Ringer's Solution Group Research Articles

Pyruvate Ringer's Solution Corrects Lactic Acidosis and Prolongs Survival during Hemorrhagic Shock in Rats

BackgroundLactic acidosis is a life-threatening complication of hemorrhagic shock. There is no ideal therapy for it in the clinical setting. ObjectiveThis study was designed to investigate whether pyruvate Ringer's solution could treat hypoxic lactic acidosis associated with lethal hemorrhagic shock in rats. MethodsA total of 54 rats were subjected to hemorrhagic shock with mean arterial pressure (MAP) of 40 mm Hg for 1 h. They were then randomly divided into three groups (n = 18 each): Group N had no fluid resuscitation; Group L received lactated Ringer's solution infusion; and Group P received pyruvate Ringer's solution infusion. The survival rate was investigated after 24 h. In addition, a second set of 54 rats was selected for blood sampling, with identical methods for shock and resuscitation being followed, to determine arterial pH, blood gas analysis, lactate, pyruvate, and organs' enzyme activities at various time points. The MAP was monitored for 6 h in both populations. ResultsPyruvate Ringer's solution significantly increased the survival rate of rats subjected to fatal shock and receiving pyruvate Ringer's solution (Group P) by 1.5 times the survival rate in Group L at 24 h after fluid resuscitation (55.6% vs. 22.2%, respectively; p < 0.05). Pyruvate infusion maintained a higher MAP and fully corrected severe acidosis 1 h after resuscitation in comparison to the lactated infusion, and markedly decreased blood lactate levels and the lactate-to-pyruvate ratio 4 h after resuscitation. It also significantly improved serum markers of organ dysfunction. ConclusionPyruvate Ringer's solution efficiently treated hypoxic lactic acidosis and significantly increased the survival rate in rats with lethal hemorrhagic shock. Pyruvate Ringer's solution is potentially applicable to clinical resuscitation in humans.

The Relationship of Intravenous Dextrose Administration During Emergence from Anesthesia to Postoperative Nausea and Vomiting

Postoperative nausea and vomiting (PONV) may occur despite antiemetic prophylaxis and is associated with unanticipated hospital admission, financial impact, and patient dissatisfaction. Previous studies have shown variable impact of IV dextrose on PONV. We sought to determine the relationship of IV dextrose administered during emergence from anesthesia to PONV. This was a prospective, double-blind randomized placebo-controlled trial. Adult female ASA physical status I and II nondiabetic patients scheduled for outpatient gynecologic, urologic, or breast surgery were randomly assigned to infusion of 250 mL lactated Ringer's solution (group P; n = 75) or dextrose 5% in lactated Ringer's solution (group D; n = 87) over 2 hours beginning with surgical closing. Blood glucose was determined using a point-of-care device before transfer to the operating room, in the operating room immediately before study fluid infusion, and in the recovery room after study fluid infusion. No antiemetics were given before arrival in the recovery room. PONV scores were recorded at 0, 30, 60, and 120 minutes and 24 hours after arrival in the recovery room. Medication administration was recorded. Data from 162 patients with normal baseline blood glucose were analyzed. There were no significant intergroup differences in demographics, history of PONV, or tobacco use. There was no significant intergroup difference in PONV during the first 2 hours after anesthesia (group D 52.9% vs group P 46.7%; difference, 6.2%; 95% confidence interval [CI], -9.2% to 21.6%; P = 0.43). Patients in groups D or P who developed PONV within 2 hours of anesthesia had similar number of severity scores ≥1 during recovery stay (1.5 vs 1.0; difference, 0; 95% CI, 0%-0%; P = 0.93); and similar proportions of: PONV onset within 30 minutes of recovery room arrival (65.2% vs 57.1%; difference, 8.1%; 95% CI, -13.1% to 28.8%; P = 0.46); more than 1 dose of antiemetic medication (56.5% vs 62.9%; difference, 6.3%; 95% CI, -26.9% to 15.1%; P= 0.65); or more than 1 class of antiemetic medication (50.0% vs 54.3%; difference, 4.3%; 95% CI, -25.5% to 17.4%; P = 0.82). The administration of dextrose during emergence from anesthesia was not associated with a difference in the incidence of PONV exceeding 20% or in the severity of PONV in the first 2 hours after anesthesia. The relationship between PONV and the optimal dose and timing of IV dextrose administration remains unclear and may warrant further study.

