blood pressure （SBP）. SBP of group A and group B were about 70 and 80 mmHg, respectively; and the SBP of group C was over 90 mmHg. Results, （1） There was no significant difference in age, gender, and injury severity score （ISS）, initiated resuscitation time and initiated operation time among the 3 groups. Preoperatively, there was significant difference in the amount of fluid resuscitation and infused erythrocyte suspension among group A, B and C （1687 ± 96 ml, 2096 ± 87 ml, 2976±93 ml, P〈0. 05; and 294±110 ml, 404±113 ml, 798±230 ml, P〈0. 05）. （2） The hemoglobin level in group C （94±45 g/L） was lower than that in group A （110±22 g/L） and group B （103±24 g/L） （P〈0.05）. However, there was no significant difference in the level of hemoglobin between group A and B. （3） There was no significant difference in the incidence of acute renal failure （ARF） among the 3 groups. The incidence of acute respiratory distress syndrome （ARDS） of group C （31.2%） was higher than that of group A （16.7%） and group B （18.2%） （P〈0.05）. The mortality of group C （34.4%） was higher than that of group A （12. 5% ） and group B （12. 1% ） （P〈0.05）. Conclusion： Preoperative limited resuscitation applied on patients with traumatic shock can reduce blood loss, incidence of ARDS and mortality.

Prognostic value of hemodynamic indices in patients with sepsis after fluid resuscitation

BACKGROUND Sepsis usually causes hemodynamic abnormalities.Hemodynamic index is one of the factors to identify the severity of sepsis and an important parameter to guide the procedure of fluid resuscitation.The present study investigated whether the assessment of hemodynamic indices can predict the outcomes of septic patients undergoing resuscitation therapy.AIM To evaluate the prognostic value of hemodynamic indices in patients with sepsis after fluid resuscitation.METHODS A retrospective study was conducted in 120 patients with sepsis at Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University between October 2016 and October 2019.All patients were treated with sodium chloride combined with dextran glucose injection for fluid resuscitation.Patients’hemodynamic parameters were monitored,including heart rate(HR),cardiac index(CI),systemic vascular resistance index(SVRI),mean arterial pressure(MAP),central venous pressure(CVP),and central venous oxygen saturation.The prognostic value of hemodynamic indices was determined based on the prognosis status.RESULTS During fluid resuscitation,86 patients developed septic shock and 34 did not.Ninety-nine patients survived and 21 patients died at 28 d after the treatment.Heart rate,CI,mean arterial pressure,SVRI,and CVP were higher in patients with septic shock and patients who died from septic shock than in non-shock patients and patients who survived,and central venous oxygen saturation was lower in patients with shock and patients who died than in non-shock patients and thesurvivors (P < 0.05). When prognosis was considered as a dependent variable andhemodynamic parameters was considered as independent variables, the results ofa logistic regression analysis showed that CI, SVRI, and CVP were independentrisk factors for septic shock, and CI was an independent risk factor for 28-dmortality (P < 0.05).CONCLUSIONHemodynamic indices can be used to evaluate the prognosis of septic patientsafter fluid resuscitation.

The Influence of HIF-1α Expression on Apoptosis and Number of T Lymphocyte in Peyer’s Patches after Burn with Delayed Fluid Resuscitation in Rats at Plateau

Objective: To research the expression of hypoxia inducible factor-1 alpha (HIF-1 alpha) on the apoptosis and number of T lymphocyte in Peyer’s patches after severe burn on plateau in rats. Methods: Wistar rats (n = 130) were subjected to deep thickness burn injury (30% TBSA, III degree), at two different altitudes. 60 of them were given delayed fluid resuscitation (DFR, n = 30 at each altitude) 6 h after burn at different altitude;60 of them were carried out immediate fluid resuscitation (IFR, n = 30 at each altitude);10 rats were subjected to 37°C warm water as sham burn (SG, n = 10). The Peyer’s patches were harvested from the ileum of rats at different time point after burn respectively. The expression of HIF-1 alpha, CD3(+) and the apoptosis and number of T lymphocyte in Peyer’s patches were detected by tissue microarray technology and immunohistochemistry. Results: The apoptosis was higher in DFR group than that in IFR group. The increase in HIF-1 alpha expression was observed mainly on cell nucleus in T lymphocytes. The expression levels of HIF-1 alpha in Peyer’s patches were much higher in DFR group and IFR group than those in SG, and they were higher at high altitude (3848 metres) than those at lower altitude (1517 metres), and also higher in DFR group compared with IFR group (all P < 0.05). The expression levels of CD3+ in Peyer’s patches were much lower in DFR group and IFR group than those in sham group, and the lowest value appeared at 12 hours after burn (all P < 0.05). Conclusion: High expression of HIF-1 alpha may induce the apoptosis of T lymphocytes in Peyer’s patches after severe burn with delayed fluid resuscitation in rats at plateau.

