Effects of oral fluid resuscitation with pyruvate-oral rehydration solution on the hemodynamic parameters and organ functions during shock stage in dogs with a 50% total body surface area full thickness burn / 中华外科杂志

<p><b>OBJECTIVE</b>To study the effect of oral fluid resuscitation with pyruvate sodium-glucose-electrolyte solution (PGES) on hemodynamics, organ functions and mortalities during shock stage in dogs with burn.</p><p><b>METHODS</b>In comparison of oral pyruvate sodium-glucose-electrolyte solution (PGES) with NaHCO₃-glucose-electrolyte solution (HGES), beagle dogs with intubation of the carotid artery, jugular vein and jejunum for 24 hours were subjected to a 50% total body surface area (TBSA) burn, and were divided into three groups: pure burn without fluid resuscitation (NR, n = 8), and two oral fluid resuscitation (each n = 10), in which dogs were given with Pry-GES (OP) or NaHCO₃-GES (OH) according to Parkland formula. The hemodynamic and organ functions were measured serially before burn and 2, 6, 8, 12 and 24 hours after burn at no anaesthesia state A. Twenty-four hours mortality rate following burn was also recorded.</p><p><b>RESULTS</b>Two hours after burn, the mean arterial pressure of NR, OH and OP group was (45 ± 8), (57 ± 8) and (80 ± 9) mmHg (1 mmHg = 0.133 kPa) respectively, which were significantly reduced (t = 16.967, 14.595 and 10.100, all P < 0.05) compared with those before injury ((42 ± 6), (144 ± 6) and (142 ± 6) mmHg respectively), the change of cardiac output, dp/dtmax of left ventricular contractility and intestinal mucosal blood flow had the same trend as the mean arterial pressure. The systemic vascular resistance and organ parameters (Cr, CK-MB, ALT and DAO) in all groups increased obviously (t = -46.894--2.465, all P < 0.05). All measurements of NR group kept worsening, and all died within 24 hours after burn; while those of two oral resuscitation groups had improved gradually (F = 0.001-1.600, all P < 0.05), OP group was significantly superior to OH group (F = 0.013-0.466, P < 0.05). At 24 hours after burn, 6 (6/10) survived in OP group, 4 (4/10) in OH group and 0 (0/8) in NR group.</p><p><b>CONCLUSION</b>The Pyr-GES may be superior to the standard NaHCO₃-GES in the improvement of hemodynamics and organ functions during oral resuscitation in dogs with 50%TBSA full thickness burn.</p>

Effects of oral pyruvate-glucose-electrolyte solution on organ function and survival in resuscitation of lethal hemorrhagic shock rats / 中华急诊医学杂志

Objective To study the effects of oral rehydration with the solution of pyruvate-glucoseelectrolyte (PGES) by comparison with the bicarbonate-glucose-electrolyte solution (BGES) on resuscitation in rats with lethal hemorrhagic shock.Methods Sixty adult male SD rats with intra-gastric tube,and cannulation of femoral artery and vein were subjected to 45％ total blood volume loss from the femoral artery,and then randomly divided into three groups (n =20 in each group):no fluid resuscitation group (NR),oral fluid resuscitation with the PGES group (PGES) and oral fluid resuscitation with the BGES group (BGES).In NR group,the animals received no fluid replacement or any other treatment.Rats in PGES and BGES groups were infused intra-gastrically with pre-warmed PGES or BGES in volume of 2 times shed blood given at 30 min after hemorrhage and completed within 6 hours.Blood samples in each group were collected from the abdominal aorta before or at 0,1,2,4 h post hemorrhage to detect serum alanine aminotransferase (ALT),creatinine (Cr),creatine phosphate kinase isoenzyme (CK-MB) and intestinal fatty acid binding protein (iFABP).Another 84 rats randomly divided into four groups:NR group (n =24),PGES group (n =24),BGES group (n =24),and no hemorrhage group (NH group,n =12).Rats in the three hemorrhage groups were treated the same as described above,and the rats in NH group underwent the same surgical procedure without hemorrhage were served as the sham group.All these rats were observed for their 24-hour survival rates.Results The 24-hour survival rates of PGES and BGES groups were both significantly higher than the rate of NR group (11/24 vs.1/24,x2 =18.087,P ＜0.01 ; 5/24 vs.1/24,x2 =6.445,P ＜ 0.05) ; the survival rate of PGES group was also significantly higher than that of BGES group (11/24 vs.5/24,x2 =4.02,P ＜ 0.05).All levels of ALT,CK-MB,Cr and iFABP in both the NR group and two oral resuscitation groups at 1 h,2 h and 4 h post hemorrhage were significantly higher than those before the blood loss,respectively (P ＜ 0.01).These biomarkers at 2 h,4 h post hemorrhage were significantly lower in the PGES and BGES groups than those in NR group (P ＜ 0.01) ; the serum levels of ALT,CK-MB,Cr and iFABP were significantly lower in the PGES group than those in the BGES group at 2 h and 4 h post hemorrhage,respectively (P ＜ 0.05).Conclusions Present results demonstrated that the pyruvate-enriched oral re-hydration solution (ORS =PGES) was more effective in preserving the organ function and prolonging the animal survival after resuscitation of lethal hemorrhagic shock in comparison with the bicarbonate-containing ORS (BGES).The oral re-hydration solution (PGES) recommended by the World Hygiene Organization (WHO ORS) may require further improvement in oral resuscitation of shock and the PGES may be recommended as a choice of oral re-hydration salts in the treatment of lethal hemorrhagic shock when intravenous administration is not available.

