AIM: To test the hypothesis that fluid resuscitation with Ringer's solution enriched with pyruvate(PR), a physiological antioxidant and energy substrate, affords protection of myocardial metabolism and electrophys...AIM: To test the hypothesis that fluid resuscitation with Ringer's solution enriched with pyruvate(PR), a physiological antioxidant and energy substrate, affords protection of myocardial metabolism and electrophysiological performance superior to lactated Ringer's(LR) during hypovolemia and hindlimb ischemia-reperfusion.METHODS: Male domestic goats(25-30 kg) were exsanguinated to a mean arterial pressure of 48 ± 1 mm Hg. Right hindlimb ischemia was imposed for 90 min by applying a tourniquet and femoral crossclamp. LR or PR, infused iv, delivered 0.05 mmol/kg per minute L-lactate or pyruvate, respectively, from 30 min hindlimb ischemia until 30 min post-ischemia. Time controls(TC) underwent neither hemorrhage, hindlimb ischemia nor resuscitation. Goats were sacrificed and left ventricular myocardium biopsied at 90 min fluid resuscitation(n = 6 per group) or 3.5 h later(n = 9 LR, 10 PR, 8 TC).RESULTS: Myocardial 8-isoprostane content, phosphocreatine phosphorylation potential, creatine kinase activity, and heart rate-adjusted QT interval(QTc) vari- ability were evaluated at 90 min resuscitation and 3.5 h post-resuscitation. PR sharply lowered pro-arrhythmic QTc variability vs LR(P < 0.05); this effect persisted 3.5 h post-resuscitation. PR lowered myocardial 8-isoprostane content, a product of oxidative stress, by 39 and 37% during and 3.5 h after resuscitation, respectively, vs LR. Creatine kinase activity fell 42% post-LR vs TC(P < 0.05), but was stable post-PR(P < 0.02 vs post-LR). PR doubled phosphocreatine phosphorylation potential, a measure of ATP free energy state, vs TC and LR(P < 0.05); this energetic enhancement persisted 3.5 h post-resuscitation.CONCLUSION: By augmenting myocardial energy state and protecting creatine kinase activity, pyruvateenriched resuscitation stabilized cardiac electrical function during central hypovolemia and hindlimb ischemiareperfusion.展开更多
Objective: To investigate the dynamic variation and action mechanism of sICAM-1 and p38 mitogen-activated protein kinases (MAPK) signal transduction in human severe trauma and resuscitation, as well as the effect of l...Objective: To investigate the dynamic variation and action mechanism of sICAM-1 and p38 mitogen-activated protein kinases (MAPK) signal transduction in human severe trauma and resuscitation, as well as the effect of lactated Ringer's solution ( LR), 7.5% sodium chloride solution ( HS ) and 20% albumin injection ( ALB ) on the incidence and mortality of multiple organ dysfunction syndrome (MODS).Methods: Seventy-two severe trauma patients (ISS score 16-43) were divided into ISS≤25 and ISS＞25 groups (each group was subdivided into LR, HS and ALB groups). ELISA was used to measure the concentration of sICAM-1. Western blot was used to measure the expression of p38 MAPK.Results: Compared with LR group, the transfusion volume needed for maintaining systolic blood pressure ≥ 90 mm Hg was significantly decreased in HS and ALB groups (P＜0.05). Compared with the control group, the concentration of blood sICAM-1 and the expression of p38 MAPK was elevated from 4 to 48 hours after trauma in all experimental groups (P ＜ 0.05 -0.01 ). At 4, 12, and 24 hours, there was significant correlation between the expression of p38 MAPK and sICAM-1 (P ＜ 0. 