OBJECTIVETo explore the effects of resuscitation with different kinds of colloids on oxygen metabolism of swine during shock stage of burn injury.

METHODSEighteen Guangxi Bama miniature swine were inflicted with 40% TBSA full-thickness burn on the back. And then they were divided into succinylated gelatin group (S) , hydroxyethyl starch group (H), and allogeneic plasma group (A) according to the random number table, with 6 swine in each group. The fluid resuscitation was begun at post injury hour (PIH) 2. The colloids used in groups S, H, and A were respectively succinylated gelatin, 60 g/L hydroxyethyl starch 130/0.4, and allogeneic plasma. The blood pressure, urine volume, heart rate, and central venous pressure (CVP) were recorded before injury and at the first and second PIH 24. The volume of resuscitation fluid was recorded at the first and second PIH 24. The changes in oxygen delivery., oxygen consumption, oxygen extraction ratio and D-lactate were determined and calculated before injury and at PIH 4, 8, 24, and 48. Data were processed with analysis of variance of repeated measurement, one-way analysis of variance and LSD test.

RESULTSThere were no statistically significant differences among the three groups in blood pressure, urine volume, heart rate, and CVP at each time point (with P values above 0. 05). There were no statistically significant differences in resuscitation fluid volume among the three groups at the first and second PIH 24 (with F values respectively 0. 239 and 2. 023, P values respectively 0. 790 and 0. 167). The oxygen consumption of swine in group S was (201 ± 38) L · min(-1) · m(-2) at PIH 48, which was significantly higher than that in group A [(150 ± 37) L · min(-1) · m(-2), P < 0.05], and the oxygen consumption was similar among the three groups at the rest time points (with P values above 0.05). The oxygen delivery of swine in group S was (484 ± 63) L · min(-1) · m(-2) at PIH 8, and it was significantly lower than that in group A [(652 ± 65) L(-1) min(-1) · m(-2), P < 0.01]. The oxygen delivery of swine in group S reached (903 ± 132) and (1,028 ± 98) L · min(-1) · m(-2) at PIH 24 and 48, respectively, and they were significantly higher than those in group A [(686 ± 72) and (720 ± 75) L · min(-1) · M(-2), with P values below 0.01]. Oxygen delivery in group H was similar to that of group A at each time point (with P values above 0.05). The oxygen extraction ratio in group S or group H was close to that of group A at each time point (with P values above 0.05). The D-lactate level in group S was (69 ± 9) mmol/L, and it was significantly higher than that in group A [(52 ± 4) mmol/L, P < 0.01] at PIH 48. The D-lactate level was similar among the three groups at the rest time points (with P values above 0.05).

CONCLUSIONSAccording to the changes in oxygen metabolism of swine during shock stage of burn injury resuscitated with different kinds of colloids, it is found that allogeneic plasma is better than artificial colloid, and 60 g/L hydroxyethyl starch 130/0.4 is superior to succinylated gelatin.

Animals ; Blood Pressure ; Burns ; China ; Colloids ; administration & dosage ; pharmacology ; Fluid Therapy ; Hydroxyethyl Starch Derivatives ; Oxygen ; metabolism ; Resuscitation ; methods ; Shock ; Swine

BACKGROUNDThere are controversies about the use of artificial colloids. This research was aimed to determine the effect of various artificial colloids on blood coagulation in the shock stage of severe burn injury.

METHODSTotally, 18 female Ba-Ma mini-pigs were subjected to a 40% total body surface third-degree flame burn under anesthesia. Resuscitation therapy was applied 2 hours after the injury, using the burn shock fluid resuscitation formula commonly accepted in the surgical treatment of burns. The Ba-Ma mini-pigs were randomly assigned to three groups (six pigs in each group): succinylated gelatin group (the artificial colloid used was succinylated gelatin Injection), hydroxyethyl starch group (the artificial colloid used was hydroxyethyl starch (130/0.4)), and allogeneic plasma group (the colloid used was allogeneic plasma). Blood samples were collected from the animals prior to the burn injury and again at intervals of 4, 8, 24 and 48 hours post-injury. The platelet count (PLT), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen (Fib) were measured, followed by a statistical analysis of all results.