COMPUTER SIMULATION OF SYSTEM CONTROLAPPLICATION IN DESIGNING ON ANTI-SHOCK RESUSCITATION THERAPY FOR BURN INJURED PATIENTS

Objective To create a new fluid resuscitation technique for burn injury patient which makes burninjury patient pass smoothly the acute phase with less edema. Methods Mathematical model of fluid and proteinbalance of burn injured patient in acute phase was adopted and computer simulation of the system control wasutilized. The fluid resuscitation protocol designed by computer simulation were applied to twelvepatients.Results The new method has better effects with less side- effects. Conclusion The computer- simulationdesigned fluid therapy protocol provide a better resuscitation than the fluid therapy protocol produced by usingempirical formula.

Update on the strategy for intravenous fluid treatment in acute pancreatitis

Fluid therapy/resuscitation is mandatory in acute pancreatitis due to the pathophysiology of fluid loss as a consequence of the inflammatory process.For many years,without clear evidence,early and aggressive fluid resuscitation with crystalloid solutions(normal saline solution or Ringer lactate solution)was recommended.Recently,many randomized control trials and meta-analyses on fluid therapy have revealed that high fluid rate infusion is associated with increased mortality and severe adverse events compared to those resulting from moderate fluid rates,and this has triggered a paradigm shift in fluid management strategies.Meanwhile,there is evidence to show that Ringer lactate solution is superior to normal saline solutions in this context.The purpose of this review is to provide an update on the strategies for intravenous fluid treatment in acute pancreatitis,including the type,optimal amount,rate of infusion,and monitoring guides.Recommendations from recent guidelines are critically evaluated for this review in order to reach the authors'recommendations based on the available evidence.

复方电解质注射液(Ⅱ)与醋酸林格液对重症创伤患者早期液体复苏效果

目的 探讨对重症创伤患者输注不同平衡盐溶液后的液体复苏效果及预后情况,为临床急救液体复苏的液体选择提供参考。方法 选取急诊科行液体复苏的重症创伤患者作为研究对象。根据急诊液体复苏时输注的平衡盐溶液类型的不同,将患者随机分为试验组(n=100)和对照组(n=98)。试验患者给予输注复方电解质注射液(SF),对照组患者给予输注醋酸林格液(RA)。采集两组患者的肾损伤指标(血肌酐及尿素氮变化及30 d内肾脏主要不良事件)、血气分析指标(pH、剩余碱(BE)值、碳酸氢根(HCO-3)和血乳酸)、机械通气撤机时间、血管活性药使用时间、重症加强护理病房(ICU)住院时长、总住院时长及28 d内的生存率。结果 两组患者在伤后96 h内的血肌酐、尿素氮变化及30 d内肾脏主要不良事件发生率比较差异无统计学意义(P>0.05)。液体复苏早期(24 h内),试验组的pH、BE值、HCO-3及血乳酸与对照组比较能较快恢复到正常范围(P<0.05)。在重要临床结局(28 d生存率、机械通气撤机时间、血管活性药物使用时间、ICU住院时长和总住院时长)上两组比较差异无统计学意义(P>0.05)。结论 与醋酸林格液比较,复方电解质溶液在重症创伤早期液体复苏过程中能较快纠正代谢性酸中毒,但这种生物化学上的优势并不能改善相关的临床结局。