Effects of pyruvate Ringer's solution on erythrocyte deformation function in patients undergoing cardiopulmonary bypass in vitro / 中华麻醉学杂志

Objective To evaluate the effects of pyruvate Ringer' s solution on erythrocyte deformation function in the patients undergoing cardiopulmonary bypass (CPB) in vitro.Methods Thirteen patients of both sexes,aged 25-64 yr,of ASA physical status Ⅱ or Ⅲ (NAHY Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement under CPB were enrolled in the study.At 10 and 60 min of CPB (T1,2) and 60 min after termination of CPB (T3),blood samples 18 ml were drawn from the radial artery and each patient's blood sample was equally divided into 6 parts (3 ml per part).The blood samples were divided into 3 groups (n =13 each):control group (group C),lactated Ringer's solution group (group R),and pyruvate Ringer's solution group (group P).In C,R and P groups,normal saline 1 ml,lactated Ringer's solution 1 ml,and pyruvate Ringer's solution 1 ml were added,respectively,and then the erythrocytes were incubated for 60 min at 37 ℃.At 30 and 60 min of incubation,the erythrocyte rigidity index (ERI) and erythrocyte deformation index (EDI) were detected.Results Compared with C and R groups,the ERI was significantly decreased at 30 and 60 min of incubation at T1,the EDI was decreased at 30 min of incubation at T1,2,and no significant change was found in ERI at T2,3 or in EDI at T3 in group P.There was no significant difference in ERI and EDI at different time points of incubation within groups.Conclusion Pyruvate Ringer's solution can enhance erythrocyte deformation function in the patients undergoing CPB.

Effects of pyruvate sodium on energy metabolism of erythrocytes in dog blood during circulation in cardiopulmonary bypass machine / 中华麻醉学杂志

ObjectiveTo investgate the effects of pyruvate sodium on energy metabolism of erythrocytes in dog blood during circulation in cardiopulmonary bypass machine.MethodsTen healthy adult mongrel dogs of both sexes weighing 12-18 kg were anesthetized with intraperitoneal 2.5％ pentobarbital 25 mg/kg.Femoral artery was cannulated and 500 ml of blood was collected from femoral artery in each dog.Blood samples from the 10 dogs were divided into 2 equal parts (250 ml each).Each part was mixed with 250 ml lactated Ringer's solution (group C) or 250 ml pyruvate sodium (group P).Flow rate of 4 L/min was employed and blood temperature was kept at 30-32 ℃ during circulation in cardiopulmonary bypass machine.The blood sanples were collected before (baseline value,T1 ) and at 30,60,90,120 min of circulation (T2-5) for determination of ATP,ADP and AMP concentrations in RBC.ResultsThe ATP and AMP concentrations were significantly higher at T2-5,while ADP concentration was higher in group P than in group C.ConclusionPyruvate sodium can improve energy metabolism of erythrocytes in dog blood druing circulation in cardiopulmary bypass machine.