You are here

Home » Content

Kontrolsüz hemorajik şok modelinde sıvı replasman tedavisi zamanlaması ve hızının böbrek ve karaciğer fonksiyonları üzerine etkileri

Effects of timing and rate of fluid replacement therapy on renal and liver functions in uncontrolled haemorrhagic shock model.

Journal Name:

  • Selçuk Tıp Dergisi

Publication Year:

  • 2004

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
Objective: To investigate the effects ofdifFerent volume resuscitation regimens on organ functions in uncontrol¬led haemorrhagic shock before surgical control of bleeding. Material and methods: Total 37 New-Zeland type rabbits dividedinto fourgroups designatedas S(sham, n=7), C(control, n=10), ECR(eariy controlled resuscitation, n=10) and EFR(eariy fast resuscitation, n=10). Rabbits were let bleeding until mean arterial pressure decreased to 30 mmHg then intracut was taken out to permet free bleeding. S group is sham-operated group. Group C did not receive any volume replacement for an hour after the onset of shock. Volume resuscitation with şalin begin-ned at rate 2 cc/kg/mîn to achive MAP 60 mmHg in group ECR while volume resuscitation with şalin beginned at rate 4 cc/kg/min to achive MAP 80 mmHg in group EFR. Bleeding was controlled at first hour İn study groups and resuscitation went on for an hour. Liver and renal function tests and haematocrit values were studied basally, first hour and 24th hour respectively. Results: Urea and creatinin levels increased at the first hour in group C. SGOT ievels were found to be elevated at 24 hours İn group C, ECR, and EFR. Haematocrit values were decreased at 24th hour in group C, ECR, and EFR. Most severe decrease in haematocrit values were observed in group EFR. Conclusion: it is concluded that early controlled resuscitation in haemorrhagic shock is effective in preventing the organ damage that can develop during haemorrhagic shock when compared to late oragressive resuscitation.
Bookmark/Search this post with
Abstract (Original Language): 
Amaç: Kontrolsüz hemorajik şokta, kanamanın cerrahi kontrolünden Önce yapılan farklı sıvı resusitasyon rejimle¬rinin organ fonksiyonları üzerine etkilerinin araştırılması. Gereç ve Yöntem: Toplam 37 adet Yeni-Zelanda tipi tav¬şan S (sham, n=7), K (kontrol, n=10), EK (erken kontrollü resusitasyon, n=10) ve EH (erken hızlı resusitasyon, n=10) olarak dört gruba ayınldı. Denekler femoral arterden ortalama arteriyel basınç (OAB) 30 mmHg oluncaya kadar kanatıldı ve intraket çekilerek serbest kanamaya bırakıldı. S grubu sham operasyon grubu idi. K grubuna şoktan sonraki bir saatlik sürede sıvı replasmanı yapılmadı. EK grubunda serum fizyolojikle 2 cc/kg/dk hızında, OAB 60 mmHg ve EH grubuna 4 cc/kg/dk hızında, OAB 80 mmHg olması hedeflenerek resusitasyona başlandı. Çalışma gruplarında birinci saatte kanama kontrolü sağlandı ve bir saat daha resusitasyona devam edildi. Bazal, birinci ve 24. saatlerde karaciğer ve böbrek fonksiyon testleri, hematokrit çalışıldı. Bulgular: Birinci saatte üre ve kreatinin değerleri K grubunda artma gösterdi. K, EK, EH gruplarının SGOT değerleri 24. saatte yüksek olarak bu¬lundu. K, EK, EH gruplarında 24. saatte ölçülen hematokrit değerlerinde düşme oldu. Hematokrit değerlerinde en fazla düşme EH grubunda gözlendi. Sonuç: Geç veya agressif resusitasyon yapılan gruplarla karşılaştırıldığında, erken kontrollü sıvı resusitasyonunun hemorajik şokta gelişebilecek organ hasarını önlemede daha etkili olduğu sonucuna varıldı.
FULL TEXT (PDF): 
PDF icon arastirmax-kontrolsuz-hemorajik-sok-modelinde-sivi-replasman-tedavisi-zamanlamasi-hizinin-bobrek-karaciger-fonksiyonlari-uzerine-etkileri.pdf
  • 1
33-38
  • Turkish

REFERENCES

References: 

