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Li Q, Yang Q, Tian C, Guo Y, Liu H, Cheng Y, Bi SZ, Chen JH. Effects of different types of Ringer's solution on patients with traumatic haemorrhagic shock: a prospective cohort study. Eur J Med Res 2024; 29:215. [PMID: 38566152 PMCID: PMC10988935 DOI: 10.1186/s40001-024-01664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/11/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To compare the fluid resuscitation effect of sodium acetate Ringer's solution and sodium bicarbonate Ringer's solution on patients with traumatic haemorrhagic shock. METHOD We conducted a prospective cohort study in our emergency department on a total of 71 patients with traumatic haemorrhagic shock admitted between 1 December 2020 and 28 February 2022. Based on the time of admission, patients were randomly divided into a sodium bicarbonate Ringer's solution group and sodium acetate Ringer's solution group, and a limited rehydration resuscitation strategy was adopted in both groups. General data were collected separately, and the patients' vital signs (body temperature, respiration, blood pressure and mean arterial pressure (MAP)), blood gas indices (pH, calculated bicarbonate (cHCO3-), partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (pCO2) and clearance of lactate (CLac)), shock indices, peripheral platelet counts, prothrombin times and plasma fibrinogen levels were measured and compared before and 1 h after resuscitation. RESULTS The post-resuscitation heart rate of the sodium bicarbonate Ringer's solution group was significantly lower than that of the sodium acetate Ringer's solution group (p < 0.05), and the MAP was also significantly lower (p < 0.05). The patients in the sodium bicarbonate Ringer's solution group had significantly higher pH, cHCO3- and PaO2 values and lower pCO2 and CLac values (p < 0.05) than those in the sodium acetate Ringer's solution group, and the post-resuscitation peripheral platelet counts and fibrinogen levels were significantly higher, with shorter plasma prothrombin times and smaller shock indices (p < 0.001). CONCLUSION Sodium bicarbonate Ringer's solution is beneficial for maintaining MAP at a low level after resuscitation. The use of sodium bicarbonate Ringer's solution in limited fluid resuscitation has positive results and is of high clinical value.
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Affiliation(s)
- Qing Li
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China.
| | - Qiang Yang
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
| | - Chao Tian
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
| | - Yao Guo
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
| | - Hui Liu
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
| | - Yadong Cheng
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
| | - Shu-Zhen Bi
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
| | - Jin-Hua Chen
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
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Xu S, Qiu Z, Zheng C, Li L, Jiang H, Zhang F, Wang Z. Effect of miR-21-3p on lung injury in rats with traumatic hemorrhagic shock resuscitated with sodium bicarbonate Ringer's solution. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1331. [PMID: 36660723 PMCID: PMC9843335 DOI: 10.21037/atm-22-5148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/18/2022] [Indexed: 12/27/2022]
Abstract
Background Restricted fluid resuscitation is the most important early method for treating traumatic hemorrhagic shock (THS). This study sought to explore whether micro ribonucleic acid (miR)-21-3p affected resuscitated THS rats by regulating the glycocalyx and inflammation. Methods MiRNAs extracted from the lung tissues were analyzed by miRNA microarray assays. A rat model of THS was induced by hemorrhage from a left femur fracture. The pathological change in the lung tissues and glycocalyx structure was observed by hematoxylin and eosin staining and a transmission electron microscope examination. The miR-21-3p expression in the lung tissues and serum was detected by real-time quantitative polymerase chain reaction (RT-qPCR). The levels of glycocalyx-related factors and inflammation-related factors were determined by enzyme linked immunosorbent assays. The expression of glycocalyx-related proteins, cell junction-related proteins, and the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt)/nuclear factor kappa B (NF-κB) signaling pathway-related proteins was analyzed by Western blot. Results After RT-qPCR verification, the variation trend of miR-21-3p was in line with expected trends. The mean arterial pressure (MAP) and heart rate (HR) were decreased, and the lung injury and damage to the glycocalyx were all aggravated in the THS rats resuscitated with sodium bicarbonate Ringer's solution (BRS) or sodium lactate Ringer's solution (LRS). The expression of miR-21-3p was decreased in the THS rats resuscitated with BRS and increased in the THS rats resuscitated