| Background and ObjectiveThe liver is the most common injury in blunt abdominal trauma,and its functionality will be affected in the presence of hemorrhagic shock.Fluid resuscitation is an important method of treating patients with traumatic hemorrhagic shock.At present,balanced salt solution is the most widely used.Lactated ringer’s solution(LRS)and Bicarbonated ringer’s solution(BRS)are balanced salt solutions.The difference is that LRS mainly corrects acidosis through bicarbonate produced by liver metabolism,while BRS can provide bicarbonate without liver metabolism.However,there are few studies comparing the two at present.Therefore,we proposed a hypothesis:Is there an advantage in using Bicarbonate ringer’s solution for fluid resuscitation compared to Lactated ringer’s solution on hemorrhagic shock due to liver trauma?This experiment was designed to explore the effects of different balanced salt solutions on hemodynamics,acid-base balance and organ function in a porcine model of hemorrhagic shock due to liver trauma.MethodsAll experimental porcines were randomly assigned to 4 groups(4 in each group,16 in total),including a sham-operated group(Sham group)without operation and fluid infusion and Normal saline(NS)group,LRS group and BRS group with operation and fluid infusion.Infusion was continued for 6 hours,and various experimental data were collected.ResultsThe cardiac index(CI)of the LRS group increased significantly at the 0.5th hour of fluid infusion(2.16±0.34vs1.70±0.37,L/min/m2,P<0.01),and the CI of the BRS group started to increase significantly at the 2nd hour of fluid infusion(2.76±0.08vsl.85±0.29,L/min/m2,P<0.01).The stroke volume index(SVI)of the LRS group increased significantly at the 0.5th hour of fluid infusion(13±3vs11±4,m1/m2,P<0.05),and the SVI of BRS group increased significantly at the 6th hour of fluid infusion(29±2vs12±2,ml/m2,P<0.05).The global end-diastolic volume index(GEDI)of the LRS group was significantly increased at the 6th hour of fluid infusion(364±91 vs252±73,m1/m2,P<0.05).The pulse pressure variability(PPV)in the LRS group was significantly lower at the 6th hour(10±3vs22±5,%,P<0.01).Compared with the NS group,the systemic vascular resistance index(SVRI)of the LRS group was significantly different at the 4th hour of infusion(1875±384vs2815±618,dyn · s·cm-5 m2,P<0.05),but no difference was found in the BRS group.The BE value of the LRS group had a significant increase in the first and second hours of fluid replacement(0.65±3.4、2.4±2.4vs-1.3±3.2,mmol/L,P<0.05).And there was a significant difference between the LRS group and the NS group at 6 hours of fluid infusion(5.4±1.5vs-0.7±0.6,mmol/L,P<0.05).There were significant differences in chloride ion concentration between LRS group and NS group at the 4th and 6th hour afterinfusion(100±2vs109±3,100±1vs109=3,mmol/L,P<0.01).Compared with the NS group,No significant differences were found in the LRS group and the BRS group showed the histopathology of plasma creatinine,blood urea nitrogen,neutrophil gelatinase-.associated lipocalin(NGAL)and HE staining of glomeruli and tubules.ConclusionsLRS and BRS improved hemodynamics better than NS in our experiments,among them,LRS is better than BRS in improving CI,SVI,GEDI,PPV and SVRI.The ability of LRS to correct acid is better than that of BRS,and it can improve the level of BE value faster.Compared with NS,LRS had a significant difference in the change of chloride concentration,but BRS had no significant difference.No significant difference was found in the effects of LRS,BRS and NS on renal function. |
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