PURPOSE: To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful rate of rescue for the fatal hemorrhagic shock caused by pelvic fractures. METHODS: A retrospective analysis was conducted in 68 cases of multiple trauma combined with severe pelvic fractures in recent 10 years (from Jan. 2006 to Dec. 2015). There were 57 males and 11 females. Their age ranged from 19 to 75 years, averaging 42 years. Causes of injury included traffic accidents in 34 cases (2 cases of truck rolling), high falling injuries in 17 cases, crashing injuries in 15 cases, steel cable wound in 1 case, and seat belt traction injury in 1 case. There were 31 cases of head injury, 11 cases of chest injury, 56 cases of abdominal and pelvic injuries, and 37 cases of spinal and limb injuries. Therapeutic methods included early anti-shock measures, surgical hemostasis based on internal iliac artery devasculization for pelvic hemorrhage, and early treatment for combined organ damage and complications included embolization and repair of the liver, spleen and kidney, splenectomy, nephrectomy, intestinal resection, colostomy, bladder ostomy, and urethral repair, etc. Patients in this series received blood transfusion volume of 1200-10,000 mL, with an average volume of 2850 mL. Postoperative follow-up ranged from 6 months to 1.5 years. RESULTS: The average score of ISS in this series was 38.6 points. 49 cases were successfully treated and the total survival rate was 72.1%. Totally 19 patients died (average ISS score 42.4), including 6 cases of hemorrhagic shock, 8 cases of brain injury, 1 case of cardiac injury, 2 cases of pulmonary infection, 1 case of pulmonary embolism, and 1 case of multiple organ failure. Postoperative complications included 1 case of urethral stricture (after secondary repair), 1 case of sexual dysfunction (combined with urethral rupture), 1 case of lower limb amputation (femoral artery thrombosis), and 18 cases of consumptive coagulopathy. CONCLUSION The early treatment of multiple injuries combined with severe pelvic fractures should focus on pelvic hemostasis. Massive bleeding-induced hemorrhagic shock is one of the main causes of poor prognosis. The technique of internal iliac artery devasculization including ligation and embolization can be used as an effective measure to stop or reduce bleeding. Consumptive coagulopathy is difficult to deal with, which should be detected and treated as soon as possible after surgical measures have been performed. The effect of using recombinant factor VII in treating consumptive coagulopathy is satisfactory.
Adult ; Embolization, Therapeutic ; methods ; Factor VII ; administration & dosage ; Female ; Fractures, Bone ; complications ; therapy ; Hemostasis, Surgical ; Humans ; Iliac Artery ; surgery ; Injury Severity Score ; Ligation ; Male ; Middle Aged ; Multiple Trauma ; complications ; therapy ; Pelvic Bones ; injuries ; Prognosis ; Recombinant Proteins ; administration & dosage ; Retrospective Studies ; Shock, Hemorrhagic ; etiology ; prevention & control ; Young Adult

Fluid resuscitation, hemostasis, and transfusion is essential in care of hemorrhagic shock. Although estimation of the residual blood volume is crucial, the standard measuring methods are impractical or unsafe. Vital signs, central venous or pulmonary artery pressures are inaccurate. We hypothesized that the residual blood volume for acute, non-ongoing hemorrhage was calculable using serial hematocrit measurements and the volume of isotonic solution infused. Blood volume is the sum of volumes of red blood cells and plasma. For acute, non-ongoing hemorrhage, red blood cell volume would not change. A certain portion of the isotonic fluid would increase plasma volume. Mathematically, we suggest that the residual blood volume after acute, non-ongoing hemorrhage might be calculated as 0·25N/[(Hct1/Hct2)-1], where Hct1 and Hct2 are the initial and subsequent hematocrits, respectively, and N is the volume of isotonic solution infused. In vivo validation and modification is needed before clinical application of this model.
Blood Volume ; Hematocrit ; Humans ; Isotonic Solutions/*therapeutic use ; *Models, Theoretical ; Shock, Hemorrhagic/*prevention & control/*therapy

OBJECTIVETo investigate the effect of aloe polysaccharides pretreatment on the cerebral inflammatory response and lipid peroxidation in severe hemorrhagic shock rats first entering high altitude.

