Artikel
Noradrenalin, but not colloidal fluid (amylopectin), reduces gut-induced lung injury during pre-clinical resuscitation in a trauma and haemorrhagic shock model
Suche in Medline nach
Autoren
-
Atesch Ateschrang
- Berufsgenossenschaftliche Unfallklinik Tübingen, Unfall- und Wiederherstellungschirurgie, Tübingen
-
Jörg Glatzle
- Berufsgenossenschaftliche Unfallklinik Tübingen, Unfall- und Wiederherstellungschirurgie, Tübingen
-
Alfred Königsrainer
- Universitätsklinik Tübingen, Abteilung für Allgemein-, Viszeral- und Transplantationschirurgie, Tübingen
| Veröffentlicht: | 20. Mai 2011 |
|---|
Gliederung
Text
Introduction: Vasopressin enhances survival compared with crystalloid and colloid fluids in animal trials after T/HS. The aim of this study was to compare the effects of pre-clinical application of noradrenalin and amylopectin due to T/HS on developing secondary lung and gut injury.
Materials and methods: Male Sprague-Dawley rats weighing 300 to 400 g were anesthetized with intraperitoneal ketamin and midozalim. The internal jugular vein and femoral artery were isolated and cannulated with 50-gauge silicone catheter containing 0,1ml heparinised saline. Tracheotomy secured the airways. A 3 cm laparotomy (trauma) was performed followed by closure with a running 3-0 suture. The femoral artery was attached in line to a blood-pressure monitor. Blood was then withdrawn from the internal jugular vein. The mean arterial pressure was reduced to 30 mmHg for a time period of 45 minutes. Resuscitation involved noradrenalin for group A (n=8) and amylopectin (HAES 6%) for group B (n=8) for a time of 45 minutes to simulate pre-clinical circumstances. The shed blood was kept at 37°C and re-infused to simulate clinical treatment phase. Four hours after clinical resuscitation, rats were killed. The lung and intestinal injury were assed histologically. The lung edema was measured by light microscopy (surface of alveolar-capillary block). The intestinal injury was measured according to Park (0-III).
Results: Mean surface of the alveolar-capillary block in group A was 16,085 μm2 (14,023–19,109) and 23,382 μm2 (15,360–31,552) for group B. The intestinal basal membranes of group A and B showed an average damage score (Park) of 0,16 and 0 for the mucosa of small intestine. The damage to the muscularis averaged 0,33 for both groups.
Conclusion: Resuscitation using noradrenalin produced less lung injury compared to colloidal fluid resuscitation, while no histological difference of intestinal injury was observed. Further trials with longer observation periods are necessary to rule out late onset lung and intestinal injury.
