| A paper Effects of crystalloid fluid and the whole blood damage control resuscitation on hemodynamics and oxygen dynamics in a swine model of hemorrhagic shock under hypothemia environmentObjective : To study the effects of crystalloid fluid and the whole blood damage control resuscitation on hemodynamics and oxygen dynamics in a swine model of hemorrhagic shock under hypothemia environment.Methods : 36 healthy Bama pigs,weight 20 to 24 kg,were divided into 6 groups a ccording to the different environmental temperature and recovery liquid:normal temperature control group(NC),normal temperature acetated ringer group(NS-L),normal temperature blood group(NB-L),hypothemia control group(HC),hypothemia acetated ringer group(HS-L),hypothemia blood group(HB-L),6 pigs in each group.The normal temperature groups(NC,NS-L,NB-L)weres placed in 20 ~ 22? environment.The hypothemia groups(HC,HS-L,HB-L)were placed in-10? environment.A Swan-Ganz thermal dilution catheter was inserted via the right internal jugular vein into the pulmonary artery.Bilateral femoral arteries were inserted and the left one was used to monitor hemodynamics,the right one was used to withdraw blood.Improved volume-controlled hemorrhage was initiated in each group(a speed of 2.15 ml·kg-1·min-1)within the first 7 minutes and1.15 ml·kg-1·min-1)within the next 13 minutes.After 1-hour shock,group NC and group HC would not be any processing as control groups and the rest of the groups would be recoveried with room temperature acetated ringer's solution or whole blood,group NS-L,NB-L,HS-L,HB-L maintain artery systolic blood pressure(SBP)between80~100mm Hg.The core temperature(Tp),the hemodynamic indexes such as heart rate(HR),mean arterial pressure(MAP),cardiac index(CI),systemic vascular resistance index(SVRI)and the oxygen dynamics such as lactic acid(LA),mixed venous oxygen saturation(Smv O2),oxygen delivery(DO2),oxygen consumption(VO2),oxygen uptake rate(O2ER)were recorded at the point of time before bloodletting(BH),the point of time after bloodletting(AH),the point of time before recovery(R0)and the points of time after recovery(R1 to R6).Record the input of the liquid.Result:1.General conditions and core temperature changesThere were no statistical significance on the body weight,body length and surface area between groups(p > 0.05).Core temperature declined in all normal temperature groups.Group NS-L and group NC decreased at the same degree(p>0.05);The degree of decrease of group NB-L was less than group NC and group NS-L after R3 point(p<0.05).Core temperature declined in all normal temperature groups.Group HS-L consistent with the group HC(p>0.05);The degree of decrease of group HB-L was less than group HC and group HS-L after R2 point(p<0.05).Compared with the normal temperature group,low temperature groups declined significantly(p<0.05).2.hemodynamic change2.1 HR changeHR rised on AH in each normal temperature group.Compared with the group NS-L and group NB-L,group NC were rised significantly on R2,R3 points(p<0.05).Compared with the group NS-L,NB-L was lower on R1,R4,R5,R6 points(p<0.05).HR rised on AH in each low temperature group,Group HC and group HS-L are both decreased,but the degree of decrease of group HS-L was more than group HC(p<0.05);Group HB-L was higher than group HC,HS-L after R1point(p<0.05).Low temperature groups compared with the normal groups,the HR decreased more significantly(p<0.05).2.2 MAP changeMAP decreased on AH in each normal temperature group.Compared with group NS-Land NB-L,group NC was decreased significantly on R4(p<0.05).Compared with group NS-L,NB-L was higher on R2 ~ R6(p<0.05).MAP decreased on AH in each low temperature group.Compared with group HS-Land HB-L,group HC was decreased significantly on R4(p<0.05).Compared with the group HS-L,HB-L significantly increased on R2 ~ R5(p<0.05);Low temperature groups compared with normal temperature groups,compared with the group NC,HC wan significantly higher on R1 ~ R3(p<0.05);Compared with the group NS-L,HS-L was lower after R4 point(p<0.05);Compared with the group NB-L,HB-L was significantly higher on R5(p<0.05).2.3 CI changeCI decreased on AH in each normal temperature group,compared with NS-L and NB-L,group NC were higher on R2,R3 