1. Schlichtig R, Kramer DJ, Pînsky MR. Flow redistrib-ution during progressive hemorrhage is a determinant of critical 02 delivery. J Appl Physiol. 1991 ;70:169-78
2. Darlingtorı DN, Shinsako J. Dallman MF. Responses of ACTH, epinephrine, norepinephrine, and cardiovascular sysîem to hemorrhage. Am J Physiol. 1986; 251:612-8.
3. Tung SH, Wang BC, Brown EB. Intracelluiar and extra-cellular acid-base changes İn hemorrhagic shock. Respir Physiol 1976;26:229-37.
4. Ploucha JM, Fink GD. Hemodynamics of hemorrhage in the conscious rat and chicken. Am J Physiol. 1986;251:846-50.
5. Carrico JC, Canizaro PC, Shires GT. Fluid resuscita¬tion following injury. Rationale for the use of balanced salt solutions. Crit Care Med. 1976;4:46-54.
6. Moss GS, Lowe RJ, JilekJM. Colloid or crystalloid in the resuscitation of hemorrhagic shock: A controlled clinictrial. Surgery 1981;89:434-8
7. Comittee on trauma: Advanced Trauma Life Support Course for Physicians. Chicago, American College of Surgeons, 1993.
8. Kaweskİ SM, Sise MJ, Virgiiio RW. The effect of pre-hospital fluids on survival in trauma patients. J Trauma 1990;30:1215-9
9. Bickell WH, Wall MJ, Pepe PE, Martin RR. Ginger W, Ailen MK, et al. Immediate versus delayed fluid resus¬citation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994;331:1105-9
10. Gross D, Landau EH, Assalia A, Krausz MM. İs hyper-tonic şaline resuscitation safe in uncontrolled hemor¬rhagic shock? J Trauma 1988;28:7G1-G
11. Bickell WH, Brutting SP, Wade CE. Hemodynamic response to abdominal aortotomy in the anesthetized swine. Circ Shock 1989;28:321-32
12. Gross D, Landau EH, Klin B, Krausz MM. Treatment of uncontrolled hemonrhagıc shock with hypertonic şaline solution. Surg Gynecol Obstet 1990; 170:106-12
13. Bickell WH, Brutting SP, MiIInamow GA, O'Benar J, Wade CE. The detrimental effects of intravenous crys¬talloid after aortotomy in swine. Surgery 1991 ;10:529¬36
14. Ak A, Ustun ME, Ogün CO, Duman A, Bor MA. Effects of nimodipine on tissue lactate and malondialdehyde leveis in experimental head trauma. Anaesth intens care 2001;29:484-8
15. Milles G, Koucky CJ, Zacheis HG. Experİmental uncontrolled arterial hemorrhage. Surgery 1966: 60:434-42
16. Chaudry IH, Clemens MG, Baue AE. Alterations in celi function with ischemia and shock and their correction. Arc Surg 1981;! 16:1309
17. Malone PC: Mightthe aphorism "there is no indication in
medîcine for a pint of blood" lie behind some of the residual morbidiry and mortality of surgery? Med hypotheses 1988;27:5-13
18. Owens TM, VVatson WC, Prough DS, Uchida T, Kramer GC. Limitîng resuscitation of uncontrolled hemorrhage reduces internal bleeding and subse-quent volume requirements. J Trauma 1995;39:200-9
19. Cryer HG, Leong K, McArthur DL, Demetriades D, Bongard FS, Fleming AW. Multiple organ failure: By the time you predict it, ifs already there. J Trauma 1999; 46:597-604
20. Bland RD, Shoemaker WC, Abraham E, Cobo JC. Hemodynamic and oxygen transport patterns in surviv-ing and nonsurviving patients. Crit Care Med 1985;13:85-8
21. Moore FA, Haenel JB, Moore EE, VVhitehili TA. Incommensature oxygen consumption in response to maximal oxygen availability predicts postinjury multiple organ failure. J Trauma 1992;33:58-62
22. Kaufman BS, Rackow EC, Faik JL. The relationship betvreen oxygen delivery and consumption during fluid resuscitation of hypovolemic and septic shock. Chest 1984;85:336-40
23. Shaftan GW, Chiu C, Dennis C, Haris B. Fundamentais of physiologic controi of arterial hemorrhage. Surgery 1964;58: 851-6
24. Bickell WH., Brutting SP, Millnamow GA, O'Benar J, Wade CE. The use of hypertonic saline/dextrane vs lactated Ringer's solution as a resuscitation fluid fol-lowing uncontrolled aortic hemorrhage in anes¬thetized swine. Ann Emerg Med.I992;21:1077-85
25. Riddez L, Hahn RG Suneson A, Hjelmqvist H. Central and regional hemodynamics during crystalloid fluid therapy after uncontrolled intra-abdominal bleeding. J Trauma 1998;44:433-9
26. Lewis FR. Prehospital intravenous fluid therapy; phys¬iologic computer modelling. J Trauma 1986;26:804-11
27. Spaite DW, Criss EA, Valenzuela TD, Meislin HW. Prehospital advanced life support for majör trauma.crit-ical need for clinical trials. Ann Emerg Med 1998;32:480-9

28. Avery B, Nathens M, Ronaid M. Shock and resuscita-
tion. in: Teffrey A, Randal R, Alfred E, Stephen F. Eds. Surgery. Basic science and clinical evidence. International Edition 2000:259-65
29. Wang JH, Chen HS, Wang T, Tian ki, Diao YF. Role of
oxygen derivated free radicals in superior mesenteric artery occlusion shock in rat. Chin Med J(Engl) 1990: 103:278-82
30. Rosner MJ. Role of cerebral perfusion in acute brain trauma. (letter; comment.). Crit Care Med 1996;24:1274-6. Comment on: Crit Çare Med 1995;23:1412-7
31. Rosner MJ, Rosner SD, Johnson AH. Cerebral perfu-
sion pressure: management proiocol and clinical
results. J Neurosurg 1995;83:949-62. Comment in: J
Neurosurg 1996; 85:365-7
32. Bullock R, Chesnut RM, Clifton G, Ghajar J, Maridon DW, Narayan DK, et al. Guidelines for the manage¬ment of severe head injury. Brain trauma foundation. Eur J EmergMed 1996:3:109-27

Thank you for copying data from http://www.arastirmax.com