METHODSForty healthy male SD rats weighing 250-300 g were randomly divided into 5 groups (n = 8 each): sham group, shock group, AP group was further divided into 3 subgroups (AP1 0.75 mg/kg; AP2 1.50 mg/kg; AP3 3.00 mg/kg). The different doses AP were given iv respectively at 30 min before hemorrhagic shock. The mean blood pressure (MAP) was maintained at (35 ± 5) mmHg (1 mmHg = 0.133 kPa) for 60 minutes. The animals were killed at 2 hours after resuscitation. Blood samples were obtained from femoral artery for detecting tumor necrosis factor α (TNF-α), IL-6 and IL-10 concentrations; the frontal and parietal lobes brain and the hippocampus were separated from brain tissues on the ice for detecting superoxide dismutase (SOD) activity and myeloperoxidase (MPO) activity, malondialdehyde (MDA) concentration, brain Wet-dry weight ratio (W/D).

RESULTSCompared with sham group, hemorrhagic shock significantly increased serum TNF-α ((76 ± 11) ng/L), IL-6 ((1303 ± 141) ng/L) and IL-10 concentrations ((95 ± 14) ng/L), MPO activity ((20.72 ± 2.28)×10(-2) U/g) and MDA concentration ((80 ± 13) nmol/mgprot) in the brain tissue and brain W/D (6.21 ± 0.18) (t = 6.928 - 14.565, P < 0.05), while SOD activity ((56 ± 11) U/mgprot) decreased significantly (t = -5.374, P < 0.05). There were no significant difference between shock and AP1 groups. AP2 group significantly inhibited hemorrhagic shock-induced increase serum TNF-α ((54 ± 12) ng/L), IL-6 ((846 ± 78) ng/L) and IL-10 concentrations ((66 ± 11) ng/L), MPO activity ((13.13 ± 1.23)×10(-2) U/g) and MDA concentration ((56 ± 9) nmol/mgprot) in the brain tissue and brain W/D (5.71 ± 0.18) (t = -6.905 - -3.357, P < 0.05), while SOD activity ((86 ± 12) U/mgprot) increased significantly compared to shock group (t = 4.240, P < 0.05). There were no significant difference between AP2 and AP3 groups.

CONCLUSIONAP pretreatment can attenuate the cerebral ischemia and reperfusion injury in severe traumatic-hemorrhagic rats first entering high altitude through inhibiting systemic inflammatory response and leukocyte aggregation and lipid peroxidation in the brain.

Aloe ; chemistry ; Altitude ; Animals ; Brain ; metabolism ; pathology ; Brain Ischemia ; drug therapy ; prevention & control ; Disease Models, Animal ; Interleukin-10 ; blood ; Interleukin-6 ; blood ; Lipid Peroxidation ; Male ; Malondialdehyde ; metabolism ; Polysaccharides ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; drug therapy ; prevention & control ; Shock, Hemorrhagic ; metabolism ; pathology ; Superoxide Dismutase ; metabolism ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVETo investigate the protective effect of limited fluid resuscitation against intestinal ischemia- reperfusion injury in postpartum rabbits with severe uncontrolled obstetrical hemorrhagic shock.

METHODSTwenty- four postpartum rabbits were randomly assigned into sham shock group (group P), shock group without interventions (group P0), conventional fluid resuscitation group (group PNL), and limited fluid resuscitation group (group PLH), and the model of severe uncontrolled hemorrhagic shock was established in the latter 3 groups. The rabbits were sacrificed 4 h later, and SOD activity and MDA content in the intestinal mucosa and the degree of injury to the intestinal mucosa were observed.

RESULTSIschemia-reperfusion injury of the intestine due to uncontrolled hemorrhagic shock resulted in decreased SOD activity and increased MDA content. The MDA content was significantly lower and SOD activity was significantly higher in group PLH than in group PNL (P<0.05), and the intestinal mucosal tissue morphology and intestinal mucosa barrier lesion increased in group PLH.

CONCLUSIONInitial limited fluid resuscitation can relieve intestinal ischemia-reperfusion injury in postpartum rabbits with severe uncontrolled obstetrical hemorrhagic shock.

Animals ; Disease Models, Animal ; Female ; Fluid Therapy ; methods ; Intestines ; blood supply ; Pregnancy ; Rabbits ; Reperfusion Injury ; etiology ; prevention & control ; Shock, Hemorrhagic ; complications

The cholinergic anti-inflammatory pathway (CAP) is a neurophysiological mechanism that regulates the immune system. The CAP inhibits inflammation by suppressing cytokine synthesis via release of acetylcholine in organs of the reticuloendothelial system, including the lungs, spleen, liver, kidneys and gastrointestinal tract. Acetylcholine can interact with alpha7 nicotinic acetylcholine receptors (alpha7 nAchR) expressed by macrophages and other cytokine producing cells, down-regulate pro-inflammatory cytokine synthesis and prevent tissue damage. Herein is a review of the neurophysiological mechanism in which the CAP regulates inflammatory response, as well as its potential interventional strategy for inflammatory diseases.
Acetylcholine ; pharmacology ; Animals ; Humans ; Inflammation ; immunology ; prevention & control ; Myocardial Infarction ; immunology ; Pancreatitis ; immunology ; Receptors, Muscarinic ; physiology ; Receptors, Nicotinic ; physiology ; Reperfusion Injury ; immunology ; Sepsis ; immunology ; Shock, Hemorrhagic ; immunology ; Spleen ; immunology ; innervation ; Vagus Nerve ; physiology ; alpha7 Nicotinic Acetylcholine Receptor