Protective effect of hydrogen-lactated Ringer's solution against extensive burn-induced intestine injury in rats after delayed fluid resuscitation

Objective To investigate the protective effect of hydrogen-rich lactated Ringer's solution(HRS) against intestine injury induced by extensive burn in Sprague-Dewley(SD) rat model after delayed fluid resuscitation. Methods Thirty-six male SD rats were randomly divided into three groups(n=12): sham-burn group(S group),burn plus normal lactated Ringer's solution(NRS) group(BR group) and burn plus hydrogen-rich lactated Ringer's solution(HRS) group(BH group).Rats in the S group were immersed into 37℃ water without fluid replacement;those in BR group and BH group were subjected to 30% total body surface area(TBSA) Ⅲ degree full-thickness scald.At first,a total of 2 ml·(1% TBSA)-1·kg-1 of HRS or NRS were replaced at 7 h post-burn and half volume of the total solution was replaced at the 9 h and 17 h.All rats were sacrificed at 24 h.Small intestine tissues were removed for H-E staining and determination of MDA content,MPO and SOD activity;and the levels of the IL-1β and TNF-α were determined by ELISA.Results The intestinal injury was relieved in BH group compared with BR group.The intestinal MDA content(P0.05) and activities of MPO and SOD(P0.01) were all decreased in BH group.IL-1β and TNF-α levels in BH group were significantly lower than those in the BR group(P0.01).Conclusion HRS can attenuate intestine injury induced by extensive burn after delayed fluid resuscitation.It can decrease the oxidative injury following extensive burn and delay fluid resuscitation,and it can also suppress the generation of proinflammatory cytokine IL-1β and TNF-α.

Inflammatory Response to Colloids Compared to Crystalloid Priming in Cardiac Surgery Patients with Cardiopulmonary Bypass

"Cardiac surgery with cardiopulmonary bypass (CPB) induces a systemic inflammatory response syndrome that may contribute to postoperative morbidity and mortality. We investigated the in-flammatory responses to colloids compared to crystalloid priming in cardiac surgery patients with cardiopulmonary bypass. Thirty patients undergoing coronary artery bypass grafting (CABG) preparing for CPB were randomized into Ringer's solution (RS), 10% hydroxyethyl starch (HES) or 25% human albumin (HA) group. Serum concentrations of tumor necrosis factor-α (TNF-α), interleukin-1 β (IL-1β ), interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured before CPB, at the end of CPB and 1, 6 and 12 h after CPB. Serum C-reactive protein (CRP) was determined pre-operatively and then daily for 2 days. Body-weight gain was significantly decreased on the day after surgery in the HES group than in the RS group. Volume priming in CPB for CABG patients using HA or HES preparation had less tendency for intense inflammatory response with lower levels of TNF-α, IL-1 β , IL-6 and higher levels of IL-10 compared to patients treated with RS. HES prime had lower levels of circulating CRP than in patients treated with HA or Ringer prime on the second post-operative day. Our data indicate that volume priming using colloid during CPB in CABG patients might exert beneficial effects on inflammatory responses."

Effects of lactated Ringer's solution on ischemic myocardium during optical coherence tomography

The examinations of optical coherence tomography (OCT) images were obtained in 136 patients. Lactated Ringer's solution or physiological saline was used randomly as perfusate. Their electrocardiogram and cardiac enzymes were acquired to compare the safety and image quality of two perfusates.The incidence of ventricular arrhythmia and rise of cardiac enzymes were lower in the lactated Ringer's solution group than those in the physiological saline group.Yet the image quality of OCT had no difference.The use of lactated Ringer's solution as perfusate instead of physiological saline in OCT examination may protect the ischemic myocardium and reduce the incidence of complications. Key words: Tomography,optical coherence; Myocardium

Effect of hydroxyethyl starch on tissue perfusion and serum TNF-α、IL-6、IL-8 levels in patients with severe acute pancreatitis

Objective To observe effects of hydroxyethyl starch(130/0.4,voluven)on tissue perfusion and serum TNF-α,IL-6,IL-8 levels in patients with severe acute pancreatitis(SAP).Methods 60 SAP patients with non-operative treatment were randomly divided into voluven group and Ringer's solution group(n =30 per group).In addition to conventional drugs and treatment,of which voluven group daily 15ml/kg intravenously for 5 d;Ringer's solution group daily 20ml/kg intravenously for 5d.Hemodynamic parameters and tissue perfusion indicators were monitored,TN F-α,IL-6,IL-8 levels were examined after treatment 0,12,24,48,96 hours.Results Compared with Ringer solution group,Voluven group therapy high efficiency,faster raise MAP,ScvO2,Phi value,lower HR,Hct(t =2.785,3.126,4.132,3.168,2.218,all P ＜ 0.05).TNFα,IL-6 after 48h treatment,IL-8 after 96h treatment,both groups were significantly decreased,but the voluven group was significantly lower than Ringer's solution group(P ＜ 0.05).Conclusion Voluven could effectively and quickly maintain hemodynamic stability,improve the hemorheological and tissue perfusion,could be more conducive to improving the pancreatic microcirculation,thus inhibiting inflammatory cytokines TNF-α,IL-6,IL-8 release,and had favorable treatment effect on patients with SAP. Key words: Pancreatitis; Hydroxyethyl starch; Tumor necrosis factor-alpha; Interleukin-6; Interleukin-8

Fluid management in diabetic-acidosis--Ringer's lactate versus normal saline: a randomized controlled trial

