Guided by aim of improving the survival rate of the injuries, damage control surgery (DCS) have undergone developments from simple gauze packing to planned resuscitation and reoperation for nearly a century, which leads to a great improvement in the treatments. In recent years, the concept of DCS has been more and more widely accepted and applied in many fields other than abdominal trauma. Besides, the technologies have been constantly standardized and the procedures have been more scientific. At the same time, some remarkable progress has been made in the research of DCS, such as new concepts of damage control resuscitation, permissive hypotension, and new technologies such as resuscitative balloon aortic occlusion and hybrid emergency surgery system.

Objective To test the protective effect of a new Ringer's malate solution on intestine's apoptosis caused by hemorrhagic shock in rats.Methods Forty-eight Sprague-Dawley male rats, weighing 280-320 g, were randomly assigned into four groups: sham shock group (group SS), normal saline group (group NS), Ringer's lactate group (group RL) and Ringer's malate (group RM), n=12 each.The group SS was served as control group, the other groups were subjected to 60 min of hemorrhagic shock followed by crystalloid resuscitation.Those rats were sacrificed 3 h after resuscitation.Intestinal tissue was harvested to detect Bcl-2/Bax protein level, the bioactivity of superoxide dismutase (SOD) and malondialdehyde (MDA) level.The level of intestinal cell apotosis was measured using TUNEL method and apoptosis index was calculated.The intestinal histopathology was examined.Results Compared with group SS, the expression of Bcl-2 and the bioactivity of SOD were lower, the level of Bax protein, MDA and apoptotic index were higher in groups NS, RL and RM (P<0.05).Compared with groups NS and RL, the expression of Bcl-2 and the bioactivity of SOD was higher, the level of Bax protein, MDA and apoptotic index were lower in group RM (P<0.05).Histopathological examination showed that group RM was better than group NS and group RL.Conclusion Ringer's malate alleviated intestinal apoptosis caused by hemorrhagic shock in rats.The study suggests that Ringer's malate solution could be a potential new therapeutic agent for fluid resuscitation.

Objective To compare the degree of liver injury during resuscitation with different crystalloid solutions in a rat model of hemorrhagic shock.Methods Forty-eight SPF healthy male SpragueDawley rats,aged 7-9 weeks,weighing 280-320 g,were assigned into 4 groups (n=12 each) using a random number table:sham operation group (group S),normal saline group (group NS),Ringer's lactate solution group (group RL) and Ringer's malate solution group (group RM).Hemorrhagic shock was induced by withdrawing blood from the right internal jugular vein until mean arterial pressure was reduced to 35-45 mmHg which was maintained for 1 h.The internal jugular vein and artery were cannulated after anesthetization,but no animals were subjected to hemorrhage in group S.The crystalloid solution (2 times the volume of blood loss) was infused intravenously over 30 min starting from 1 h of shock.The animals were resuscitated with 0.9％ sodium chloride solution in group NS,with Ringer's lactate solution in group RL,and with Ringer's malate solution in group RM.Mean arterial pressure was continuously monitored and recorded during the experiment.Before shock (T1),at 1 h of shock (T2) and at 4 h after resuscitation (T3),blood samples were collected from the right internal jugular vein for determination of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) concentrations by enzyme-linked immunosorbent assay.Rats were sacrificed at T3,and livers were removed for measurement of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in liver tissues (using colorimetric method) and for examination of pathological changes of liver tissues (with light microscope).Results Compared with group S,the serum ALT and AST concentrations at T2.3 and SOD activity and MDA content at T3 were significantly increased in NS,RL and RM groups (P＜0.05).Compared with group NS or group RL,the serum ALT and AST concentrations were significantly decreased,the SOD activity was increased,and the MDA content was decreased at T3 (P＜0.05),and the pathological changes of liver tissues were significantly attenuated in group RM.Conclusion Ringer's malate solution produces better efficacy than normal saline and Ringer's lactate solution when used for resuscitation and mitigating liver injury in a rat model of hemorrhagic shock.

Objective To study the effects of two types of crystalloids on postoperative inflam-matory reaction during the process of cesarean section.Methods Sixty patients undergoing cesarean section were randomly divided into Ringer lactate solution group (RL)and Ringer acetate solution group (RA)with 30 cases in each group.Before anesthesia,10 ml/kg crystal solution was infused, the infusion rate was 1 5-20 ml·kg-1 ·h-1 .The patients were performed epidural anesthesia in left lateral position.Crystal solution was infused to maintain the blood pressure during the operation.Ve-nous blood was drawn at the beginning of the operation (T1 ),the end of the operation (T2 ),four hours after operation (T3 ),twenty-four hours after operation (T4 )in order to measure the blood plasma value of IL-6,TNF-α,CRP.Results The blood plasma value of IL-6,TNF-α,CRP had no significant differences at T1 ,T4 ;but the value of group RA was significantly higher than that of group RL (P <0.05)at T2 ,T3 .Conclusion Ringer acetate solution causes more significant postop-erative inflammatory cytokine release than Ringer lactate solution does during the process of cesarean section.

