Abstract
Shenfu injection (SFI) is a traditional Chinese herbal medicine which has been clinically used for treatment of septic shock and cardiac shock. The aim of this study was to clarify effects of SFI on cerebral microcirculation and brain injury after hemorrhagic shock (HS). Twenty-one domestic male Beijing Landrace pigs were randomly divided into three groups: SFI group (SFI, n = 8), saline group (SA, n = 8) or sham operation group (SO, n = 5). In the SFI group, animals were induced to HS by rapid bleeding to a mean arterial pressure of 40 mmHg within 10 minutes and maintained at 40±3 mmHg for 60 minutes. Volume resuscitation (shed blood and crystalloid) and SFI were given after 1 hour of HS. In the SA group, animals received the same dose of saline instead of SFI. In the SO group, the same surgical procedure was performed but without inducing HS and volume resuscitation. The cerebral microvascular flow index (MFI), nitric oxide synthase (NOS) expression, aquaporin-4 expression, interleukin-6, tumor necrosis factor-α (TNF-α) and ultrastructural of microvascular endothelia were measured. Compared with the SA group, SFI significantly improved cerebral MFI after HS. SFI up regulated cerebral endothelial NOS expression, but down regulated interleukin-6, TNF-α, inducible NOS and aquaporin-4 expression compared with the SA group. The cerebral microvascular endothelial injury and interstitial edema in the SFI group were lighter than those in the SA group. Combined application of SFI with volume resuscitation after HS can improve cerebral microcirculation and reduce brain injury.
Highlights
Hemorrhagic shock (HS) is a rare but serious complication, which may occur in many emergency diseases and has a high mortality rate [1]
Activated inflammatory system caused by ischemia/reperfusion (I/R) injury can lead to vascular endothelial damage, and cause the cerebral microcirculation disturbance [3,4] and brain edema [5]
No significant differences in body weight, hemoglobin, measure arterial pressure (MAP) or shed blood were detected among the three groups (SO, Shenfu infusion (SFI) and SA) at baseline (Table 1)
Summary
Hemorrhagic shock (HS) is a rare but serious complication, which may occur in many emergency diseases and has a high mortality rate [1]. Activated inflammatory system caused by ischemia/reperfusion (I/R) injury can lead to vascular endothelial damage, and cause the cerebral microcirculation disturbance [3,4] and brain edema [5]. Our previous animal experiments showed that SFI can improve myocardial dysfunction [6,7] and microcirculation [8], reduce inflammation and brain injury [9] after cardiac arrest, which is the most severe state of shock. We established a porcine model of HS to determine if SFI can improve cerebral microcirculation and reduce brain injury after HS resuscitation. The aim of this study was to clarify effects of Shenfu infusion (SFI) on cerebral microcirculation and brain injury after hemorrhagic shock (HS)
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