points(p<0.05);Compared with NB-L,NS-L were lower on R5,R6 points(p<0.05).CI decreased on AH in each low temperature group,compared with group HC and HS-L,HB-L was higher on R2~R5(p<0.05);Low temperature groups compared with normal temperature groups,group HS-L was lower than NS-L(p<0.05);Compared with NB-L,HB-L was higher than HB-L on R2,R4 but lower on R5(p<0.05).2.4 SVRI changeSVRI rised on AH in each normal temperature group,then NC,NS-L continued to rise,group NC was higher than group NS-L(p <0.05).NB-L fell on R3,compared with group NC and NS-L,group NB-L was lower after R3 point(p<0.05).SVRI rised on AH in each low temperature group,the group HC was higher than group HS-L and HB-L.HB-Lwas decreased on R3.Compared with group HS-L,HB-L was lower on R3~R6 points(p <0.05).Low temperature groups compared with normal temperature groups,the SVRI were higher(p<0.05).3.Oxygen dynamics change3.1 LA changeLA rised on AH in each normal temperature group,compared with group NC,group NS-L,NB-L was lower after R1(p<0.05);Compared with group NS-L,NB-L was lower after R2(p<0.05).LA rised on AH in each low temperature group,compared with group HC,group HS-L and HB-L was lower after R1(p<0.05);Compared with group HS-L,HB-L was lower on R4,R5(p<0.05);Low temperature groups compared with normal temperature groups,LA were lower(p<0.05).3.2 SmvO2 changeSmvO2 decreased on AH in each normal temperature group,Compared with group NC,NS-L were significantly increased on R0~R2(p<0.05);Compared with group NC,NB-L were significantly increased on R1~R4(p<0.05)Compared with group NS-L,NB-L were significantly increased on R1~R6(p<0.05).Smv O2 decreased on AH in each low temperature group,compared with group HC,HS-L was significantly decreased on R1?R2(p<0.05);compared with group HC,HB-L was significantly increased on R0~R 4(p<0.05);Compared with group HS-L,HB-L was significantly increased on R0~R5(p<0.05).Low temperature groups compared with normal temperature groups,Smv O2 were higher(p<0.05).3.3 DO2 changeDO2 decreased on AH in each normal temperature group,Compared with group NC,NS-L were significantly decreased on R2?R3,but were significantly increased on R4(p<0.05);Compared with group NC,NB-L were significantly increased on R1?R4,but were significantly decreased on R2?R3(p<0.05);Compared with group NS-L,NB-L were higher on R1~R6(p<0.05).DO2 decreased on AH in each low temperature group,compared with group HC,HS-L was decreased on R3(p<0.05);Compared with group HC,HB-L was significantly increased on R1~ R4(p<0.05);Compared with group HS-L,HB-L was significantly increased on R1~R5(p<0.05);Low temperature groups compared with normal temperature groups,DO2 were lower(p<0.05).3.4 VO2 changeThere were no changes on BH~R0 in each normal temperature groups,compared with group NC,NS-L,NB-L were significantly decreased on R2,R3(p<0.05);Compared with group NS-L,NB-L was higher on R2,R6 but lower on R3,R4(p<0.05);There were no changes on BH~R0 in each normal temperature groups,compared with group HC,HS-L significantly decreased on R2,R3(p<0.05);Compared with group HC,HB-L was increased on R1~R4(p<0.05);Compared with group HS-L,HB-L was higher on R1~R5(p<0.05).Low temperature groups compared with normal temperature groups,group HC and HS-L were obviously lower than NC and NS-L after R1(p<0.05);Compared with NB-L,HB-L was lower on R5 but higher on R6(p<0.05).3.5 O2 ER changeO2ER rised on AH in each normal temperature group,compared with group NC,NS-L was significantly decreased on R0~R2(p<0.05),Compared with group NC,NB-L was significantly decreased on R1~R4(p<0.05);Compared with group NS-L,NB-L was lower on R1~R6(p<0.05).O2 ER rised on AH in each low temperature group,compared with group HC,HS-L was lsignificantly decreased on R1~R3(p<0.05);Compared with group HC,HB-L was significantly decreased on R0~ R4(p<0.05);Compared with group HS-L,HB-L was significantly decreased on R0~R5(p<0.05).Low temperature groups compared with normal temperature groups,O2 ER were lower(p<0.05).4.Liquid input comparisonThere was significantly different between group NS-L and group NB-L,the liquid input of group NS-Lwas more than group NB-L(p<0.05);There was significantly different between group HS-L and group HB-L,the liquid input of