Experimental Study On The Treatment Of Traumatic Hemorrhagic Shock With Hypertonic Sodium Chloride Hydroxyethyl Starch 40

Background Traumatic hemorrhagic shock is a common acute and severe emergency.Emergency in pre-hospital and hospital,because they do not have blood transfusion or surgical conditions,fluid resuscitation is the only choice.But the mechanism of the occurrence and development of traumatic hemorrhagic shock patients is complex,not suitable for fluid resuscitation will further accelerate the development of shock while the body.After acute blood loss caused by tissue hypoperfusion,tissue hypoxia and metabolic disorders,the release of a large number of excitation of inflammatory cytokines caused by systemic inflammatory response（SIRS）and blood coagulation dysfunction,also is to need to pay attention to the treatment of shock.Therefore,actively carry out effective control of bleeding and fluid resuscitation on hemorrhagic patients the early and long-term prognosis is very important.For a long time,the principle of treatment of traumatic shock patients in early stage is to add a lot of blood volume,early fluid resuscitation was full,so Blood pressure as much as possible to restore to the normal level,to ensure the important body organs and tissue perfusion,but with on traumatic hemorrhagic shock pathophysiology and pathogenesis research of deepening,the treatment scheme is further improved.Now the general view that in trauma hemorrhagic shock early limited fluid resuscitation,maintain body hypotension,both by fluid resuscitation appropriate to restore the body tissue and organ perfusion,and can reduce the amount of bleeding,reduce blood dilution,unapt too much to disrupt the body’s compensatory mechanism and internal environment.But for the selection of recovery liquid is still controversial.Purpose To establish an animal model of traumatic hemorrhagic shock,to observe the effect of limited fluid resuscitation,and to study the effect of Hypertonic Sodium Chloride Hydroxyethyl Starch 40 limited fluid resuscitation in the treatment of traumatic hemorrhagic shock.Methods In this experiment the rabbit carotid artery Bloodletting plus femoral trauma method to establish the traumatic hemorrhagic shock animal model and clinical patients in does not have the blood transfusion under the conditions of the emergency treatment process simulation.Select the health of 54 New Zealand rabbits were randomly divided into saline group（0.9% sodium chloride,NS）,Hypertonic Sodium Chloride Hydroxyethyl Starch 40 group（4.2% sodium chloride + 7.6% hydroxyethyl starch,HHS）,2:1 liquid crystal gel compound group（0.9% sodium chloride + 6% hydroxyethyl starch,the crystal and colloid volume ratio of 2:1,NHS）,18 rats in each group,respectively with the model to replicate the success（T0）,30 min after the shock（T1）,60min（T2）,90min（T3）,mean arterial blood pressure measurement（MAP）,heart rate（HR）,prothrombin time（PT）,activated partial thromboplastin time（APTT）,international standard the ratio（INR）,thrombin time（TT）,fibrinogen（Fbg）,Ca²⁺,C reactive protein（CPR）and endothelin-1（ET-1）changes,analysis of changes in level subjects of vital signs,blood coagulation function and plasma endothelin.Statistical analysis using SPSS17.0 software analysis.Results 1.In the early stage of traumatic hemorrhagic shock,there were significant differences in the total amount of liquid used in the three groups of subjects with different types of liquid,p < 0.05,the difference was statistically significant.2.Three groups of experimental subjects MAP value increased gradually with the change of time,each fluid resuscitation after T1,T2,T3 time map and T0 time than p < 0.05,the difference was statistically significant;HR value decreased in each fluid resuscitation and after time T0 HR value compared with p < 0.05,the difference was statistically significant.3.Three groups of experimental subjects PT values change over time was prolonged trend,each fluid resuscitation after T1,T2,T3 time PT value with time（T0）than p < 0.05,with statistical significance,APTT in NS group,the tendency of change is not obvious,and in HHS group APTT values change showed a decrease trend,in the NHS APTT showed an increasing trend,comparative groups after fluid resuscitation APTT values change with time T0 p < 0.05,the difference was statistically significant.4.Three groups of experimental subjects Ca²⁺ changes with time were decreased,each fluid resuscitation after T1,T2,T3 time Ca²⁺ value changes with time（T0）compared to p < 0.05,with statistical significance;INR values in the NS group with the change of time gradually of a downward trend,and in HHS group and NHS group INR value no significant time trend,NS group and HHS group recovery after T1,T2,T3 time INR values change with time t0 compared all p < 0.05 have statistical significance.5.Three groups of models of Fbg change over time showed a tendency to reduce,to T3 to minimum,compared the three groups after resuscitation Fbg in T1,T2,T3 time with T0 time,the p < 0.05,the difference was statistically significant;three groups of model TT with the change of time showed a tendency to reduce,to T3 reached minimum value,the fluid resuscitation group after T1,T2,T3 time TT and T0 time comparison of p > 0.05,the difference was not statistically significant.6.Three groups of experimental subjects recovery after T1,T2,T3 time CPR,IL-6 levels compared with T0 time gradually increased,the difference is statistically significant（p < 0.05）;endothelin-1（ET-1）in each group with the change of time value increased gradually,the HHS group at T2 time duration reached the highest T3 ET-1 levels decreased difference was statistically significant（p < 0.05）.Conclusion Compared with the NS group and the NHS,the HHS group can reduce the input quantity of the liquid,quickly raise blood pressure,inhibition of the coagulation cascade,effective mitigation of the PT,prolongation of APTT values of time,slow Ca²⁺,reduction in the levels of Fbg,preventing fibrinogen of rapid decline,also effectively reduces the inflammatory cytokine release,indicating that the HHS for treatment of trauma hemorrhage shock can not only reduce the disorder of coagulation function,reduce the risk of bleeding,but also can reduce neutrophil infiltration,thereby inhibiting systemic inflammatory response after resuscitation through inhibiting the activity of neutrophils,which may improve the prognosis of the patients.