To determine if Ringer's lactate is superior to 0.9% sodium chloride solution for resolution of acidosis in the management of diabetic ketoacidosis (DKA). Parallel double blind randomized controlled trial. Patients presenting with DKA at Kalafong and Steve Biko Academic hospitals were recruited for inclusion in this study if they were >18 years of age, had a venous pH >6.9 and ≤7.2, a blood glucose of >13 mmol/l and had urine ketones of ≥2+. All patients had to be alert enough to give informed consent and should have received <1 l of resuscitation fluid prior to enrolment. Fifty-seven patients were randomly allocated, 29 were allocated to receive 0.9% sodium chloride solution and 28 to receive Ringer's lactate (of which 27 were included in the analysis in each group). An adjusted Cox proportional hazards analysis was done to compare the time to normalization of pH between the 0.9% sodium chloride solution and Ringer's lactate groups. The hazard ratio (Ringer's compared with 0.9% sodium chloride solution) for time to venous pH normalization (pH = 7.32) was 1.863 (95% CI 0.937-3.705, P = 0.076). The median time to reach a pH of 7.32 for the 0.9% sodium chloride solution group was 683 min (95% CI 378-988) (IQR: 435-1095 min) and for Ringer's lactate solution 540 min (95% CI 184-896, P = 0.251). The unadjusted time to lower blood glucose to 14 mmol/l was significantly longer in the Ringer's lactate solution group (410 min, IQR: 240-540) than the 0.9% sodium chloride solution group (300 min, IQR: 235-420, P = 0.044). No difference could be demonstrated between the Ringer's lactate and 0.9% sodium chloride solution groups in the time to resolution of DKA (based on the ADA criteria) (unadjusted: P = 0.934, adjusted: P = 0.758) This study failed to indicate benefit from using Ringer's lactate solution compared to 0.9% sodium chloride solution regarding time to normalization of pH in patients with DKA. The time to reach a blood glucose level of 14 mmol/l took significantly longer with the Ringer's lactate solution.

Effectiveness and tissue compatibility of a 12‐week treatment of chronic venous leg ulcers with an octenidine based antiseptic – a randomized, double‐blind controlled study

The aim of this study was to evaluate the cytotoxic effect of octenidine dihydrochloride/phenoxyethanol (OHP) found in vitro by conducting a randomized, double-blind controlled clinical study focusing on its safe and effective use in chronic venous leg ulcers. In total, 126 male and female patients were treated with either OHP (n = 60) or Ringer solution (n = 66). The treatment lasted over a period of maximum 12 weeks. For the assessment of the wound-healing process, clinical outcome parameters were employed, that is, time span until 100% epithelization, wound status and the wound surface area were analysed. Side effects were recorded during the study period. The median time to complete ulcer healing was comparable between the OHP and Ringer solution groups (92 versus 87 days; P = 0·952), without being influenced by wound size or duration of the target ulcer (P-values: 0·947/0·978). In patients treated with OHP, fewer adverse events (AEs) were observed compared with the Ringer group (17% versus 29% of patients reported 20 versus 38 AEs). OHP is well suitable for the treatment of chronic wounds without cytotoxic effects. Furthermore, OHP does not impair the wound healing in chronic venous ulcers.

Effect of volume therapy with 6 ％ hydroxyethyl starch 130/0.4 on mesenteric microcirculation in a rabbit model of hypovolemia

Objective To investigate the effect of volume therapy with 6％ hydroxyethyl starch (HES) 130/0.4 on mesenteric microcirculation in a rabbit model of hypovolemia.Methods Sixty-four adult male rabbits,weighing 2.0-2.3 kg,were randomly divided into 4 groups( n =16 each):control group (group C),hypovolemia group (group HM),Ringer's solution group (group RS) and 6％ HES 130/0.4 group (group HES).The animals were anesthetized with sodiun pentobarbital 3.0-3.5 mg/kg.Femoral artery,femoral vein and right internal jugular vein were cannulated for MAP monitoring,blood withdrawing and fluid adminstration.Hypovolemia was induced by withdrawing blood from femoral vein of 30％ blood volume in 30 min in groups HM,RS and HES.In group C,no blood was withdrawed.In group RS,Ringer's solution 3 times of the volume of blood withdrawn was infused,while 6％ HES 130/0.4 equal volume of blood withdrawn was infused via right internal jugular vein immediately at the end of blood withdrawing.MAP and HR were recorded and femoral artery and femoral vein blood samples were taken before blood withdrawing (T0),immediately at the end of blood withdrawing(T1 ),immediately at the end of volume therapy(T2 ) and 30 min after volume therapy(T3 ).DO2,VO2 and ERO2 were calculated.Diameter and blood flow speed of microvessel were determined.Results Compared with group C,HR was significantly increased,MAP decreased,diameter and blood flow speed of microvessel were decreased at T1～3,DO2 was increased at T1 in group HM.Compared with group HM,MAP was significantly increased at T2,HR decreased at T2,3,DO2and VO2 were increased at T1～3,diameter of arteriole was increased at T2 whlie decreased at T3,diameter of veinule and blood flow speed of microvessel were increased at T2,3 in group RS,MAP was significantly increased at T2,HR was decreased whlie DO2 and VO2 were decreased,VO2,ERO2,diameter and blood flow speed of microvessel were increased at T2,3 in group HES.Compared with group RS,DO2,VO2 and ERO2 were significantly decreased at T3 in group HES.Conclusion Volume therapy with 6％ HES 130/0.4 can improve mesenteric microcirculation,organ perfusion and oxygen metabolic in a rabbit model of hypovolemia. Key words: Hetastarch ; Fluid therapy ; Hypovolemia; Microcirculation

