Abstract:

Objective

To study the role and significance of 7.5% hypertonic saline on proinflammatory/anti-inflammatory factor and oxygen free radicals in patients with hemorrhagic shock.

Methods

Forty five cases with hemorrhagic shock，from Emergency Medicine Department，Affiliated Zhongshan Hospital of Dalian University in May 2009 to June 2012，were randomly divided into conventional resuscitation groups（control group，n＝22）and hypertonic saline group（treatment group，n＝23）.The control group was used conventional liquid recovery，the hypertonic saline group added 300 ml with 7.5%hypertonic saline on the basis of control group.To determine the change of heart rate，mean arterial pressure，breathing rate，blood lactic acid，carbon dioxide combining power，and TNF-α，IL-1，IL-10，superoxide dismutase（SOD）activity and malondialdehyde（MDA）arrived at hospital（T₀）and after medication 1（T₁），2（T₂），6（T₁）and 12 h（T₄）.

Results

Serum TNF-αin control group increased at 1，2，6，12 h in varying degrees compared with arrived at hospital.Compared with control group，TNF-αin experimental group start decreasing from1 h（8.56±1.35）pg/ml，（11.56±1.68）pg/ml，t＝2.024，P＜0.05，and decreased obviously from 2 h to 12 h［2 h：（10.18±1.56）pg/ml，（19.36±2.21）pg/ml，t＝2.97，6 h：（15.59±1.56）pg/ml，（29.2±3.24）pg/ml，t＝3.02，12 h：（18.94±1.98）pg/ml，（30.79±3.65）pg/ml，t＝5.072，P＜0.01］.IL-1were significantly decreased after using 2，6，12 h［2 h：（6.63±0.72）pg/ml，（8.43±0.84）pg/ml，t＝2.116，P＜0.05；6 h：（7.21±0.78）pg/ml，（12.5±1.02）pg/ml，t＝4.402，12 h：（9.49±0.87）pg/ml，（15.44±1.57）pg/ml，t＝6.221，P＜0.01］.The content of IL-10 were significantly increased at 2，6，12 h［2h：（10.03±0.74）pg/ml，（8.46±0.62）pg/ml，t＝1.982，P＜0.05；6 h：（9.58±0.68）pg/ml，（7.21±0.55）pg/ml，t＝2.977，12 h：（9.21±0.61）pg/ml，（5.76±0.47）pg/ml，t＝2.582，P＜0.01］.Compared with the control group，serum MDA decreased obviously experimental group 1，2，6，12 h［1 h：（4.35±0.67）pg/ml，（7.56±0.94）pg/ml，t＝1.974，P＜0.05；2 h：（6.58±0.84）pg/ml，（11.39±1.36）pg/ml，t＝2.118，6 h：（8.41±1.14）pg/ml，（16.87±2.17）pg/ml，t＝5.691，12 h：（8.39±1.15）pg/ml，（15.42±2.08）pg/ml，P＜0.01］，while SOD decline significantly diminished［1 h：（114.86±7.62）pg/ml，（102.45±6.79）pg/ml，t＝1.968，2 h：（106.51±6.68）pg/ml，（91.44±6.82）pg/ml，t＝2.034，P＜0.05；6 h：（98.24±7.68）pg/ml，（74.45±6.27）pg/ml，t＝3.230，12 h：（90.15±7.92）pg/ml，（64.31±5.45）pg/ml，t＝4.368，P＜0.01］.The patients'heart rate，MAP，breathing rate，blood lactic acid，carbon dioxide，binding force in treatment group are improved separately compared with control group（P＜0.05）.

Conclusion

7.5 % hypertonic saline could reduce the release of TNFαand IL-1，increase contents of IL-10，and inhibit of oxygen free radical formation，reduce lipid peroxidation.

Key words: Hemorrhagic shock, Hypertonic saline, Resuscitation, Oxygen free radical, Superoxide dismutase, Malondialdehyde