RESULTSThe PLT of succinylated gelatin group and hydroxyethyl starch group at intervals of 24 and 48 hours were (124.3 ± 52.7), (78.8 ± 16.4) × 10(9)/L and (159.0 ± 62.8), (87.3 ± 32.0)× 10(9)/L respectively. But in the allogeneic plasma group at intervals of 8, 24, and 48 hours were (234.3 ± 52.6), (136.0 ± 47.4), (75.8 ± 31.0) × 10(9)/L. The decrease were all statistically significant (P < 0.05, P < 0.01) when compared to pre-burn ((383.3 ± 77.9), (382.7 ± 65.7), (381.0 ± 49.4)× 10(9)/L). The PLT among the three groups, at all the time points, had no statistical difference (P > 0.05). Compared to pre-burn ((10.8 ± 0.9), (11.4 ± 0.8), (10.6 ± 0.7) seconds), the PT of succinylated gelatin group and hydroxyethyl starch group at 24 hours were (14.5 ± 1.5) and (16.2 ± 1.3) seconds, whereas in the allogeneic plasma group at 8 and 24 hours the PT were (13.0 ± 0.9) and (14.5 ± 1.5) seconds, i.e., an increase in the statistical significance (P > 0.01). Statistical significance was observed at 8 and 48 hours between the succinylated gelatin group and hydroxyethyl starch group, and at 48 hours between the hydroxyethyl starch and allogeneic plasma group (P < 0.05). The INR at 24 hours were (1.26 ± 0.13) in the succinylated gelatin group, (1.40 ± 0.11) in the hydroxyethyl starch group, and (1.13 ± 0.07) and (1.26 ± 0.13) at 8 and 24 hours in the allogeneic plasma group. When compared with pre-burn ((0.94 ± 0.08), (0.99 ± 0.07), and (0.92 ± 0.06) seconds), the other groups have increased significantly (P > 0.01). The comparison at 8 and 48 hours between the succinylated gelatin group and the hydroxyethyl starch group, at 48 hours between hydroxyethyl starch group and allogeneic plasma group showed statistical difference (P < 0.01). The APTT of succinylated gelatin group and hydroxyethyl starch group at 24 hours were (13.1 ± 1.1) and (14.6 ± 2.9) seconds. The APTT of the allogeneic plasma group at 4, 8 and 24 hours were (10.9 ± 1.4), (11.8 ± 1.1), and (13.7 ± 1.5) seconds. Compared to pre-burn ((11.5 ± 4.2), (11.2 ± 3.3), (10.1 ± 1.4) seconds), they were statistically significant (P < 0.05). There was no statistical difference in the APTT between the three groups, at all the time points. The Fib of the succinylated gelatin group at 24 and 48 hours were (4.3 ± 0.3) and (4.7 ± 0.2) g/L, (4.1 ± 0.3), and (5.0 ± 0.1) g/L in allogeneic plasma group, and at 8, 24, and 48 hours the Fib for the hydroxyethyl starch group was (2.9 ± 0.4), (4.0 ± 0.5), and (4.6 ± 0.6) g/L. Compared to pre-burn ((2.4 ± 0.2), (2.5 ± 0.3), (2.6 ± 0.5) g/L), they were all statistically significant (P < 0.01). There was no statistical difference in APTT between the three groups, at all time points.

CONCLUSIONThe changes of the indices in blood coagulation during the shock phase of a severe burn injury correlate with the stress response to the burn, rather than to the application of HES (130/0.4) and succinylated gelatin.