01).Compared with LR group, sICAM-1 and p38 MAPK in HS and ALB groups were decreased (P ＜ 0.05). sICAM-1 and p38 MAPK were significantly higher in the group of ISS ＞25 than that of ISS ≤ 25 (P ＜ 0.05 ). MODS incidence and mortality were significantly higher in the group of ISS ＞ 25 than that of ISS ≤ 25 ( P ＜ 0.05 ). MODS incidence and mortality were lower in HS and ALB groups than LR group (P＜0.05).Conclusions: The up-regulation of polymorphonuclear neutrophil-endotheliocytes (PMN-EC) adhesion may be due to the increased sICAM-1 expression during severe trauma. The up-regulation of sICAM-1 expression is correlated with the activation of p38 MAPK. During severe trauma, the levels of sICAM-1 and p38 MAPK, as well as the incidence and mortality of MODS are lower when HS and ALB are used than single lactated LR solution is used.展开更多
目的探讨乳酸林格氏液和羟乙基淀粉130/0.4容量负荷治疗的效果。方法本研究为双盲前瞻性研究。选择2011年7月—2013年3月择期胃肠外科肿瘤手术患者81例,美国麻醉医生分级Ⅰ~Ⅱ,分成2组:Ⅰ组(羟乙基淀粉130/0.4容量负荷组,n=56)和Ⅱ组(...目的探讨乳酸林格氏液和羟乙基淀粉130/0.4容量负荷治疗的效果。方法本研究为双盲前瞻性研究。选择2011年7月—2013年3月择期胃肠外科肿瘤手术患者81例,美国麻醉医生分级Ⅰ~Ⅱ,分成2组:Ⅰ组(羟乙基淀粉130/0.4容量负荷组,n=56)和Ⅱ组(乳酸林格氏液容量负荷组,n=25)。麻醉诱导后予以3次容量负荷,每次3 m L·kg?1羟乙基淀粉130/0.4或者乳酸林格氏液,7 min输毕。麻醉前后、每次容量负荷后稳定5 min,记录平均动脉压(MAP)、每博心脏输出量指数(SVI)、血容量扩张效率和氧供(DO_2)。结果麻醉诱导期间SVI和MAP均降低,两组相当;Ⅰ组和Ⅱ组患者对3次容量负荷的反应性分别为64%对20%(P<0.001)、43%对13%(P<0.001)和23%对14%(P=0.101);而第1或2次容量负荷后Ⅰ组患者达到容量最优化的累计比例低于Ⅱ组(25%对74%,P<0.001;46%对81%,P<0.001),第3次2组差异无统计学意义(88%对89%,P=0.825)。3次容量负荷后SVI上升的幅度Ⅰ组(基础值86%)高于II组(基础值68%)(P<0.001),而MAP变化2组差异无统计学意义。第1次负荷后2种液体的血容量扩张效率相当,第2次和第3次负荷Ⅰ组高于Ⅱ组。麻醉诱导和血液稀释均导致氧供下降,2种液体之间没有区别。结论容量优化治疗中胶体液的容量治疗效果优于晶体液,建议采用胶体液进行容量负荷治疗。展开更多
目的探讨术中输入乳酸林格氏液体和羟乙基淀粉130/0.4氯化钠注射液对腹腔镜下胃肠癌根治术患者术后结局的影响。方法本研究为随机、双盲前瞻性研究。选择2011年7月—2013年3月择期胃肠外科肿瘤大手术患者88例,美国麻醉医生分级（ASA）Ⅰ...目的探讨术中输入乳酸林格氏液体和羟乙基淀粉130/0.4氯化钠注射液对腹腔镜下胃肠癌根治术患者术后结局的影响。方法本研究为随机、双盲前瞻性研究。选择2011年7月—2013年3月择期胃肠外科肿瘤大手术患者88例,美国麻醉医生分级（ASA）Ⅰ~Ⅱ,随机分成4组：Ⅰ组（乳酸林格氏液负荷和维持）,Ⅱ组（羟乙基淀粉130/0.4氯化钠注射液负荷,乳酸林格氏液维持）,Ⅲ组（羟乙基淀粉130/0.4氯化钠注射液负荷和维持）,Ⅳ组（预注乳酸林格氏液体,羟乙基淀粉130/0.4氯化钠注射液负荷,乳酸林格氏液体维持）;负荷治疗以9 m L·L^-1羟乙基淀粉130/0.4氯化钠注射液或者乳酸林格氏液,再以12 m L·L^-1羟乙基淀粉130/0.4氯化钠注射液或者乳酸林格氏液体输注1 h,之后液体治疗根据麻醉医师判断,将心搏出量变异（SVV）值维持在13%左右。术后观察包括术后胃肠功能恢复时间、并发症以及术后住院时间。结果输液顺序不影响术后结局。术中输入乳酸林格氏液体≥2 L以及并发症影响术后肠蠕动恢复时间和进食恢复时间（双因素ANOVA,P=0.020）,但是只有术后并发症延长术后住院时间（P=0.001）。术中输入乳酸林格氏液和并发症作为独立因素均延长进食恢复时间达2 d。术中输入〉1 L的羟乙基淀粉130/0.4氯化钠注射液对术后胃肠功能恢复无影响,而且维持术中尿液分泌优于乳酸林格氏液。结论术中输入乳酸林格氏液延长腹腔镜下胃肠癌术后的胃肠功能恢复时间,而羟乙基淀粉130/0.4氯化钠注射液不影响术后胃肠功能恢复;只有并发症延长住院时间。展开更多
Objective: Evaluation of the effect of Ringer Lactate, as the resuscitative burn fluid according to Parkland Formula, on restoring the levels of body electrolytes and proteins. Design: A retrospective cohort study. Se...Objective: Evaluation of the effect of Ringer Lactate, as the resuscitative burn fluid according to Parkland Formula, on restoring the levels of body electrolytes and proteins. Design: A retrospective cohort study. Setting: The National Burns Unit, Mafraq Hospital, Abu Dhabi, United Arab Emirates (UAE). Patients: One hundred and fifteen patients admitted with fresh burns between 1st of January 2011 and 31st of December 2013, who met inclusion and exclusion criteria. Methods: Team collected demographic and clinical data for each patient using a standard form. Patients received Ringer Lactate solely as the resuscitative burn fluid according to Parkland Formula. Baseline (pre-) and third-day (post-) variables included