OBJECTIVETo investigate the effects of ulinastatin on lung injury in hemorrhagic shock rats.

METHODSTwenty-four normal SD rats were randomly divided into 3 groups (n=8), namely the control group, hemorrhagic shock group (group H) and ulinastatin group (group U). In group H and group U, blood was drawn from the femoral artery over a period of 10 min until a mean arterial pressure of 40 mmHg was obtained. Controlled hypotension was then maintained at 40-/+5 mmHg for 60 min by blood drawing or infusion when necessary. All the blood drawn and an equivalent volume of Ringer lactate solution were subsequently infused for resuscitation. Four hours after the resuscitation, the activity of superoxidedismutase (SOD), content of malondialdehyde (MDA), expression of heme oxygenase-1 (HO-1), wet to dry weight ratio (W/D), and pathologic changes of the lung tissues were measured or observed.

RESULTSCompared with those in the control group, the content of MDA, expression of HO-1 and W/D increased significantly in both group H and group U (P<0.05); these indexes in group U were significantly lower than those in group H (P<0.05). The activity of SOD in group U was significantly lower than that in the control group (P<0.05) but higher than that in group H (P<0.05). Optical microscopy demonstrated milder inflammatory cell infiltration and interstitial edema in the lung tissues in group U than in group H.

CONCLUSIONUlinastatin can lower the content of MDA, W/D and the expression of HO-1, increase the activity of SOD, and reduce histological lung injury in rats with hemorrhagic shock.

Animals ; Glycoproteins ; pharmacology ; Heme Oxygenase-1 ; metabolism ; Lung Injury ; etiology ; prevention & control ; Male ; Malondialdehyde ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Shock, Hemorrhagic ; complications ; metabolism ; Superoxide Dismutase ; metabolism

OBJECTIVETo determine the effects of albumin administration on lung injury and apoptosis in traumatic/hemorrhagic shock (T/HS) rats.

METHODSStudies were performed on an in vivo model of spontaneously breathing rats with induced T/HS; the rats were subjected to femur fracture, ischemia for 30 min, and reperfusion for 20 min with Ringer's lactate solution (RS) or 5% (w/v) albumin (ALB), and the left lower lobes of the lungs were resected.

RESULTSAlbumin administered during reperfusion markedly attenuated injury of the lung and decreased the concentration of lactic acid and the number of in situ TdT-mediated dUTP nick-end labelling (TUNEL)-positive cells. Moreover, immunohistochemistry performed 24 h after reperfusion revealed increases in the level of nuclear factor kappaB (NF-kappaB), and phosphorylated p38 mitogen-activated protein kinase (MAPK) in the albumin-untreated group was down-regulated by albumin treatment when compared with the sham rats.

CONCLUSIONResuscitation with albumin attenuates tissue injury and inhibits T/HS-induced apoptosis in the lung via the p38 MAPK signal transduction pathway that functions to stimulate the activation of NF-kappaB.

Albumins ; administration & dosage ; Animals ; Apoptosis ; drug effects ; Enzyme Activation ; Immunohistochemistry ; In Situ Nick-End Labeling ; Lactic Acid ; blood ; Lung Diseases ; metabolism ; pathology ; prevention & control ; Male ; Oxygen ; blood ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; drug therapy ; metabolism ; pathology ; Resuscitation ; methods ; Shock, Hemorrhagic ; drug therapy ; metabolism ; pathology ; Transcription Factor RelA ; metabolism ; p38 Mitogen-Activated Protein Kinases ; metabolism

OBJECTIVETo evaluate the effects of different fluid resuscitation strategies on superoxide dismutase (SOD), malondialdehyde (MDA) and myeloperoxidase (MPO) activities in the lung tissue in pregnant rabbits with uncontrolled hemorrhagic shock.