group HS-Lwas more than group HB-L(p<0.05).B paper Effects of low pressure and high pressure damage control resuscitation on hemodynamics and oxygen dynamics in a swine model of hemorrhagic shock under hypothemia environmentObjective: To study the effects of low pressure and high pressure damage control resuscitation on hemodynamics and oxygen dynamics in a swine model of hemorrhagic shock under hypothemia environment.Methods: 36 healthy Bama swines,weight 20 to 24 kg,were divided into 6 groups according to the environmental temperature and recovery blood pressure(n=6,each):normal temperature control group(NC),normal temperature low blood pressure group(NB-L),normal temperature high blood pressure group(NB-H),low temperature control group(HC),low temperature low blood pressure group(NB-L),low temperature high blood pressure group(NB-H).Placed models of normal temperature groups(NC,NB-L,NB-H)in 20~22? environment.Placed models of low temperature groups(HC,HB-L,HB-H)in-10? environment.Group NC,NB-L,HC,HB-L were disposed the same with paper A;Groups NB-H and HB-H used the methods mentioned in the paper A to build tube mould.1 hour later,room temperature whole blood would be used and maintain SBP on100~120mm Hg.Record the hemodynamic parameters and calculate the oxygen dynamics.Result:1.General conditions and core temperature changesThere were no statistical significance on the body weight,body length and surface area between groups(p > 0.05).Core temperature began to decline on R2 in each normal temperature group.Group NC decreased more than group NB-L,NB-H(p<0.05).Group NB-L was consistent with group NB-H,there was no statistical significance(p>0.05).Core temperature began to decline on R1 in each low temperature group.The group HC decreased more than group HB-L,HB-H(p<0.05);There was no statistical difference between HB-L and HB-H(p>0.05);Compared with normal group,the group in low temperature correspondly were higher after R0 point(p<0.05).2.hemodynamic change2.1 HR changeHR rised on AH in each normal temperature group,compared with group NB-L,NC was higher on R2,R3 and lower on R4(p<0.05);Compared with group NB-H,NC was higher on R2,R3(p<0.05);Compared with group NB-L,NB-H was lower on R4 ~ R6(p<0.05).HR rised on AH in each low temperature group,compared with group NB-L,NB-H,group NC was decreased on R1~R4(p<0.05);Compared with group HB-L,group HB-H was higher on R1,R2,R4(p<0.05).Low temperature groups compared with the normal groups,HR were lower(p<0.05).2.2 MAP changeMAP decreased on AH in each normal temperature groups,compared with group NC,group NB-Lwas increased on R4(p<0.05);Compared with group NC,group NB-H was increased on R1~R4(p<0.05);Compared with group NB-L,group NB-H increased significantly on R1~R6(p<0.05).MAP decreased on AH in each low temperature group,compared with group HC,group HB-L was increased on R4(p<0.05);Compared with group HC,group HB-H was increased on R2~R4(p<0.05);Compared with group HB-L,HB-H was higher on R1~ R3,R5,R6(p<0.05).low temperature groups compared with each normal temperature corresponding groups,MAP were higher(p<0.05)2.3 CI changeCI decreased on AH in each normal temperature group,compared with group NB-L,NB-H,group NC was significantly decreased on R4(p<0.05);Compared with group NB-L,NB-H was higher on R1,R2,and lower on R4,R5(p<0.05).CI decreased on AH in each low temperature group,compared with group HB-L,HB-H,group HC was significantly decreased on R1~R4(p<0.05);Compared with HB-L,HB-H was lower on R3,R4(p<0.05);low temperature groups compared with each normal temperature corresponding groups,CI were lower(p<0.05).2.4 SVRI changeSVRI rised on AH in each normal temperature group,Compared with group NC,group NB-L,NB-H were significantly decreased on R1~ R4(p<0.05);Compared with group NB-L,NB-H was no statistical difference on each point(p>0.05);SVRI rised on AH in each low temperature group,Compared with group HC,group HB-L,HB-H were significantly decreased on R1~R4(p<0.05);Compared with group HB-L,HB-H was lower on R5(p<0.05).low temperature groups compared with each normal temperature corresponding groups,the SVRI were obviously higher(p<0.05).3.Oxygen dynamics change3.1 LA changeLA rised on AH in each normal temperature