levels of sodium, potassium, chloride, proteins, and albumin. Researchers then performed paired comparisons of serum electrolytes and protein levels. Results: Mean values showed maintenance of the potassium and chloride levels within the normal range after administering the Ringer Lactate, significant decline in sodium, and a marked hypoproteinaemia and hypoalbuminaemia post-resuscitation. Conclusions: Ringer Lactate used as the mere resuscitative post burn fluid is suboptimal. Sodium supplementation may be required to correct hyponatremia. Colloids, preferably intravenous albumin should be added, as advised by the original Parkland Formula.展开更多
目的:比较超声乳化过程中分别使用乳酸林格液和平衡盐溶液进行灌注,对角膜内皮细胞密度和形态的影响。方法:前瞻性随机对照研究于2017-02/2017-04期间在印度尼西亚日惹市Dr.YAP眼科医院进行。共有年龄相关性白内障患者52例52眼纳入了研...目的:比较超声乳化过程中分别使用乳酸林格液和平衡盐溶液进行灌注,对角膜内皮细胞密度和形态的影响。方法:前瞻性随机对照研究于2017-02/2017-04期间在印度尼西亚日惹市Dr.YAP眼科医院进行。共有年龄相关性白内障患者52例52眼纳入了研究,分为两组,一组26例26眼术中使用乳酸林格液作为灌注液,另一组26例26眼使用平衡盐溶液作为灌注液。术后1、7和28d,评估角膜内皮细胞的密度和形态,同时比较两组患者眼内炎症反应情况。结果:纳入的全部52例52眼接受了超声乳化白内障摘除术联合人工晶状体植入。术后28d,平衡盐溶液组角膜内皮细胞减少了173.96/mm^2,较乳酸林格液组低(253.20/mm^2);角膜内皮细胞变异系数增加了2.92%,也较乳酸林格液组低(3.42%);六角形细胞百分比减少程度(4.30%)较乳酸林格液组(4.84%)低。平衡盐溶液组角膜中央厚度增加程度与林格液组相当(4.69μm vs 4.53μm)。两组角膜内皮细胞相关指标的差异均无显著性。两组之间炎症反应情况也相似。结论:平衡盐溶液和乳酸林格液在避免老年白内障患者超声乳化术后角膜内皮细胞丢失和形态改变方面效果相当。展开更多
基金Supported by Grant#W911NF0910086 from the United States Department of DefensePredoctoral fellowships from the Graduate School of Biomedical Sciences,University of North Texas Health Science Center to Gurji HA and White DW
文摘AIM: To test the hypothesis that fluid resuscitation with Ringer's solution enriched with pyruvate(PR), a physiological antioxidant and energy substrate, affords protection of myocardial metabolism and electrophysiological performance superior to lactated Ringer's(LR) during hypovolemia and hindlimb ischemia-reperfusion.METHODS: Male domestic goats(25-30 kg) were exsanguinated to a mean arterial pressure of 48 ± 1 mm Hg. Right hindlimb ischemia was imposed for 90 min by applying a tourniquet and femoral crossclamp. LR or PR, infused iv, delivered 0.05 mmol/kg per minute L-lactate or pyruvate, respectively, from 30 min hindlimb ischemia until 30 min post-ischemia. Time controls(TC) underwent neither hemorrhage, hindlimb ischemia nor resuscitation. Goats were sacrificed and left ventricular myocardium biopsied at 90 min fluid resuscitation(n = 6 per group) or 3.5 h later(n = 9 LR, 10 PR, 8 TC).RESULTS: Myocardial 8-isoprostane content, phosphocreatine phosphorylation potential, creatine kinase activity, and heart rate-adjusted QT interval(QTc) vari- ability were evaluated at 90 min resuscitation and 3.5 h post-resuscitation. PR sharply lowered pro-arrhythmic QTc variability vs LR(P < 0.05); this effect persisted 3.5 h post-resuscitation. PR lowered myocardial 8-isoprostane content, a product of oxidative stress, by 39 and 37% during and 3.5 h after resuscitation, respectively, vs LR. Creatine kinase activity fell 42% post-LR vs TC(P < 0.05), but was stable post-PR(P < 0.02 vs post-LR). PR doubled phosphocreatine phosphorylation potential, a measure of ATP free energy state, vs TC and LR(P < 0.05); this energetic enhancement persisted 3.5 h post-resuscitation.CONCLUSION: By augmenting myocardial energy state and protecting creatine kinase activity, pyruvateenriched resuscitation stabilized cardiac electrical function during central hypovolemia and hindlimb ischemiareperfusion.
