출혈성 쇼크에서 하이드록시에틸 스타취(Hydroxyethyl Starch)와 7.5% 고장식염수 혼합수액 소생술이 급성 폐손상 억제에 미치는 효과 (The Effect on Acute Lung Injury When 7.5% Hypertonic Saline-Hydroxyethyl Starch for Resuscitated Rats after Hemorrhagic Shock)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 20권 / 3호 / 272 ~ 279페이지
· 저자명 : 박경혜, 이강현, 김현, 황성오

초록

Purpose: Acute lung injury/acute respiratory distress syndrome
is common following major trauma, and is one of the
most important causes of mortality and morbidity.
Compared with gelatine, resuscitation with hydroxyethyl
starch (HES) reduces posttrauma capillary leak.
Furthermore, hypertonic saline (HTS) is known as a promising
fluid resuscitation therapy with the potential to reduce
lung injury caused by severe trauma. The aim of this study
was to test the hypothesis that resuscitation with mixed fluids,
HTS and HES, will reduce inflammation in hemorrhagic
shock induced by acute lung injury compared to control
(sham injury) or to either fluid alone.
Methods: Spraque-Dawley (SD) rats were divided into five
groups randomly: Group I were cannulated but not bled
(sham); Group II bled and received Ringer’s lactated solution;
Group III bled and received 7.5% HTS; Group IV bled
and received HES; Group V bled and received a mixeture
of HTS and HES (HTS-HES). After anesthetizing the rat,
two catheters were inserted into femoral vessels: the
femoral artery for monitoring blood pressure and pulse rate;
the femoral vein for bleeding and fluid resuscitation. Blood
sampling was done for arterial blood gas analysis (ABGA),
Tumor necrosis factor-α(TNF-α), Interleukin-6 (IL-6) before
shock, after fluid resuscitation and after 48 hours of survival.
Bronchoalveolar lavage (BAL) and a lung histology study
were conducted in surviving rats.
Results: Survival rates were as follows; Group I, 80%;
Group II, 100%; Group III, 70%; Group IV, 70%; Group V,
100%. There were no significant between group differences
in initial ABGA, hemoglobin, or TNF-α. TNF-αlevels postresuscitation
were significantly higher in group II compared
to groups IV and V. After 48 hours of survival, TNF-αwas
higher in groups IV and V than in group II. After survival,
The IL-6 level of group V was significantly lower compared
to that of the control group. IL-6 levels in BAL fluid were
higher in groups IV and V than in groups I and II. Lung
injury histology scores were significantly higher in groups IV
and V than in the control group.
Conclusion: After moderate hemorrhagic shock, lung
injury is more severe in rats resuscitated with HTS-HES
than in the control groups.

영어초록

Purpose: Acute lung injury/acute respiratory distress syndrome
is common following major trauma, and is one of the
most important causes of mortality and morbidity.
Compared with gelatine, resuscitation with hydroxyethyl
starch (HES) reduces posttrauma capillary leak.
Furthermore, hypertonic saline (HTS) is known as a promising
fluid resuscitation therapy with the potential to reduce
lung injury caused by severe trauma. The aim of this study
was to test the hypothesis that resuscitation with mixed fluids,
HTS and HES, will reduce inflammation in hemorrhagic
shock induced by acute lung injury compared to control
(sham injury) or to either fluid alone.
Methods: Spraque-Dawley (SD) rats were divided into five
groups randomly: Group I were cannulated but not bled
(sham); Group II bled and received Ringer’s lactated solution;
Group III bled and received 7.5% HTS; Group IV bled
and received HES; Group V bled and received a mixeture
of HTS and HES (HTS-HES). After anesthetizing the rat,
two catheters were inserted into femoral vessels: the
femoral artery for monitoring blood pressure and pulse rate;
the femoral vein for bleeding and fluid resuscitation. Blood
sampling was done for arterial blood gas analysis (ABGA),
Tumor necrosis factor-α(TNF-α), Interleukin-6 (IL-6) before
shock, after fluid resuscitation and after 48 hours of survival.
Bronchoalveolar lavage (BAL) and a lung histology study
were conducted in surviving rats.
Results: Survival rates were as follows; Group I, 80%;
Group II, 100%; Group III, 70%; Group IV, 70%; Group V,
100%. There were no significant between group differences
in initial ABGA, hemoglobin, or TNF-α. TNF-αlevels postresuscitation
were significantly higher in group II compared
to groups IV and V. After 48 hours of survival, TNF-αwas
higher in groups IV and V than in group II. After survival,
The IL-6 level of group V was significantly lower compared
to that of the control group. IL-6 levels in BAL fluid were
higher in groups IV and V than in groups I and II. Lung
injury histology scores were significantly higher in groups IV
and V than in the control group.
Conclusion: After moderate hemorrhagic shock, lung
injury is more severe in rats resuscitated with HTS-HES
than in the control groups.

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