Effects of acute hypervolumic hemodilution with 6％ hydroxyethyl starch (130/0.4) on glycometabolism in patients with posterior lumbar decompression and bone graft fixation

Objective To investigate the effects of acute hypervolumic hemodilution (AHH) with 6％ hydroxyethyl starch (130/0.4) on glycometabolism in patients with posterior lumbar decompression and bone graft-fixation. Methods Sixty ASA Ⅰ -Ⅱ selective surgery patients were randomly divided into three groups(n=20): control group (group A), Ringer's solution group (group B) and voluven group (group C). In group B and C, 15 ml/kg Ringer's solution or voluven were infused respectively in 20 min-30 min after induction of anesthesia. The hemodynamics were continuously monitored in three groups. Blood samples were taken and the level of Hb, Hct, glucose(glu), cortisol(cor), glucagon(gln) and insulin(ins) were examined at different time points: prior to the AHH (T1), AHH finished immediately (T2), after surgery (T3), and 2 h after surgery (T4). Also the HOMA-insulin resistance index (HOMA-IRI) and insulin sensitivity index(ISI) were calculated. Results The hemodynamics of B and C groups remained stable at T2 compared with that at T1, but the level of glu, cor, gln and ins declined. At T3 and T4 in group A and B Hb, Hct and ISI significantly decreased(P＜0.05). Glu(11.6±2.3) mmol/L, ins(11.2±2.5) mIU/L, cor(347±39) μg/L, gln (230±19) ng/L and IRI increased markedly (P＜0.05). There were significant changes of glu, cor, gln, ins, IRI and ISI at T1. At T3 and T4 in group C, glu (8.0±2.0) mmol/L, ins (8.5±2.3) mIU/L, cot (282±21) μg/L, gln (197±28) ng/L and IRI elevated to a less degree than that observed in group A and B (P＜0.05). ISI decreased slightly in group C at post operation compared with that in other two groups (P＜0.05). Conclusion Implemented AHH with voluven before surgery can reduce posterior lumbar decompression and bone graft in patients with the concentration of stress hyperglycemia, cortisol, glucagon and insulin resistance. Key words: 6％ hydroxyethly starch; Hemodilution; Blood glucose; Glycometabolism

The Effect of HTK Solution Modification by Addition of Prolactin on Biochemical Indices Reflecting Ischaemic Damage to Porcine Kidney

Introduction The aim of our study was to evaluate the impact of perfusion with HTK solution, modified by the addition of prolactin (PRI), on selected biochemical parameters of porcine renal damage within 24 and 48 hours after the onset of cold ischemia time. Methods Each study group consisted of 10 adult pigs. During harvesting the kidneys were rinsed with Ringer's solution (group 1), HTK (group 2), and HTK+PRL in a dose of 0.2 mg/dL, 0.02 mg/dL, and 0.01 mg/dL in groups 3, 4 and 5, respectively. The levels of lactate dehydrogenase, asparagine (AST) and alanine aminotransferases, lactates, total protein, potassium and calcium were determined in the perfusate. After 24 and 48 hours the rinsing procedure and the abovementioned tests were repeated. Results After 24 hours of storage, in 4 groups, significantly lower levels of LDH (U/L) were recorded compared with HTK solution alone, namely 235 ± 93 versus 271 ± 125 (perfusion minute, 0), and 55 ± 21 versus 125 ± 94 (30th minute). Similar behavior pattern was presented by AST (U/L) and potassium (mmol/L), and the results were 31 ± 8 versus 35 ± 12 and 16 ± 10 versus 29 ± 14, and 12 ± 3 versus 16 ± 3 and 10 ± 1 versus 13 ± 1, respectively. The changes described above were not observed in the 48th hour of reperfusion. Conclusion Our study results indicate the possibility of cytoprotective action of PRL after adding it to the fluid perfusing kidneys during cold ischemia. This effect, observed after 24 hours of storage, was to a considerable extent dose dependent. In our experiment the effect was pronounced only at 0.02 mg/dL supply of PRL.