文摘Objective: To investigate the dynamic variation and action mechanism of sICAM-1 and p38 mitogen-activated protein kinases (MAPK) signal transduction in human severe trauma and resuscitation, as well as the effect of lactated Ringer's solution ( LR), 7.5% sodium chloride solution ( HS ) and 20% albumin injection ( ALB ) on the incidence and mortality of multiple organ dysfunction syndrome (MODS).Methods: Seventy-two severe trauma patients (ISS score 16-43) were divided into ISS≤25 and ISS＞25 groups (each group was subdivided into LR, HS and ALB groups). ELISA was used to measure the concentration of sICAM-1. Western blot was used to measure the expression of p38 MAPK.Results: Compared with LR group, the transfusion volume needed for maintaining systolic blood pressure ≥ 90 mm Hg was significantly decreased in HS and ALB groups (P＜0.05). Compared with the control group, the concentration of blood sICAM-1 and the expression of p38 MAPK was elevated from 4 to 48 hours after trauma in all experimental groups (P ＜ 0.05 -0.01 ). At 4, 12, and 24 hours, there was significant correlation between the expression of p38 MAPK and sICAM-1 (P ＜ 0. 01).Compared with LR group, sICAM-1 and p38 MAPK in HS and ALB groups were decreased (P ＜ 0.05). sICAM-1 and p38 MAPK were significantly higher in the group of ISS ＞25 than that of ISS ≤ 25 (P ＜ 0.05 ). MODS incidence and mortality were significantly higher in the group of ISS ＞ 25 than that of ISS ≤ 25 ( P ＜ 0.05 ). MODS incidence and mortality were lower in HS and ALB groups than LR group (P＜0.05).Conclusions: The up-regulation of polymorphonuclear neutrophil-endotheliocytes (PMN-EC) adhesion may be due to the increased sICAM-1 expression during severe trauma. The up-regulation of sICAM-1 expression is correlated with the activation of p38 MAPK. During severe trauma, the levels of sICAM-1 and p38 MAPK, as well as the incidence and mortality of MODS are lower when HS and ALB are used than single lactated LR solution is used.
文摘目的探讨乳酸林格氏液和羟乙基淀粉130/0.4容量负荷治疗的效果。方法本研究为双盲前瞻性研究。选择2011年7月—2013年3月择期胃肠外科肿瘤手术患者81例,美国麻醉医生分级Ⅰ~Ⅱ,分成2组:Ⅰ组(羟乙基淀粉130/0.4容量负荷组,n=56)和Ⅱ组(乳酸林格氏液容量负荷组,n=25)。麻醉诱导后予以3次容量负荷,每次3 m L·kg?1羟乙基淀粉130/0.4或者乳酸林格氏液,7 min输毕。麻醉前后、每次容量负荷后稳定5 min,记录平均动脉压(MAP)、每博心脏输出量指数(SVI)、血容量扩张效率和氧供(DO_2)。结果麻醉诱导期间SVI和MAP均降低,两组相当;Ⅰ组和Ⅱ组患者对3次容量负荷的反应性分别为64%对20%(P<0.001)、43%对13%(P<0.001)和23%对14%(P=0.101);而第1或2次容量负荷后Ⅰ组患者达到容量最优化的累计比例低于Ⅱ组(25%对74%,P<0.001;46%对81%,P<0.001),第3次2组差异无统计学意义(88%对89%,P=0.825)。3次容量负荷后SVI上升的幅度Ⅰ组(基础值86%)高于II组(基础值68%)(P<0.001),而MAP变化2组差异无统计学意义。第1次负荷后2种液体的血容量扩张效率相当,第2次和第3次负荷Ⅰ组高于Ⅱ组。麻醉诱导和血液稀释均导致氧供下降,2种液体之间没有区别。结论容量优化治疗中胶体液的容量治疗效果优于晶体液,建议采用胶体液进行容量负荷治疗。