with LRS, and the upregulation of miR-21-3p further decreased the MAP and HR, and increased the levels of syndecan-1 (SDC-1), heparanase-1 (HPA1), interleukin (IL)-6, IL-1β, and tumor necrosis factor alpha (TNF-α) in the serum of the THS rats resuscitated with BRS. The upregulation of miR-21-3p also increased the expression of SDC-1, HPA1, β-catenin, matrix metallopeptidase (MMP)2, and MMP9, but decreased the expression of E-cadherin (E-cad) and activated the PI3K/Akt/NF-κB signaling pathway in the THS rats resuscitated with BRS and transfected with miR-21-3p compared to that of the THS rats resuscitated with BRS and transfected with miR-negative control (NC). Conclusions miR-21-3p promoted inflammation and glycocalyx damage by activating the PI3K/Akt/NF-κB signaling pathway, thereby aggravating the lung injury in the THS rats resuscitated with BRS.
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Affiliation(s)
- Shugen Xu
- Cheeloo College of Medicine, Shandong University, Jinan, China;,Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China;,Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Zhaolei Qiu
- Department of Emergency Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China;,Institute of Emergency and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Chuanming Zheng
- Department of Emergency Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China;,Institute of Emergency and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Lei Li
- Department of Emergency Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China;,Institute of Emergency and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Hai Jiang
- Department of Emergency Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China;,Institute of Emergency and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Fulong Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China;,Institute of Emergency and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Zhenjie Wang
- Cheeloo College of Medicine, Shandong University, Jinan, China;,Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China;,Department of Emergency Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China;,Institute of Emergency and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
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Chen Y, Xu Z, Song Q, Wang Z, Ji Z, Qiu Z, Cheng F, Jiang H. [Mechanism of ulinastatin in reducing lung inflammatory injury in rats with hemorrhagic shock]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:1232-1238. [PMID: 31801723 DOI: 10.12122/j.issn.1673-4254.2019.10.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the effect of ulinastatin on the inflammatory mediators and their signaling pathways miR-146a/TLR4/NF-κB in rats with hemorrhagic shock. METHODS Seventy-two SD rats were randomly assigned into shock without resuscitation group (SR group, n=24), acetated Ringer's solution resuscitation group (AR group, n=24) and ulinastatin treatment group (n=24). In all the 3 groups hemorrhagic shock models were established by femoral artery bleeding (with the mean arterial pressure maintained at 30-40 mmHg) without resuscitation (in SR group) or with resuscitation (in AR and ulinastatin groups) using acetated Ringer's solution for 30 min at 60 min after the onset of shock. At 1, 4, and 6 h after the shock onset or immediately after shock if the rats died, the lung tissues were taken for measurement of mRNA expressions of miR-146a, tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), IL-4, IL-6 and IL-10 using real-time quantitative PCR and the protein expressions of TLR4, MyD88, IκB-α, p-IκB-α, NF-κB p65, IRAK4, p-IRAK4 (Thr345, Ser346), p-IRAK4 (Thr342) and TRAF6 using Western blotting. The lung histopathology of the rats was examined under optical microscope with HE staining. RESULTS Compared with the SR group, the rats in the AR group showed slightly alleviated inflammatory infiltration in the lung tissues with significantly increased mRNA levels of miR-146a, IL-4 and IL-10 (P < 0.05) and protein expressions of IκB-α, p-IRAK4 (Thr342) and p-IRAK4 (Thr345, ser346) (P < 0.05), and decreased mRNA levels of TNF-α, IL-1 and IL-6 (P < 0.05) and protein expressions of TLR4, MyD88, NF-κB p65, p-IκB-α, IRAK-4 and TRAF6 (P < 0.05). Compared with those in AR group, the rats in ulinastatin group showed further alleviation of inflammatory lung tissue injury, with increased mRNA levels of miR-146a, IL-4 and IL-10 (P < 0.01) and protein expressions of IκB-α, p-IRAK4 and p-IRAK4 (P < 0.01) and decreased mRNA levels of TNF-α, IL-1 and IL-6 (P < 0.01) and protein expressions of TLR4, MyD88, NF-κB p65, p-IκB-α, IRAK-4 and TRAF6 (P < 0.01). CONCLUSIONS Ulinastatin combined with acetated Ringer's solution resuscitation alleviates lung inflammations in rats with hemorrhagic shock possibly by enhancing miR-146a expression to regulate TLR4/NF-κB signaling pathway through a negative feedback mechanism and thus modulate the balance of pro-inflammatory and anti-inflammatory factors.