床旁超声在儿童脓毒性休克液体复苏中的应用价值

目的探讨床旁超声在脓毒性休克患儿液体复苏中的临床价值。方法选取2021年12月至2023年1月收治河北医科大学附属河北省儿童医院重症医学一科诊断为脓毒性休克的患儿50例,采用随机数字表法分为常规组和超声组,每组25例。患儿入院后均给予抗感染、呼吸支持等对症治疗。2组均给予初始液体复苏(20 mL/kg醋酸钠林格液)。常规组在初始液体复苏后按照指南(早期目标导向治疗6 h目标)继续液体复苏;超声组在初始液体复苏后根据超声测下腔静脉内径及肺部超声检查指导后续液体复苏。比较2组液体复苏6、12 h后心率、平均动血压(mean arterial pressure,MAP)及中心静脉血氧饱和度(Systemic central venous oxygen saturation,ScvO_(2))指标变化,并比较2组患儿24 h液体入量及血管药物评分、液体复苏12、24、48 h氧合指数变化、肺水肿发生例数及28 d病死率。结果液体复苏6、12后2组患儿的心率、MAP、ScvO_(2)指标比较,差异无统计学意义(P>0.05)。超声组24 h液体总入量少于常规组,差异有统计学意义(P<0.05),24 h血管活性药物评分低于常规组,但差异无统计学意义(P>0.05)。液体复苏12 h超声组氧合指数高于常规组,但差异无统计学意义(P>0.05),液体复苏24、48 h超声组患儿的氧合指数明显高于常规组,差异有统计学意义(P<0.05)。超声组液体复苏期间发生肺水肿的例数少于常规组,差异有统计学意义(P<0.05);2组患儿的28 d病死率比较,差异无统计学意义(P>0.05)。结论床旁超声测下腔静脉内径联合肺部超声可以指导儿童脓毒性休克的液体管理,减少液体入量,优化容量状态,改善血流动力指标,降低肺水肿发生的风险,因超声具有无创性,在儿科临床应用更广泛,益于儿童。

超声指导脓毒性休克液体复苏疗效的Meta分析

目的采用Meta分析比较超声指导液体复苏与早期目标导向治疗(EGDT)在脓毒性休克中的应用效果。方法通过计算机检索PubMed、Ovid、Scopus、Embase、Cochrane Library、Web of Science、中国知网(CNKI)、万方数据知识服务平台(WANFANG)、中国生物医学文献数据库(CBM)、维普中文科技期刊全文数据库(VIP)、中国临床实验数据中心和ClinicalTrials.gov,搜集从建库至2022年10月23日有关比较超声指导液体复苏和EGDT在脓毒性休克中应用效果的随机对照试验(RCT)。采用Review Manager5.3统计软件进行Meta分析。结果共纳入8篇文献,包括482例脓毒性休克患者,3篇文献风险偏移较低。Meta分析结果显示,两组的6、12、24 h乳酸清除率(LCR)、急性肾损伤(AKI)发生率、28 d病死率比较,差异无统计学意义(P>0.05);试验组的24 h复苏液体总量、24 h液体净平衡量低于对照组(P<0.00001);试验组的组织水肿发生率低于对照组(P=0.001);试验组的治疗6 h后每小时尿量多于对照组(P<0.00001);试验组的机械通气时间及ICU住院时间短于对照组,差异具有统计学意义(P=0.009、0.002)。结论超声指导脓毒性休克液体复苏可降低24 h复苏液体总量及组织水肿发生率,增加治疗6 h后每小时尿量,缩短机械通气时间及ICU住院时间。

中心静脉血氧饱和度联合静动脉二氧化碳分压差在产后出血液体复苏治疗中的指导作用

目的探讨中心静脉血氧饱和度(ScvO_(2))联合静动脉二氧化碳分压差[P(v-a)CO_(2)]在产后出血(PPH)液体复苏治疗中的指导作用。方法选取2022年2月至2023年3月江西省妇幼保健院收治的60例胎盘植入、前置胎盘剖宫产术中大出血患者作为研究对象,按照随机数字表法分成试验组(n=30)和对照组(n=30)。对照组行常规液体复苏干预,试验组行ScvO_(2)联合P(v-a)CO_(2)监测指标进行复苏干预。比较两组患者容量达标时间、液体复苏前后氧合指数、6 h乳酸清除率、24 h乳酸清除率及并发症发生率。结果试验组的容量达标时间短于对照组,差异有统计学意义(P<0.05);液体复苏6、24 h后试验组的氧合指数均高于对照组,差异有统计学意义(P<0.05);试验组6h乳酸清除率、24h乳酸清除率均高于对照组,差异有统计学意义(P<0.05);试验组的并发症总发生率(16.67%)低于对照组(40.00%),差异有统计学意义(P<0.05)。结论ScvO_(2)联合P(v-a)CO_(2)监测对PPH患者液体复苏治疗具有指导作用,能缩短液体复苏时间,提高氧合指数和乳酸清除率,降低并发症的发生。

