Effects of limited fluid resuscitation on immune function and inflammatory mediators in patients with multiple bone fractures complicated with traumatic hemorrhagic shock / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the effects of limited fluid resuscitation (LFR) on immune function and inflammatory mediators in patients with multiple bone fracturescomplicated with traumatic hemorrhagic shock. Methods One hundred and two patients with multiple bone fractures complicated with traumatic hemorrhagic shock admitted to the Affiliated Hospital of Medical College of Ningbo University from January 2014 to June 2016 were enrolled, and they were divided into a LFR group and a early sufficient routine fluid resuscitation (RFR) group by random number table, each group 51 cases. After admission, the patients in the two groups underwent bandaging and hemostasis at the traumatic sites and preoperative management was prepared. The patients in RFR group were treated with early sufficient RFR, while LFR group was treated with LFR. The changes of hematocrit (HCT), blood platelet count (PLT), prothrombin time (PT), blood lactic acid and immune cells, inflammatory mediators and micro RNA-155 (miR-155) were observed in patients of the two groups at 4 hours after resuscitation.Results Compared with RFR group, the resuscitation time (hours 3.67±1.45 vs. 5.14±1.61), levels of PT (s 11.43±2.21 vs. 15.73±2.52), serum lactic acid (mmol/L 3.35±0.15 vs. 3.81±0.25), tumour necrosis factor-α [TNF-α (ng/L) 14.10±3.39 vs. 16.28±3.47], interleukin [IL-10 (ng/L) 31.43±10.51 vs. 40.09±13.23, IL-6 (ng/L) 490.10±55.13 vs. 610.30±63.15] and endothelin-1 [ET-1 (pg/L) 183.35±30.51 vs. 250.01±31.23] in LFR group were significantly decreased (allP < 0.01), while PLT (×109/L 134.58±28.13 vs. 108.12±30.35), HCT (×10-2 0.34±0.04 vs. 0.24±0.05), miR-155 (0.15±0.02 vs. 0.08±0.02) and CD4+CD25+ regulatory T cell [CD4+CD25+Treg (×10-2) 2.28±0.47 vs. 2.10±0.39] in LFR group were obviously increased (allP < 0.01).Conclusions Using LFR in the emergency treatment of patients with multiple bone fractures complicated with traumatic hemorrhagic shock can effectively shorten the resuscitation time, regulate the patients' coagulation function, reduce the unnecessary excessive liquid infusion, improve immune status and decrease the degree of inflammatory reaction.