文摘目的探讨术中输入乳酸林格氏液体和羟乙基淀粉130/0.4氯化钠注射液对腹腔镜下胃肠癌根治术患者术后结局的影响。方法本研究为随机、双盲前瞻性研究。选择2011年7月—2013年3月择期胃肠外科肿瘤大手术患者88例,美国麻醉医生分级（ASA）Ⅰ~Ⅱ,随机分成4组：Ⅰ组（乳酸林格氏液负荷和维持）,Ⅱ组（羟乙基淀粉130/0.4氯化钠注射液负荷,乳酸林格氏液维持）,Ⅲ组（羟乙基淀粉130/0.4氯化钠注射液负荷和维持）,Ⅳ组（预注乳酸林格氏液体,羟乙基淀粉130/0.4氯化钠注射液负荷,乳酸林格氏液体维持）;负荷治疗以9 m L·L^-1羟乙基淀粉130/0.4氯化钠注射液或者乳酸林格氏液,再以12 m L·L^-1羟乙基淀粉130/0.4氯化钠注射液或者乳酸林格氏液体输注1 h,之后液体治疗根据麻醉医师判断,将心搏出量变异（SVV）值维持在13%左右。术后观察包括术后胃肠功能恢复时间、并发症以及术后住院时间。结果输液顺序不影响术后结局。术中输入乳酸林格氏液体≥2 L以及并发症影响术后肠蠕动恢复时间和进食恢复时间（双因素ANOVA,P=0.020）,但是只有术后并发症延长术后住院时间（P=0.001）。术中输入乳酸林格氏液和并发症作为独立因素均延长进食恢复时间达2 d。术中输入〉1 L的羟乙基淀粉130/0.4氯化钠注射液对术后胃肠功能恢复无影响,而且维持术中尿液分泌优于乳酸林格氏液。结论术中输入乳酸林格氏液延长腹腔镜下胃肠癌术后的胃肠功能恢复时间,而羟乙基淀粉130/0.4氯化钠注射液不影响术后胃肠功能恢复;只有并发症延长住院时间。
文摘Objective: Evaluation of the effect of Ringer Lactate, as the resuscitative burn fluid according to Parkland Formula, on restoring the levels of body electrolytes and proteins. Design: A retrospective cohort study. Setting: The National Burns Unit, Mafraq Hospital, Abu Dhabi, United Arab Emirates (UAE). Patients: One hundred and fifteen patients admitted with fresh burns between 1st of January 2011 and 31st of December 2013, who met inclusion and exclusion criteria. Methods: Team collected demographic and clinical data for each patient using a standard form. Patients received Ringer Lactate solely as the resuscitative burn fluid according to Parkland Formula. Baseline (pre-) and third-day (post-) variables included levels of sodium, potassium, chloride, proteins, and albumin. Researchers then performed paired comparisons of serum electrolytes and protein levels. Results: Mean values showed maintenance of the potassium and chloride levels within the normal range after administering the Ringer Lactate, significant decline in sodium, and a marked hypoproteinaemia and hypoalbuminaemia post-resuscitation. Conclusions: Ringer Lactate used as the mere resuscitative post burn fluid is suboptimal. Sodium supplementation may be required to correct hyponatremia. Colloids, preferably intravenous albumin should be added, as advised by the original Parkland Formula.
文摘目的:比较超声乳化过程中分别使用乳酸林格液和平衡盐溶液进行灌注,对角膜内皮细胞密度和形态的影响。方法:前瞻性随机对照研究于2017-02/2017-04期间在印度尼西亚日惹市Dr.YAP眼科医院进行。共有年龄相关性白内障患者52例52眼纳入了研究,分为两组,一组26例26眼术中使用乳酸林格液作为灌注液,另一组26例26眼使用平衡盐溶液作为灌注液。术后1、7和28d,评估角膜内皮细胞的密度和形态,同时比较两组患者眼内炎症反应情况。结果:纳入的全部52例52眼接受了超声乳化白内障摘除术联合人工晶状体植入。术后28d,平衡盐溶液组角膜内皮细胞减少了173.96/mm^2,较乳酸林格液组低(253.20/mm^2);角膜内皮细胞变异系数增加了2.92%,也较乳酸林格液组低(3.42%);六角形细胞百分比减少程度(4.30%)较乳酸林格液组(4.84%)低。平衡盐溶液组角膜中央厚度增加程度与林格液组相当(4.69μm vs 4.53μm)。两组角膜内皮细胞相关指标的差异均无显著性。两组之间炎症反应情况也相似。结论:平衡盐溶液和乳酸林格液在避免老年白内障患者超声乳化术后角膜内皮细胞丢失和形态改变方面效果相当。