METHODSThirty pregnant New Zealand rabbits were randomized into 5 equal groups, namely the sham shock.(SS) group, shock group without interventions (SH group), and hemorrhagic shock groups with conventional normal saline (NS) resuscitation, NS hypotensive resuscitation, and hypertonic hyperosmotic hypotensive resuscitation (NS, NH, HHH groups, respectively) 30 min after the shock. At the end of the experiment, the rabbits were sacrificed, and the lungs were taken for detection of MDA, MPO and SOD levels.

RESULTSIschemia-reperfusion injury of the lungs in uncontrolled hemorrhagic shock resulted in decreased SOD and increased MDA and MPO contents. The MDA and MPO contents in HHH group were significantly lower than those in NH group, and both the groups, MDA and MPO contents were significantly lower than those of NS group (P<0.05). SOD activity was significantly higher in HHH group than in NH group (P<0.05).

CONCLUSIONIn pregnant rabbits with uncontrolled hemorrhagic shock, hypotensive resuscitation more effectively ameliorates ischemia-reperfusion injuries in the lungs than aggressive fluid resuscitation, and hyperosmotic crystalloid and hyperonoctic colloid resuscitation provide significant protective effects against such injuries.

Animals ; Female ; Fluid Therapy ; methods ; Hypertonic Solutions ; therapeutic use ; Hypotonic Solutions ; therapeutic use ; Lung ; blood supply ; enzymology ; Peroxidase ; metabolism ; Pregnancy ; Pregnancy Complications ; therapy ; Rabbits ; Random Allocation ; Reperfusion Injury ; prevention & control ; Resuscitation ; methods ; Shock, Hemorrhagic ; complications ; therapy ; Superoxide Dismutase ; metabolism

OBJECTIVETo study the protective effect of lidocaine against lung injury after hemorrhagic shock in rabbits.

METHODSEighteen healthy rabbits were randomly divided into 3 groups (n=6), namely lidocaine group (group L), hemorrhagic shock group (group H) and control group (group C). Hemorrhagic shock model was established in rabbits in groups L and H, and the venous blood samples were collected for measurement of plasma malondialdehyde (MDA) and superoxidedismutase (SOD) before phlebotomy (T0), 2 h after hemorrhagic shock (T1) and 2 h after resuscitation (T2). Blood samples were also taken for measurement of MDA and SOD at the same time points in group C. The wet to dry weight ratio of the lung (W/D) was measured at T2.

RESULTSMDA level was significantly lower while SOD level significantly higher in group L than in group H (P<0.05). The W/D ratio in group L was reduced significantly as compared with that in group H (P<0.05).

CONCLUSIONLidocaine can remarkably alleviate lung injury after hemorrhagic shock by inhibiting MDA production and increasing SOD content.

Animals ; Disease Models, Animal ; Lidocaine ; pharmacology ; Lung ; drug effects ; metabolism ; Lung Injury ; prevention & control ; Malondialdehyde ; blood ; Rabbits ; Shock, Hemorrhagic ; drug therapy ; Superoxide Dismutase ; blood

AIMTo study the protective effect of sodium pyruvate on ischemia/reperfusion injury following hemorrhagic shock.

METHODSRat models of hemorrhagic shock were built up. When the shed blood was infused, the rats were also randomly provided by one of normal saline, glutathione and sodium pyruvate. Rats were killed 3 hours after the reperfusion, the activity of plasma lactate dehydrogenase (LDH) and glutamic-oxaloacetic transaminase (GOT), the level of tissue malondialdehyde (MDA) and the activity of tissue myeloperoxidase (MPO) were detected. Biopsy specimens were obtained to investigate morphological changes of the myocardial, hepatic, lung and renal tissue.

RESULTSThe activity of plasma LDH and GOT, the level of MDA of hepatic, lung and renal tissue and the activity of MPO of myocardial, lung and renal tissue decreased remarkably in group given sodium pyruvate compared with group given normal saline, and the effect of group given sodium pyruvate was more remarkable than group given glutathione.

CONCLUSIONThese data support the view that sodium pyruvate shows protective effect on ischemia/reperfusion injury following hemorrhagic shock. It is possibly relevant to scavenging of oxygen free radicals, reduction of neutrophil, and anti-inflammatory response.

Animals ; Aspartate Aminotransferases ; blood ; Disease Models, Animal ; Kidney ; metabolism ; pathology ; L-Lactate Dehydrogenase ; blood ; Liver ; metabolism ; pathology ; Lung ; metabolism ; pathology ; Male ; Malondialdehyde ; analysis ; Peroxidase ; analysis ; Protective Agents ; pharmacology ; Pyruvic Acid ; pharmacology ; Rats ; Rats, Wistar ; Reperfusion Injury ; blood ; pathology ; prevention & control ; Shock, Hemorrhagic ; blood ; pathology