温阳利水法治疗感染性休克液体复苏后患者体液潴留临床研究

目的:分析温阳利水法治疗感染性休克液体复苏后体液潴留的临床效果。方法:选取80例感染性休克患者,患者接受液体复苏后均出现不同程度体液潴留,采用随机数字表法分为对照组(n=40,接受西药治疗)和观察组(n=40,对照组治疗基础上采用加味真武汤治疗),比较两组患者疗效、中医证候积分、中心静脉压(CVP)、氧合指数(PaO_(2)/FiO_(2))、下腔静脉内径(IVC)及呼吸变异度(RVI)。结果:观察组治疗总有效率及各项中医证候积分优于对照组(均P<0.05)。液体复苏后T1、T2、T3观察组CVP水平低于对照组,PaO_(2)/FiO_(2)水平高于对照组(均P<0.05)。治疗后观察组RVI大于对照组,IVC最小内径(IVCmin)小于对照组(均P<0.05)。结论:真武汤治疗感染性休克液体复苏后体液潴留患者效果显著,可改善患者中医症状及容量状态。

人工胶体液和晶体液感染性休克液体复苏对比研究

目的回顾性对比分析人工胶体液和晶体液在容量反应性感染性休克患者液体复苏的疗效及不良反应。方法选取2013年1月至2020年6月于我院ICU住院138例脓毒症伴感染性休克患者。分为羟乙基淀粉氯化钠扩容(A)组和复方氯化钠注射液扩容(B)组。比较两组治疗72小时后,电解质、肌酐、活化部分凝血酶时间(APTT)、凝血酶原时间(PT)、动脉血气分析、PICCO血流动力学监测心脏指数(CI)、心搏指数(SVI)、血管外肺水(EVLW)、肺血管通透性指数(PVPI)、全心舒张末容积指数(GEDI)、中心静脉压(CVP)、水肿情况。结果A组GEDI较B组增加,A组肌酐、乳酸、EVLW、PVPI、水肿较B组少,剩余碱较B组更高,电解质、APTT、PT、CI、SVI、CVP两组没有显著差异。结论感染性休克患者液体复苏,使用羟乙基淀粉氯化钠扩容较晶体液显著改善循环血容量,减少毛细血管渗漏、血管外肺水,减少水肿发生及肾损害,更能显著改善代酸和降低乳酸水平,不增加对凝血功能、电解质及心功能影响。

急性胰腺炎患者早期液体复苏管理审查指标的制订及障碍因素分析

目的 全面评估急性胰腺炎患者早期液体复苏管理相关证据的应用现状,制定审查指标,分析障碍因素及促进因素。方法 以知识转化框架(KTA)为理论框架,确定临床问题,组建循证团队,系统检索、评价及整合证据,制订审查指标及明确审查方法。于2022年5月1日-10月1日进行临床审查,并根据审查结果分析障碍因素及促进因素,制订行动策略。结果 该研究最终纳入15条最佳证据,制订了16条审查指标,其中15条审查指标执行率<60%。对审查结果逐条分析得出主要障碍因素:证据不可及,改变了既往工作模式;潜在采纳者认知度不够,相关知识和技能有待提高,证据转化会增加临床工作量;实践环境缺乏基于证据相关流程和变革所需设备,多学科沟通渠道不畅。主要促进因素:本院为复旦大学循证护理证据应用基地,已有多项循证项目成功转化经验;转化科室为江苏省重点专科,有变革所需要的各类人才储备,医护合作氛围良好,积极性高,学习能力强。结论 急性胰腺炎患者早期液体复苏管理的临床实践与最佳证据间尚存在较大差距,通过深入辨析障碍因素,制定相应的行动策略,促进证据向临床有效转化,以保障急性胰腺炎患者早期液体复苏执行的安全性及合理性。

TIG模式在儿科重症监护室护士的液体复苏管理培训中的效果分析

目的探讨TIG模式在儿科重症监护室(pediatric intensive care unit,PICU)护士液体复苏管理培训中的应用效果。方法按病区将长沙市某三级甲等医院PICU护士分为对照组和观察组,各28例。对照组采用常规的PICU护士液体复苏管理培训方案,观察组采用基于TIG模式的PICU护士液体复苏管理培训方案。比较2组护士对液体复苏管理的知信行水平、核心胜任力及团队合作能力。结果干预后,观察组护士的液体复苏管理的知信行水平、核心胜任力及团队合作能力均好于对照组(t=-5.231,P<0.001;t=-17.618,P<0.001;t=-8.972,P<0.001)。结论基于TIG模式的液体复苏管理培训可提高PICU护士对液体复苏管理的知信行水平、核心胜任力及团队合作能力,值得在临床推广应用。

