Protection Against Intestinal And Remote Organ Injuries From Hemorrhagic Shock By Direct Peritoneal Resuscitation With Pyruvate In Rats

Part 1 Effect of Direct Peritoneal Resuscitation with Pyruvate on Intestinal Injury from Hemorrhagic Shock in RatsObjective We explored the effects of direct peritoneal resuscitation (DPR) with pyruvate-peritoneal dialysis solution (PDS) following intravenous resuscitation (VR) on intestinal ischemia-reperfusion injury (IRI) in rats with hemorrhagic shock (HS).Methods Fifty rats were randomly assigned equally to five groups. In Group SHAM, a surgical operation was performed on rats without shock or resuscitation. In Group VR, rats were only subjected to intravenous resuscitation. In the Groups NS, LA and PY, DPR was performed with normal saline (NS), lactate-based PDS (Lac-PDS) and pyruvate-based PDS (Pyr-PDS), respectively, after VR. Mean arterial pressure (MAP) was continuously monitored in the right common carotid artery. Two hours after resuscitation, the wet weight/dry weight (WW/DW) of the intestine was determined. The intestinal mucosal damage index (IMDI) was estimated and ultrastructural changes in the intestinal mucosa were observed.Results Two hours after HS and resuscitation, the increase in intestinal WW/DW declined significantly in rats from Groups LA and PY compared with Groups VR and NS (P<0.05), while Group PY was more advantageous in the change of this parameter (P?0.05). The IMDI and ultrastructural changes were also improved in Groups LA and PY when compared with Groups VR and NS (P?0.05), and protection was more apparent with Pyr-PDS than Lac-PDS (P?0.05).Conclusion DPR with Lac-PDS and Pyr-PDS following VR alleviated intestinal injury from hemorrhagic shock in rats, and Pyr-PDS was superior to Lac-PDS in its protective effect.Part 2 Effects of Direct Peritoneal Resuscitation with Pyruvate on Acid-Base Disturbance and Remote Organ Injuries from Hemorrhagic Shock in Rats..Objective We explored the effects of direct peritoneal resuscitation (DPR) with pyruvate-peritoneal.dialysis solution.(.PDS):followaving intravenous resuscitation (VR) on acid-base disturbance and remote organ injuries in rats with hemorrhagic shock (HS).Methods. Fifty.rats.were.randomfy assigned equally to five groups.In Group. SHAM, a, surgical, operation was performed on rats, without shock or resuscitation. In Group VR, rats were only subjected to intravenous resuscitation. In the Groups NS, LA and PY,DPR was performed with norrnal(NS) lactate-based PDS (Lac-PDS) and pyruvate-based PDS (Pyr-PDS), respectively, after VR. Mean arterial pressure (MAP) was continuous monitored in the-right common carotid artety. Two hours after resuscitation, the Factate level, pHa, PaO2 paCO2 and base excess (BE) in arterial blood were.determined The pathological morphology of hepatic tissue and renal tissue was observed and evaluated with the light microscope.Results Two hours after HS and resuscitation, the increase in arterial blood lactate and PaCO2 declined significantly in rats from. Groups LA.and.PY compared with. Groups VR and NS (P?0.05), while Group PY was more advantageous in the changes of these parameters (p<0.05). The decrease in arterial blood pHa, PaO2 and BE declined signigicantly in rats from Groups. J A and P Y compared with Greup V.R and NS (P?0.05), while Group PY was more advantageous in the changes of these parameters(p?0.05)The pathological mjuries of hepatic tissue and renal tissue were alleviated in Groups LA and PY when compared with Groups VR and NS (P?0.05), and protection was more apparent with pyr-PDS(p?0.05)Conclusion DPR with Lac-PDS and Pyr-PDS following VR alleviated acid-base disturbance and remote organ injuries from hemorrhagic shock in rats, and Pyr-PDS was superior to Lac-PDS in its protective effect: Shock in Rats..Part 3 Protective Mechanism against Intestinal Injury from Hemorrhagic Shock by Direct Peritoneal Resuscitation with Pyruvate in RatsObjective We explored the protection of direct peritoneal resuscitation (DPR) with pyruvate-peritoneal dialysis solution (PDS) following intravenous resuscitation (VR) on intestinal ischemia-reperfusion injury (IRJ) in rats with hemorrhagic shock (HS) and the possible mechanism.Methods Fifty rats were.randomly assigned equally to five groups. In Group SHAM, a surgical operation was performed on rats without shock or resuscitation. In Group VR, rats were only subjected to intravenous resuscitation. In the Groups NS, LA and PY, DPR was performed with normal saline (NS), lactate-based PDS (Lac-PDS) and pyruvate-based PDS (Pyr-PDS), respectively, after VR. Mean arterial pressure (MAP) was continuously monitored in the right common carotid artery. Two hours after resuscitation, malondialdehyde (MDA), superoxide dismutase (SOD), myeloperoxidase (MPO), nitric oxide (NO), interleukin-6 (IL-6) and tumor necrosis factor a (TNF-a) levels of the intestine were measured.Results Two hours after hemorrhagic shock and resuscitation, HS resulted in a significant increase in MDA levels and MPO activity (P?O.05), and was accompanied by overexpression of IL-6 and TNF-a (P?O.05) and a reduction in SOD activity and NO levels (P?O.05). These changes were significantly attenuated by Lac-PDS and Pyr-PDS at 2 h after resuscitation (P?O.05), and Pyr-PDS showed more effective protection for the intestine than Lac-PDS (P?O.05).Conclusion DPR with Lac-PDS and Pyr-PDS following VR alleviated intestinal injury and-remote orgarr injuries from hemonrrhagic shock in rats, and Pyr-PDS was superior to Lac-PDS in its protective effect. Mechanisms of action might include the elimination of free oxygen radicals, reduction of neutrophil infiltration, inhibition of the inflammatory response and regulation of intestinal mucosal blood flow and barrier function.