Animals ; Blood Coagulation ; drug effects ; Burns ; drug therapy ; metabolism ; Colloids ; chemistry ; therapeutic use ; Female ; Fibrinogen ; metabolism ; Partial Thromboplastin Time ; Shock ; drug therapy ; metabolism ; Swine

The effects of estriol on oxygen uptake, glucose release, lactate and pyruvate production, beta-hydroxybutyrate and acetoacetate production in perfused rat liver as well as, carbon uptake in rat liver and intracellular calcium in isolated Kupffer cells were investigated. Basal oxygen consumption of perfused liver increased significantly in estriol or ethanol-treated rats. But these increased effects were blocked by gadolinium chloride pretreatment. In a metabolic study, pretreatment with estriol resulted in a decrease in glucose production and in glycolysis while an increase in ketogenesis. A more oxidized redox state of the mitochondria was indicated by increased ratios of perfusate [lactate]/[pyruvate] and decreased ratios of perfusate [beta-hydroxybutyrate]/[acetoacetate]. Carbon uptake of Kupffer-cell increased significantly in estriol-treated rats. But these increased uptake were not shown in rats pre-treated by gadolinium chloride blocking phagocytosis. In isolated Kupffer cells from estriol-treated rats, intracellular calcium was more significantly increased after addition of lipopolysaccharide (LPS) than in controls. These findings suggest that the metabolic effects of estriol (two mg per 100 mg body wt) can be summarized to be highly toxic in rat liver, and these findings suggest that oral administration of estrogens may induce hepatic dysfunctions and play a role in the development of liver disease.
3-Hydroxybutyric Acid/metabolism ; Acetoacetates/metabolism ; Animal ; Calcium/metabolism ; Carbohydrates/metabolism ; Carbon/metabolism ; Cells, Cultured ; Colloids/metabolism ; Estriol/pharmacology* ; Estriol/metabolism ; Ethanol/pharmacology ; Female ; Gadolinium/pharmacology ; Glucose/biosynthesis ; Intracellular Fluid/metabolism ; Kupffer Cells/metabolism ; Kupffer Cells/cytology ; Lactates/metabolism ; Lipids/metabolism ; Liver/metabolism ; Liver/drug effects* ; Oxygen Consumption ; Phagocytosis ; Pyruvic Acid/metabolism ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo determine the optimal dose of colloid preload, which is both safe and effective, for preventing hypotension in parturients undergoing cesarean section under spinal anesthesia.

METHODSForty-five healthy, termed parturients scheduled for cesarean delivery under spinal anesthesia were randomly assigned to 3 colloid preload groups to receive gelofusine infusion at the rates of 5, 10, or 15 ml·kg(-1)·h(-1) (groups I, II, and III, respectively). Colloid preload was administered 10 min before spinal anesthesia and maintained until the delivery. Blood pressure (BP) and heart rate (HR) of the parturients were monitored during the operation, and Apgar scores at 1 and 5 min after birth were recorded. S100β protein concentration and blood gas values of the umbilical artery were also measured. The vascular adaptation in the placental villous capillary was evaluated stereologically.

RESULTSAt each time point of measurement, BP and HR showed no significant differences among the 3 groups during the operation (P>0.05), but within the same group, BP and HR underwent significant variations during the operation; groups II and III maintained more stable hemodynamics compared to group I. Apgar scores and blood gas analysis, pH value, and S100β protein in the umbilical artery showed no significant differences among the 3 groups (P>0.05). The 3 groups exhibited no significant differences in the length and volume density of the placental villous capillaries (P>0.05).

CONCLUSIONColloid preload with gelofusine administered at the rate of 10 ml·kg(-1)·h(-1) can reduce the incidence and severity of hypotension in cesarean section under spinal anesthesia with the least adverse maternal and fetal effects.

Adult ; Anesthesia, Obstetrical ; Anesthesia, Spinal ; Cesarean Section ; methods ; Colloids ; administration & dosage ; Female ; Fetal Blood ; metabolism ; Humans ; Hypotension ; prevention & control ; Nerve Growth Factors ; blood ; Placenta ; blood supply ; Polygeline ; administration & dosage ; Pregnancy ; S100 Proteins ; blood