Effect Of Initial Fluid Resuscitation On Septic Shock And Its Mechanism

PARTⅠ Clinical study on the effect of the completion time of initial 30 mL/kg fluid resuscitation on the prognosis of patients with septic shockObjectiveTo investigate the effect of the completion time of initial 30 mL/kg fluid resuscitation on the prognosis of patients with septic shock.MethodsA prospective observational study was conducted.The inpatients with septic shock admitted to intensive care unit（ICU）of Subei People’s Hospital of Jiangsu Province,Affiliated Hospital of Yangzhou University and Jiangdu People’s Hospital from October 1st,2018 to September 30th,2020 were enrolled.The general data including gender,age,body mass index（BMI）,patient source,site of infection,acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score,sequential organ failure assessment（SOFA）score,arterial blood lactate（Lac）,fluid resuscitation dose,completion time of initial 30 mL/kg fluid resuscitation,mechanical ventilation,incidence of acute renal injury（AKI）,continuous renal replacement therapy（CRRT）,length of ICU stay and 28-day mortality.The relationship between the completion time of initial 30 mL/kg fluid resuscitation and AS OFA score（the difference between SOFA score 3 hours after fluid resuscitation and initial SOFA score）was analyzed.In addition,the completion time（T）of initial 30 mL/kg fluid resuscitation was divided into T≤1 hour group,1 hour3 hours group,the prognosis among the groups was compared.Results① A total of 131 patients were enrolled,including 94 males and 37 females with an average age of（68.3±14.9）years old.The median APACHE Ⅱ score was 27（21,34）,the median of initial SOFA score was 12（10,14）,the median of initial Lac was 5.0（3.4,7.1）mmol/L,and the most common source of infection was pulmonary,total of 87 patients（66.41%）.The completion time of initial 30mL/kg fluid resuscitation and ΔSOFA score fitted the Logistic curve,which suggested that the early or slow completion time of initial fluid resuscitation had adverse effects on the prognosis of patients with septic shock.② There was no significant difference in infection site,APACHE Ⅱ score,initial Lac,and initial SOFA score among different completion time of initial 30mL/kg fluid resuscitation groups.The 28day mortality was the highest in the T ≤1 hour group（64.29%）,and the lowest in the 1 hour3 hours,the difference among the groups was statistically significant（P<0.01）.Further study and analysis showed that the respiratory support rate,the incidence of AKI and the patients of CRRT in the T ≤1 hour group were significantly higher than those in the 1 hour3 hours group[respiratory support rate:78.57%vs.75.51%,42.86%,75.00%;incidence of AKI:57.14%vs.20.41%,21.43%,50.00%;CRRT（cases）:15 vs.0,2,2],the differences among the groups was statistically significant（all P<0.05）.ConclusionsCompletion of initial 30mL/kg fluid resuscitation in 1-2 hours after septic shock may reduce the 28-day mortality and improve organ dysfunction,and initial fluid resuscitation prematurely or too late may increase 28-day mortality.But further research and verification are needed.PART Ⅱ Effect of initial fluid resuscitation on endothelial glycocalyx in septic shock ratsObjectiveTo explore the effects of different does of initial fluid resuscitation on endothelial glycocalyx in rats with septic shock.Methods30 rats were randomly divided into 5 groups:one group was normal group,and the others were septic shock groups.And the left 4 groups for initial fluid resuscitation of 30ml/kg,finishing time were lhour or 3hour,and the initial resuscitation fluid were 0.9%saline or sodium bicarbonate Ringer’s solution.After the completion of initial fluid resuscitation,a lood sample is left for blood gas analysis,IL-6 and Heparan sulfate（HS）.Pathological analysis of the lungs,liverkidneys is carried out after the death.ResultsAfter the initial fluid resuscitation,pH was lower in the 1hNS group compared with 1hBRS group;the Na+level in the blood is higher in the 3hNS group compared with 3hBRS group;HCO3-level in the blood is lower in the 1hNS group compared with 1hBRS group,and HCO3 level in the blood is lower in the 3hNS group compared with 3hBRS group;IL-6、HS level in the blood is lower in the 3hBRS group compared with 3hNS group.ConclusionsInitial resuscitation fluid of 30ml/kg sodium bicarbonate Ringer within the first 3 hours can reduce the damage of endothelial glycocalyx in rats with septic shock,which may be du e to the reduction of metabolic acidosis and inhibition of inflammation.