group,Compared with group NC,group NB-L,NB-H were decreased on R1~R4(p<0.05);Compared with group NB-L,NB-H was lower on R1~R3(p<0.05).LA rised in AH in each low temperature group,compared with group HC,HB-L,HB-H were increased on R ~R4(p<0.05);Compared with group HB-L,HB-H group was lower on R0~R2(p<0.05).low temperature groups compared with each normal temperature corresponding groups,the LA were lower(p<0.05).3.2 Smv O2 changeSmv O2 decreased on AH in each normal temperature group,compared with group NC,NB-L,NB-H was significantly increased on R1~R4(p<0.05);Compared with group NB-L,NB-H was higher on R2 and lower on R3.R5.R6(p<0.05);Smv O2 decreased on AH in each low temperature group,compared with group HC,HB-L,HB-H were significantly increased on R0~R4(p<0.05);Compared with group HB-L,HB-H was increased on R0,R2 and decreased on R3.R5.R6(p<0.05).Low temperature groups compared with each normal temperature corresponding groups,the Smv O2 were higher(p<0.05).3.3 DO2 changeDO2 decreased on AH in each normal temperature group,compared with group NC,group NB-L,NB-H were higher on R1,R4 and lower on R2 and R3(p<0.05);Compared with group NB-L,NB-H was lower on R4,R5(p<0.05).DO2 decreased on AH in each low temperature group,compared with group HC,HB-L,HB-H were significantly increased on R1~R4(p<0.05);Compared with group HB-L,HB-H was higher on R2,R5(p<0.05).Low temperature groups compared with each normal temperature corresponding groups,the DO2 were lower(p<0.05).3.4 VO2 changeVO2 in BH~R0 remained the same in each normal temperature group,compared with group NC,group NB-L was significantly decreased on R2,R3(p<0.05);Compared with group NC,NB-H was significantly decreased on R0~R3(p<0.05).Compared with group NB-L,NB-H was lower on R0,R2 and higher on R6(p<0.05).VO2 in BH~R0 remained the same in each low temperature group,compared with group HC,group HB-L,HB-H were significantly increased on R0~R4(p <0.05);Compared with group HB-L,HB-H was higher on R2,R5 and low in the R6(p<0.05).Low temperature groups compared with each normal temperature corresponding groups,the VO2 were lower(p<0.05).3.5 O2 ER changeO2ER rised on AH in each normal temperature group,compared with group NC,group NB-L,NB-H were significantly decreased on R1~R4(p<0.05);Compared with group NB-L,NB-H was higher on R3,R5,R6(p<0.05).O2 ER rised on AH in each low temperature group,compared with group HC,HB-L,HB-H were significantly decreased on R0~ R4(p<0.05);Compared with group HB-L,HB-H was lower on R0,R6(p<0.05).Low temperature groups compared with each normal temperature corresponding groups,the O2 ER were lower(p<0.05).4.Liquid input comparisonThere was significantly different between group NB-L and group NB-H,the liquid input of group NB-Hwas more than group NB-L(p<0.05);There was significantly different between group HB-L and group HB-H,the liquid input of group HB-H was more than group HB-L(p<0.05).Conclusion:1.Using acetic acid ringer's and whole blood to conduct damage control resuscitation under hypothemia environment,acetic acid ringer's cannot maintain the core temperature,hemodynamics and oxygen dynamics stabled.The whole blood can control the core temperature and maintain hemodynamics and oxygen dynamics stability with smaller amount of liquid.2.Using whole blood to conduct damage control resuscitation by low blood pressure and high blood pressure under hypothemia environment,both two can maintain core temperature,hemodynamics and oxygen dynamics stability,but the amount of liquid in low pressure group is less than the high one.3.Under hypothemia environment and normal temperature,use the acetated ringer's solution to conduct damage control resuscitation may works differently.Under the normal temperature,acetated ringer's solution can maintain stable hemodynamics and oxygen dynamics stability on the early stage,but would not works later.It unable to maintain the hemodynamics and oxygen dynamics stability under hypothemia environment.4.Under hypothemia environment and normal temperature,using the whole blood to conduct damage control resuscitation with low blood pressure or high blood pressure can both maitain the hemodynamics and oxygen dynamics stability. |
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