Staged resuscitation for uncontrolled hemorrhagic shock induced by simulated abdominal trauma in field battle / 解放军医学杂志

ABSTRACT

Objective To establish an abdominal-trauma-induced uncontrolled hemorrhagic shock (UHS) model, and explore the effect of staged resuscitation. Methods Indwelling catheters were inserted into left ventricle, femoral artery and femoral vein of 50 Sprague-Dawley rats, and then laparotomy was performed. 42 out of the 50 animals were subjected to vascular injury to simulate UHS by infra-renal arterial puncture with 25G needles, and the model was successfully established in 32 rats, for which the animals were divided into 3 groups: control group (n=10), with no resuscitation; hospital-resuscitation group (n=11), resuscitated in early injured stage; and staged-resuscitation group (n=11), resuscitated pre-hospital and then in-hospital. 8 out of the 50 rats, which were not subjected to vascular injury, served as sham-operated group. The mean aortic pressure (MAP), central venous pressure (CVP), serum lactic acid, alanine aminotransferase (ALT) and creatinine (Cr) were determined, and the volume of blood loss and survival time were recorded. Results The MAP decreased from 94.7mmHg to 28.9mmHg 15min after aortic injury in control group and rose slowly after continuous transfusion in staged-resuscitation group. Similar change was found in CVP. Serum lactic acid, ALT and Cr were increased in control group and hospital-resuscitation group at early injured stage, but the increase was delayed in staged-resuscitation group. The mean survival time in control group, hospital-resuscitation group and staged-resuscitation group were 76, 846 and 2480 min, respectively. The 72 h mortalities of the three groups were 100%, 72.7% and 36.4%, respectively. Conclusion Staged resuscitation which is characterized by slowly continuous transfusion at early aid stage cannot increase the blood pressure and circulating blood volume to normal level in UHS, but can reduce the level of serum lactic acid, ALT and Cr, and dose not increase the blood loss. The survival rate and mean survival time can be increased by this method.