Objective To investigate the effects of different doses of dexmedetomidine combined with propofol and remifentanil target controlled infusion (TCI) on postanesthesia recovery of patients in functional endoscopic sinus surgery. Methods Eighty ASA Ⅰor Ⅱ grade patients, scheduled for the endoscopic sinus surgery, were divided into control group (20 cases) and dexmedetomidine group (60 cases) according to the random digits table method. The patients in dexmedetomidine group were given loading dose dexmedetomidine 0.6 μg/kg, then were given dexmedetomidine of different maintenance doses:0.3 μg/(kg·h) in D1 group, 0.6 μg/(kg·h) in D2 group and 0.9 μg/(kg·h) in D3 group. The patients in dexmedetomidine group were given TCI propofol and remifentanil during the maintenance of general anesthesia, rocuronium was administrated intermittently during operation, and bispectral index (BIS) was controlled at 40 - 50. The changes of hemodynamics 5 - 10 min after entering operation room (T0), before induction (T1), 1 min after intubation (T2), 5 min after intubation (T3), before extubation (T4) and 5 min after extubation (T5) were observed. The spontaneous breathing recovery time, call of eye-opening time, extubation time and adverse reaction after surgery were recorded. Moreover, the visual analogue score (VAS) and Ramsay sedation score were used to evaluate the comfort level of patients. Results The mean arterial pressure (MAP) at T5 in control group and D1 group were significantly higher that in D2 group and D3 group, and there were statistical differences (P<0.05). The heart rate at T1-T5 in D1-D3 group were significantly lower than that in control group, and there were statistical differences (P<0.05). The spontaneous breathing recovery time, call of eye-opening time, extubation time in D1 - D3 group were longer than those in control group, but there were no significant differences (P>0.05). The VAS 15 min after extubation in D1 - D3 group were significantly lower than that in control group: (3.7 ± 0.3), (3.1 ± 0.4) and (3.0 ± 0.5) scores vs. (6.2 ± 0.6) scores, and there were statistical differences (P<0.05). The Ramsay sedation scores in D1 - D3 group were significantly higher than that in control group:(2.5 ± 0.2), (2.7 ±0.2) and (5.3 ± 0.3) scores vs. (1.4 ± 0.3) scores. Moreover, Ramsay sedation score in D3 group was significantly higher than that in D1 group and D2 group, and Ramsay sedation score in D2 group was significantly higher than that in D1 group. There were statistical differences (P<0.05). Four and 2 patients occurred nausea vomiting respectively in control group and D1 group within 24 h after operation. Conclusions Dexmedetomidine combined with propofol and remifentanil TCI can maintain hemodynamic stability and improve anesthesia recovery quality.

Objective To evaluate the effect of resuscitation with Ringer′s malate solution on acute lung injury caused by hemorrhagic shock in rats. Methods Forty-eight SPF healthy male Sprague-Dawley rats, aged 7-9 weeks, weighing 280-320 g, were assigned into 4 groups ( n＝12 each) using a random number table method: sham operation group (group S), normal saline group (group NS), Ringer′s lac-tate solution group ( group RL) and Ringer′s malate solution group ( group RM). In NS, RL and RM groups, the model of hemorrhagic shock was established, and rats were resuscitated after 60 min of hemor-rhagic shock. Rats were sacrificed at 3 h after resuscitation, and bronchial alveolar lavage fluid ( BALF) was collected to count neutrophils. Lung tissues were obtained for determination of the wet∕dry weight ratio (W∕D ratio), myeloperoxidase (MPO) activity, and contents of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β) and IL-6. Lung tissues were obtained for examination of the pathological changes. Results Compared with group S, the neutrophil count in BALF, W∕D ratio, MPO activity and contents of TNF-α, IL-1β and IL-6 were significantly increased in NS, RL and RM groups ( P＜0. 05). Compared with NS and RL groups, the neutrophil count in BALF, W∕D ratio, MPO activity and contents of TNF-α, IL-1β and IL-6 were significantly decreased in NS and RL groups (P＜0. 05). Conclusion The severity of acute lung injury is reduced when Ringer′s malate solution is used for resuscitation as compared with that when normal saline and Ringer′s lactate solution are used in a rat model of hemorrhagic shock.