Effects of treatment with different fluids on systemic inflammatory response in newborn rabbits with septic shock

Objective To evaluate the effects of treatment with different fluids on systemic inflammatory response in newborn rabbits with septic shock. Methods One hundred New Zealand white rabbits （3-5 days, 45- 70 kg） were randomly divided into 5 groups （n = 20 each）： group I sham operation （group S）; group II sepsis （group CLP）; group m lactated Ringer＇s solution （group R）; group IV 6% HES （group HES） and group V （group R ＋ HES）. The animals were anesthetized with intraperitoneal ketamine and midazolam. Sepsis was induced by cecal ligation and puncture （CLP）. The animals in group R and HES received lactated Ringer＇s solution and 6% hydroxyethyl starch （HES） 30 ml/kg infused iv over 1 h respectively immediately after CLP, while group R ＋ HES received Ringer＇s solution 20 ml/kg and 6% HES 10 ml/kg. No fluid was infused in groups S and CLP. Carotid artery and jugular vein were cannulated for MAP monitoring, blood sampling and drug and fluid administration. MAP was recorded immediately （T1） and at 0.5, 1, 2, 4, 8 h （ T2-6 ） after CLP. Arterial blood samples were collected at T6 for determination of plasma IL-6 and IL-10 concentrations. Results Compared with those at T1 , MAP decreased significantly after CLP at T4-6 in group CLP and at T5-6 in group R but hypotension did not develop after CLP in group HES and R ＋ HES. Plasma IL-6 concentration was significantly higher in group CLP and R than in group S. There was no significant difference in plasma IL-6 concentration between group S and group HES and R ＋ HES. Plasma IL-10 concentration was significantly lower in group CLP and higher in group HES than in group S. There was no significant difference in plasma IL-10 concentration between group S and group R and R ＋ HES. Plasma IL-6 concentration was significantly lower, while plasma IL-10 concentration was significantly higher in group R ＋ HES and HES, and plasma IL-10 concentration was significantly higher in group R than in group CLP （ P 〈 0.05 ）. Conclusion Ringer＇ s solution ＋ 6 % HES （2 ： 1 ） is better than Ringer＇ s solution or 6% HES infused iv alone in maintaining the balance between pro-and anti-inflammatory cytokines in newborn rabbits with septic shock. Key words: Fluid therapy; Shock, septic; Systemic inflammatory response syndrome

Protective effects of hydroxyethyl starch on myocardial ischemia/reperfusion injury in rabbits

Objective To observe the effects of hydroethyl starch (HES 130/0.4) on serum interleukin-8, endothelin-l(ET-1) and myocardial myeloperoxidase activity (MP0) in rabbits subjected to ischemia-reperfusion, and to explore its possible mechanism. Method Thirty-six rabbits were randomly divided into three groups: lac-tated Ringer's solution group (group A, n= 12), 5% human albumin group (group B, n= 12) and 6% hy-droethyl starch group (group C, n= 12) Hie myodardial ischemia/reperfusion (MI/R) model was established by clamping left anterior descending coronary artery for 30 minutes followed by reperfusion for 180 minutes. Fifteen minutes prior to reperfusion, animals of these 3 given groups were ifused vis right internal jugular vein with 6 ml/kg lactated Ringer'solution, 5% human albumin and hydroethyl starch, respectively. Blood samples were obtained before occlusion (I_0),30 minutes after occlusion (I_1), 60 minutes (R_1) and 180 (R_2) minutes after reperfusion to determine the activities of serum lactate dehydrogenase (LDH), serum creatine phosphokinase (CPK), serum interleukin-8(IL-8) and endotheun-1 (ET-1).The size of myocardial infarction (MI),myocardial water content and myoloperoxidase activity (MPO) were examined as well.Statistical analyses were performed by using SPSS 12.0 software. Multiple comparisons were analyzed by using one-way analysis of variance (SNK- qtest). P ＜ 0.05 was considered statistically significant. Results The serum IDH, CPK,IL-8 and ET-1 weregradually increased after reperfusion, however, 180 min after reperfusion all serum biomarkers in 6% hydroethylstarch group (group C) were significantly lower than those in Iactated Ringer's solution group (group A) [(181 ±17) U/lvs. (334±39) U/L; (1927±205) U/L vs. (2987±326) U/L; (5.03±1.16) ng/L vs. (6.96±1.21) ng/L; (380±78.4) ng/L vs. (667.2±82.1) ng/L. all P ＜0.05], and than those in 5% human albu-min group (group B) [(181 ±17) U/L vs. (320±38) U/L; (1727 ±205) U/L vs. (2218 ±290) U/L; (5.03 ±1.16) ng/L vs. (5.90±1.03) ng/L; (380.9±78.4) ng/L vs. (615.6±80.2) ng/L, all P ＜0.05]. Theactivity of MPO of ischemic area in group C (0.20 ± 0.09 ng/L) was significantly lower than that in group A(0.48±0.15 ng/L) and in group B (0.37 ±0.12 ng/L) (P ＜ 0.05). Myocardial water content and infarct sizeof heart found in group C were significantly smaller than those in both group A and group B (P ＜ 0.05). Conclu-sions The 6% hydroethyl starch exhibits its protective effects on myocardial ischemia-reperfusion injury by pre-venting the production and release of serum IL-8 and ET-1, decreasing neutrophil infiltration capillary permeabilityand improving microvascular circulation. Key words: Hydroxyethyl starch; Reperfusion injury; Interleukin-8; Endothelin-1; Myeloperoxidase

The ameliorating effect of preoperative loading infusion with 4% succinylated gelatin solution on hemorheology of gastric cancer patients during perioperative period

