Preventive effect of hydrotalcite on stress ulcer in rats after acute brain trauma

Prevention and treatment of stress-induced gastrointestinal bleeding after severe brain injury

AIM: To analyze the prevention and treatment of stress-induced gastrointestinal bleeding after severe brain injury.

METHODS: One hundred and twenty patients with severe brain injury were randomly divided into three groups: A, B and C. Group A was treated by early enteral nutrition plus drug treatment, group B by late enteral nutrition plus drug treatment, and group C by early enteral nutrition. The incidence of stress-induced gastrointestinal bleeding, gastric juice pH and the healing time of oral ulcer were compared between the three groups. The relationship of gastric juice pH and blood glucose level with the incidence of stress-induced gastrointestinal bleeding was analyzed. The clinical effects were observed.

RESULTS: The incidence rate of stress-induced gastrointestinal bleeding (10.00%, 20.00% vs 37.50%, P < 0.05) and gastric juice pH (4.97 ± 0.73, 4.49 ± 0.35 vs 3.05 ± 1.21, P < 0.05 for both) were significantly higher in the group C than in groups A and B, but the average time of ulcer healing was significantly lower in group C (22.16 ± 3.07, 29.02 ± 2.24 vs 33.26 ± 3.61, P < 0.05 for both). The above parameters also differed significantly between groups A and B (P < 0.05 for all). The incidence rate of stress-induced gastrointestinal bleeding was significantly higher in patients with gastric juice pH ≤ 2.45 than in those with gastric juice pH > 2.45 (18.62% vs 15.69%, P < 0.05), but was significantly lower in patients with blood glucose level > 10 mmol/L than in those with blood glucose level > 15 mmol/L (16.38% vs 17.72%, P < 0.05). In total, 25 cases (92.59%) had been treated successfully, and there were 2 cases (7.41%) of failure, of whom 1 had been treated successfully by surgical treatment, and 1 (3.70%) died.

CONCLUSION: Hyperacidity, gastric mucosa damage and hyperglycemia are risk factor leading to stress-induced gastrointestinal bleeding after severe brain injury. Early enteral nutrition and drug treatment can prevent stress-induced gastrointestinal bleeding.

Traumatic stress and hepatocyte apoptosis

Trauma can cause stress in organisms and may promote cell apoptosis and lead to pathological damage. A variety of factors are involved in this process. The mechanisms responsible for traumatic stress-induced apoptosis are complex and controversial, especially in non-nervous organs. The liver plays a key role in metabolism and is one of the target organs of severe stress. Stress-induced hyperglycemia, calcium overload, oxidative stress, ischemia/reperfusion, inflammatory response, and immunosuppression caused by traumatic stress may lead to hepatocyte apoptosis. Thus, it is of great significance to explore the relationship between traumatic stress and hepatocyte apoptosis.