老年脓毒症休克液体复苏的综合管理策略

老年脓毒症休克的发病率和死亡率随人口老龄化而显著上升。在临床实践中,液体复苏治疗对老年脓毒症休克的管理至关重要,但患者特殊的生理特点使得液体复苏充满挑战。尽管已有多种复苏策略被提出,但液体反应性评估、补液方式、补液速度等关键点在老年脓毒症休克患者中的最佳实践方法仍存在争议。本文就老年脓毒症休克液体应遵循的三个层次四个阶段的复苏综合管理策略作一评述,旨在为临床决策提供参考。

床旁超声指导早期液体复苏治疗脓毒性休克的临床效果分析

目的:分析床旁超声指导早期液体复苏治疗脓毒性休克的临床效果。方法:选择2020年1月—2022年11月滨州市中心医院重症医学科收治的脓毒性休克患者80例作为研究对象,按照随机数字表法分为两组,每组40例。对照组给予目标导向液体复苏治疗,观察组给予床旁超声指导早期液体复苏治疗。比较两组治疗效果。结果:治疗后,观察组机械通气时间、ICU住院时间短于对照组,液体复苏量少于对照组,降钙素原、C反应蛋白水平低于对照组,平均动脉压、中心静脉压、中心静脉血氧饱和度高于对照组(P<0.05)。治疗后,两组序贯器官衰竭评估法评分降低,且观察组低于对照组(P<0.05)。结论:床旁超声指导早期液体复苏治疗脓毒性休克的临床效果较好,可减少液体复苏量,减轻炎性反应,改善血流动力学指标及器官功能,促进患者康复。

中药抗休克合剂对严重烫伤大鼠早期肠损伤的影响

目的观察在高渗盐溶液(HS)补液基础上应用中药抗休克合剂对严重烫伤大鼠早期肠损伤的影响。方法选取32只8周龄SD大鼠,按照随机数表法将其随机分为假伤组、LR组、HS600组、HS600+中药组,每组8只。假伤组大鼠建立假伤模型以及LR组、HS600组、HS600+中药组大鼠建立烫伤模型后,LR组大鼠采用乳酸钠林格注射液(LR)补液,HS600组大鼠采用600 mmol/L HS补液,HS600+中药组大鼠采用600 mmol/L HS补液+中药抗休克合剂灌胃。对比观察模型建立24 h后各组大鼠血Na^(+)浓度,血清炎症因子水平以及小肠组织氧化应激水平与p38丝裂原活化蛋白激酶(p38MAPK)通路活化程度。结果LR组大鼠血Na^(+)浓度明显低于假伤组、HS600组及HS600+中药组(q=14910、32211、30010,P均<0001),且HS600组与HS600+中药组无明显差异(q=2198,P=0130)。LR组、HS600组及HS600+中药组大鼠血清肿瘤坏死因子-α、白细胞介素-10、白细胞介素-18水平以及小肠组织中丙二醛水平和磷酸化p38MAPK与p38MAPK比值均明显高于假伤组(肿瘤坏死因子-α:q=16070、10810、7579,P均<0001;白细胞介素-10:q=15920、20210、23850,P均<0001;白细胞介素-18:q=12750、7562、3897,P<0001、P<0001、P=0049;丙二醛:q=28450、20320、10160,P均<0001;磷酸化p38MAPK与p38MAPK比值:q=54310、15090、9196,P均<0001),且HS600+中药组大鼠血清肿瘤坏死因子-α与白细胞介素-18水平以及小肠组织中丙二醛水平和磷酸化p38MAPK与p38MAPK比值均明显低于LR组与HS600组、白细胞介素-10水平明显高于LR组与HS600组(肿瘤坏死因子-α:q=8494、3932,P<0001、P=0048;白细胞介素-18:q=9357、4165,P<0001、P=0031;丙二醛:q=18290、10160,P均<0001;磷酸化p38MAPK与p38MAPK比值:q=45110、5899,P<0001、P=0001;白细胞介素-10:q=7929、3939,P<0001、P=0047)。LR组、HS600组及HS600+中药组大鼠小肠组织中超氧化物歧化酶水平均明显低于假伤组(q=20880、14120、11110,P均<0001),且HS600+中药组明显高于LR组与HS600组(q=9772、4008,P<0001、P=0043)。结论与单独应用LR或HS补液相比,在HS补液基础上加用中药抗休克合剂可有效降低严重烫伤大鼠机体炎症反应及氧化应激反应程度、抑制p38MAPK通路过度活化,从而减轻早期肠损伤。