Objective To investigate the effect of loading infusion with succinylated gelatin(GEL) solution before surgery on hemorheology of patients with gastric cancer during perioprative period. Methods Forty patients undergoing gastric cancer radical surgery were randomly divided into 2 groups (n=20): GEL solution group (GEL group) and Ringer's Lactated solution group(RL group). Twenty people received health examination were selected as normal control group. The two kinds of solution were respectively infused at a dose of 15 ml/kg over a period of 30 rain before surgery (loading infusion, LI). Blood samples were taken for determination of hemorheology variables before LI(T_0, baseline), the end of LI(T_1), 1 h after the end of Ll(T_2)and 1 h after the end of surgery (T_3). Results The blood viscosity, plasma viscosity, erythrocyte aggregation index (EAI)and fibrinogen were higher than those in normal control group (P<0.05). The blood viscosity, plasma viscosity, EAI, fibrinogen and Hct decreased significantly as compared to the baseline values at T_0 in GEL group(P<0.05). The blood viscosity at low shear rate and EAI increased significantly as compared to the baseline values at T_0 in RL group (P<0.05). The blood viscosity, plasma viscosity, EAI, fibrinogen and Hct were lower than those in RL group at T_2 and T_3(P<0.05). Conclusion Blood of patients with gastric cancer presentes hyperviscosity state.GEL solution can ameliorate hemorheology variables and alleviate hyperviscosity state during perioperative period. Key words: Gelatin; Fluid therapy; Hemorheology; Gastric neoplasms

Evaluation of diffusion of triamcinolone acetonide from the distal interphalangeal joint into the navicular bursa in horses

To determine whether triamcinolone acetonide diffuses from the distal interphalangeal joint (DIPJ) to the navicular bursa, diffusion is direct or systemic, and addition of sodium hyaluronan has an effect on diffusion in horses. 11 adult horses without forelimb lameness. 1 randomly chosen forelimb DIPJ of each horse received an injection of 10 mg of triamcinolone acetonide plus 20 mg of sodium hyaluronan (group 1), and the contralateral forelimb DIPJ received an injection of 10 mg of triamcinolone acetonide plus 2 mL of lactated Ringer's solution (group 2). Synovial fluid samples were taken from both forelimb navicular bursae and 1 hind limb navicular bursa (systemic control group) at 6 hours. Triamcinolone acetonide concentrations in synovial fluid were quantified by use of high-performance liquid chromatography plus tandem mass spectrometry. Data were logarithmically transformed, and contrast analysis was performed on the 3 groups. Triamcinolone acetonide was detected in navicular bursal samples in all groups. Groups 1 and 2 had significantly greater concentrations of triamcinolone acetonide than the systemic control group. There was no significant difference between groups 1 and 2. Triamcinolone acetonide diffused directly from the DIPJ into the navicular bursa in clinically normal horses, and diffusion was not affected by addition of hyaluronan. Injection into the DIPJ with triamcinolone acetonide or a triamcinolone acetonide-hyaluronan combination can potentially be used for treatment of navicular syndrome, but further studies are needed to determine whether triamcinolone acetonide diffuses similarly in horses with navicular syndrome.

Effects of Different Resuscitation Fluids on Acute Lung Injury in a Rat Model of Uncontrolled Hemorrhagic Shock and Infection

To investigate the effects of different resuscitation fluids on acute lung injury in a rat model of uncontrolled hemorrhagic shock (HS) followed by mimicked infection. Sixty Sprague-Dawley rats were randomly assigned to one of the five groups (n = 12 per group) to receive the following treatments: (1) control group (group C), surgery, no hemorrhage, and no resuscitation; (2) no fluid resuscitation group; (3) lactated Ringer's solution group; (4) 7.5% hypertonic saline (HTS) group; and (5) hydroxyethyl starch group (group HES). All experimental groups were subjected to three phases: phase I entailed massive hemorrhage with a mean arterial pressure of 35 mm Hg to 40 mm Hg for 60 minutes by tail amputation and followed by mimicked infection by intratracheal administration of lipopolysaccharide 2 mg/kg. The animals in each group were then partially resuscitated with the fluid assigned to the group. Phase II of 60 minutes commenced at tail ligation, involved hemostasis, and return of all the blood initially shed. Phase III was an observation phase with no any further treatment and lasted for 3.5 hours. The survival rate at the end of the phase III was recorded. After phase III, arterial blood gases were recorded. The wet to dry lung weight ratio, pulmonary microvascular permeability, the expression of transforming growth factor (TGF)-beta1, and Smad2 were determined. The lung histology was also assessed. HES and HTS solutions were more effective than no fluid resuscitation and lactated Ringer's solution in reducing the detrimental effects of HS and infection on the lungs, as seen by the significantly lower pulmonary microvascular permeability and wet to dry lung weight ratio, the improved arterial blood gases and lower levels of TGF-beta1and Smad2 expression in lung tissues. These beneficial effects were most pronounced in the group HES. This study demonstrated that resuscitation with HTS and especially with HES could reduce lung tissue damage and pulmonary edema after severe uncontrolled HS. The TGF-beta1/Smad2 signaling pathway might play a key role in regulation of pulmonary permeability and formation of pulmonary edema in a rat model of uncontrolled HS and infection.