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Affiliation(s)
- Ying Chen
- Department of Emergency Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Zhipeng Xu
- Department of Emergency Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Qi Song
- Department of Emergency Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Zhenjie Wang
- Department of Emergency Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Zhong Ji
- Department of Emergency Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Zhaolei Qiu
- Department of Emergency Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Feng Cheng
- Department of Emergency Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Hai Jiang
- Department of Emergency Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
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Jönsson S, Melville JM, Becirovic-Agic M, Hultström M. Losartan does not decrease renal oxygenation and norepinephrine effects in rats after resuscitated hemorrhage. Am J Physiol Renal Physiol 2018; 315:F241-F246. [PMID: 29667909 DOI: 10.1152/ajprenal.00095.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Renin-angiotensin-system blockers are thought to increase the risk of acute kidney injury after surgery and hemorrhage. We found that losartan does not cause renal cortical hypoxia after hemorrhage in rats because of decreased renal vascular resistance, but we did not evaluate resuscitation. We aimed to study losartan's effect on renal cortical and medullary oxygenation, as well as norepinephrine's vasopressor effect in a model of resuscitated hemorrhage. After 7 days of losartan (60 mg·kg-1·day-1) or control treatment, male Wistar rats were hemorrhaged 20% of their blood volume and resuscitated with Ringer's acetate. Mean arterial pressure, renal blood flow, and kidney tissue oxygenation were measured at baseline and after resuscitation. Finally, the effect of norepinephrine on mean arterial pressure and renal blood flow was investigated. As expected, losartan lowered mean arterial pressure but not renal blood flow. Losartan did not affect renal oxygen consumption and oxygen tension. Mean arterial pressure and renal blood flow were lower after resuscitated hemorrhage. A smaller increase of renal vascular resistance in the losartan group translated to a smaller decrease in cortical oxygen tension, but no significant difference was seen in medullary oxygen tension, either between groups or after hemorrhage. The effect of norepinephrine on mean arterial pressure and renal blood flow was similar in control- and losartan-treated rats. Losartan does not decrease renal oxygenation after resuscitated hemorrhage because of a smaller increase in renal vascular resistance. Further, losartan does not decrease the efficiency of norepinephrine as a vasopressor, indicating that blood pressure may be managed effectively during losartan treatment.
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Affiliation(s)
- Sofia Jönsson
- Integrative Physiology, Department of Medical Cell Biology, Uppsala University , Uppsala , Sweden
| | - Jacqueline M Melville
- Integrative Physiology, Department of Medical Cell Biology, Uppsala University , Uppsala , Sweden
| | - Mediha Becirovic-Agic
- Integrative Physiology, Department of Medical Cell Biology, Uppsala University , Uppsala , Sweden
| | - Michael Hultström
- Integrative Physiology, Department of Medical Cell Biology, Uppsala University , Uppsala , Sweden.,Anesthesia and Intensive Care, Department of Surgical Sciences, Uppsala University , Uppsala , Sweden
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