Effect of whole gut irrigation solutions on gastrointestinal smooth muscle activity

Background/Purpose It has been suggested that whole gut irrigation (WGI), which is a preparation method for large bowel surgery or colonoscopy, increases gastrointestinal motility by creating a gastrocolic reflex. An experimental study was performed to evaluate the effect of different WGI solutions on gastrointestinal smooth muscle activity. Materials and Methods Thirty Wistar albino rats weighing 200 to 250 g were enrolled in the study. After anesthetization with thiopental sodium (50 mg/kg), proximal ileum, terminal ileum, and colon segments were removed via median laparotomy to obtain a control group. Four different groups (n = 6) were designated as having WGI with saline solution (SS), lactated Ringer's solution (RL), polyethylene glycol (PEG), and dibasic sodium phosphate (DNP). Bowel cleaning was performed by infusing solutions at a rate of 2 mL/min via gastric tube, until the stool was cleared. After completing the bowel cleaning, 2 cm of tissues were removed and suspended in Tyrode solution in an isolated organ bath with a resting tension of 1 g, to obtain carbachol and potassium chloride (KCl) responses. Results The mean bowel cleaning times were 87.5 ± 9.35, 81.6 ± 9.83, 86.6 ± 11.6, and 85.0 ± 0.0 minutes in SS, RL, PEG, and DNP groups, respectively. The total amounts of solutions needed for cleaning were 156.67 ± 21.6, 195.0 ± 20.0, 197.5 ± 32.8, and 70.0 ± 0.0 mL, respectively. Although there was no difference in cleaning time between the groups, the amount of solution required was significantly less in the DNP group ( P = .02). In the proximal ileum segments, though there was no difference in carbachol responses between groups, KCl responses were significantly increased in the RL group ( P < .05). When we evaluated the terminal ileum responses, carbachol responses were significantly increased in RL and PEG groups ( P = .011) and decreased in the DNP group ( P = .049). The KCl responses were also significantly increased in the RL group with respect to the other groups ( P < .05). Colon segments showed no difference in contractile responses with respect to different WGI solutions ( P > .05, analysis of variance, post hoc Dunn's test). Conclusion The different WGI solutions demonstrated no significant differences in colon contractions. The increased contractile responses in the proximal and terminal ileum segments after WGI with RL may be related to the electrolyte composition of RL. Although the lower amount of DNP solution required to achieve bowel cleaning seems to be an advantage, the decreased ileal contractions can be assessed as a disadvantage of DNP irrigations.

Effects of hypertonic saline on T-lymphocyte subpopulations in patients with traumatically hemorrhagic shock

Objective To investigate the potential and early effect of hypertonic saline resuscitation on Tlymphocyte subpopulations in patients with traumatically hemorrhagic shock.Method Eighty-two patients with acute traumatically hemorrhagic shock admitted from Department of Emergency，Beijing Tongren Hospital，from December 2006 to July 2008 were randomly divided into：hypotonic saline(HS)group(n=43)and Lactated Ringer's solution(LR)group(n=39).The criteria of eligible patients were systolic blood pressure＜90mm Hg at admission with definite evidence of blood loss.Patients with immune system diseases and those who died within 24 hours of admission were excluded.Patients in HS group received intravenous administration of 200 mL of 7.5% sodium chloride withhin 15～20 minutes，and LR group received routine therapy with Lactated Ringer's solution.Blood pressure and heart rate were recorded 10，20，and 60 minutes after the start of resuscitation and compared between two groups.Before and 24 hours after treatment，peripheral blood levels of T-lymphocyte subpopulationsincluding CD3+，CD4+，and CD8+ were measured by using direct immunofluorescence test and compared between two groups.The inter-group comparison was carried out by using independent sample t-lest and intragroup comparison using paired t-test.The numabers of operation，complication cases and death cases were conducted by using X2 test.SPAS version 11.0 software was used for statistical analysis.Results The volume of solution infused in HS group was(3820±623)mL and in LR group was(5430±1254)mL(P＜0.05).At 10 and 20 minutes after the sdministration of solution.the mean blood pressures in HS group were both significantly higher than those in LR group(P＜0.01).The levels of CD3+and CD4+lymphocytes in peripheral blood in HS group 24 hours after treatment were sinificantly higher than those in LR group(P＜0.01).Totally，63(76.8%)patients were cured and 19(23.2%)patients died.ARDS occurred in 10 patients and MODS occurred in 14 patiellts.The mortality，and the rates of ARDS and MODS in HS group were sinificantly higher than those in LP group(P＜0.05).Conclusiom In patients with acute traumatically hemorrhagic shock.HS can increase the effective circulating vol.ume，ameliorate the perfusion of tissues and organs，improve the immune fuction of T-lymphocytes，decrease the rats of ABDS and MODS，mad decrease the morality.HS is more effective than routine solution used for resuscitation. Key words: Hemorrhagic shock; Trauma; Hypertonic saline; T-lymphocyte subpopulations

The Early Effect of Voluven, a Novel Hydroxyethyl Starch (130/0.4), on Cerebral Oxygen Supply and Consumption in Resuscitation of Rabbit With Acute Hemorrhagic Shock

Voluven (hydroxyethyl starch [HES] 130/0.4), a new generation of HES product with low molecular weight, has been widely used for the treatment of traumatic and hemorrhagic shock in clinics. However, no data are available whether it affects the balance of cerebral oxygen supply and consumption when applied to resuscitate hemorrhagic shock. The purpose of this study was to address this question in rabbits subjected to a severe hemorrhagic shock. In New Zealand rabbits, an acute hemorrhagic shock was induced by withdrawing 45% to 50% of total blood volume from the femoral vein in 10 minutes when the mean arterial pressure was reduced to 60% of the baseline level. Thirty minutes after the hemorrhage, animals were infused with either an equal amount of Voluven (group V) or a tripled amount of lactated Ringer's solution (group R). The saturation of oxygen was obtained in arterial (Sao2) and venous (SjvO2) blood samples from the femoral artery and jugular bulb, respectively. Arterial oxygen content (Cao2), jugular oxygen content (CjvO2), arteriovenous oxygen difference (AVDO2), and cerebral oxygen extraction rate (CERO2) were calculated accordingly to evaluate the oxygenation state in the brain. Levels of SjvO2 and CjvO2 were decreased after hemorrhagic shock, and there were increases in AVDO2 and CERO2 values. After resuscitation, the SjvO2, AVDO2, and CERO2 levels in group V were quickly recovered to the basal levels, whereas the values in group R remained in the abnormal levels (p < 0.05). There were significant differences between the groups in their SjvO2 and CERO2 levels at 30 minutes after resuscitation. In addition, the mean arterial pressure was restored to the basal levels in group V but not in group R after resuscitation (p < 0.05). We conclude that early infusion of Voluven is beneficial for maintenance of the hemodynamic stability and for the balance of cerebral oxygen supply and consumption during the resuscitation of acute hemorrhagic shock.

HSD IS A BETTER RESUSCITATION FLUID FOR HEMORRHAGIC SHOCK WITH PULMONARY EDEMA AT HIGH ALTITUDE

To investigate the fluid tolerance of hemorrhagic shock with pulmonary edema (HSPE) at high altitude in unacclimated rats and the beneficial effect of 7.5% hypertonic saline/6% dextran (HSD). One hundred seventy-six Sprague-Dawley rats, transported to LaSa, Tibet, 3,760 m above the sea level, were anesthetized with sodium pentobarbital (30 mg/kg, i.p.) within 1 week. Hemorrhagic shock with pulmonary edema was induced by bloodletting (50 mmHg for 1 h) plus intravenous injection of oleic acid (50 microL/kg). Seventy-seven rats were equally divided into 11 groups (n = 7/group) including sham-operated control group; hemorrhagic shock control group; HSPE control group; HSPE plus 0.5-, 1.0-, 1.5-, 2.0-, or 3.0-fold volumes of lactated Ringer's solution (LR) groups; and HSPE plus 4, 6, and 8 mL/kg of HSD groups. Hemodynamic parameters including mean arterial blood pressure, left intraventricular systolic pressure, and the maximal change rate of intraventricular pressure rise or decline (+/-dp/dtmax) were observed at baseline and at 15, 30, 60, and 120 min after infusion; blood gases were measured at 30 and 120 min after infusion, and the water content of lung and brain was determined at 120 min after infusion. Additional 99 rats were used to observe the effect of these treatments on the survival time of HSPE rats; 0.5 volume of LR infusion slightly increased the mean arterial blood pressure, left intraventricular systolic pressure, and +/-dp/dtmax and prolonged the survival time of HSPE animals as compared with the HSPE group (P < 0.05 - 0.01); it did not increase the water content of lung and brain and had no marked influences on blood gases. One volume of LR infusion had somewhat improved the hemodynamic parameters for HSPE animals, but had no apparent effect on the survival time and the water content of lung and brain. Lactate Ringer's solution infusion, 1.5, 2, and 3 volumes, significantly deteriorated the hemodynamic parameters, increased the water content of lung, and decreased the survival time of HSPE animals. Hypertonic saline/6% dextran (4 - 8 mL/kg) significantly increased the hemodynamic parameters, improved the blood gases, decreased the water content of lung and brain, and prolonged the survival time of HSPE rats. Among the three dosages of HSD, 6 mL/kg of HSD had the best effect. The tolerance of fluid infusion for hemorrhagic shock with pulmonary edema at high altitude is significantly decreased. More than one volume of LR infusion would aggravate the pulmonary edema and exacerbate the resuscitation effect, but only one volume of LR cannot reach the effective volume resuscitation. Small volume of HSD could better resuscitate hemorrhagic shock with pulmonary edema at high altitude.