Publication: Travmaya bağlı hemorajik şok oluşturulan sıçanların resüsitasyonunda farklı kolloid sıvıların akciğer dokusu ve koagülasyon üzerine etkileri
Abstract
Amaç: Bu çalışma, sıçanlarda kontrolsüz hemorajik şok modeli sırasında gelatin ve hidroksi etil nişasta (HES) ile resüsitasyonun koagülopati, hemodinami, apoptozis ve doku hasarı üzerine etkilerini karşılaştırmak amacıyla yapılmıştır. Gereç ve Yöntem: Yirmi adet, altı aylık Sprague-Dawley sıçan çalışmaya dahil edilip, dört gruba ayrıldı. Kontrol Grubunda kanama oluşturulmadı. Diğerleri sıvı replasmanı yapılmayan kanama Grubu (H), kanama ve jelatin Grubu (Grup G), kanama ve HES Grubu (Grup V) olarak randomize edildi. Tromboelastogram (TEG) ve Annexin 5 değerleri için kan örnekleri kanama öncesinde (T1) ve resüsitasyon sonrası (T2) alındı. Bulgular:Kontrol Grubunda pıhıtlaşma başlamasını gösteren R (16,18±2,74) ve kinetik zamanı gösteren K (5,8±1,1) tüm gruplardan anlamlı olarak yüksek (p=0,001), TEG alfa açısı 39,54±5,94 Kontrol Grubundan anlamlı olarak düşük bulundu (p=0,001). Grup V'de TEG MA değeri 30,54±8,89'da anlamlı olarak düşük bulundu (p=0,001). Grup H, Grup G ve Grup V’ nin annexin 5 düzeyleri Kontrol Grubuna göre anlamlı olarak yüksekti (p=0,001) ve en yüksek ortalama Grup H’ de gözlendi (p=0,001). Akciğer Hasar Skoru ölçümü Kontrol Grubunda 0,60±0,19 olup Jelatin ve HES gruplarından daha yüksekti (p=0,001). Sonuç: Akciğer dokusu hasarı, apoptozis ve koagülasyon, HES veya jelatin resüsitasyonundan olumlu etkilenmiştir. HES grubunda trombositler üzerindeki olası olumsuz etki nedeniyle pıhtı oluşumunda azalma gözlenebilmektedir. Bu nedenle travmatik hemorajik şokta kan transfüzyonu başlayana kadar jelatin kullanımının avantajlı olabileceği kanaatine varılmıştır.
Objective: This study was constructed to compare the effects of resuscitation with gelatin and hydroxy ethyl starch (HES) on coagulopathy, hemodynamics, apoptosis, and tissue damage during an uncontrolled hemorrhagic shock model in rats. Material and Methods: Twenty, six-month-old Sprague-Dawley rats were included in the study and divided into four groups. There was no hemorrhage in the Control Group. The others were randomized into hemorrhage without volume replacement (Group H), hemorrhage and gelatin (Group G), and hemorrhage and HES (Group V). Blood samples for thromboelastogram (TEG) and Annexin 5 values were obtained before bleeding (T1) and after resuscitation (T2). Results: In the Control Group, the reaction time(R-value) (16.18±2.74) and the kinetic time (K value) (5.8±1.1) were significantly higher than all groups (p=0.001), TEG alpha angle was 39.54±5.94, which was found to be significantly lower than Control Group (p=0.001). In Group V, the TEG MA value was found to be significantly lower at 30.54±8.89 (p=0.001). Annexin A5 value was significantly higher in Group H, Group V, and Group G than in the Control Group and was highest in Group H (p=0.001). The lung Damage Score measurement was 0.60±0.19 in the Control Group, higher than Gelatin and HES groups (p=0.001). Conclusions: Lung tissue damage, apoptosis, and coagulation were positively affected by HES or gelatin resuscitation. A reduction in clot formation in the HES group might be observed due to the possible negative effect on platelets. Therefore, we concluded that the use of gelatin may be advantageous until blood transfusion is initiated in traumatic hemorrhagic shock.
Objective: This study was constructed to compare the effects of resuscitation with gelatin and hydroxy ethyl starch (HES) on coagulopathy, hemodynamics, apoptosis, and tissue damage during an uncontrolled hemorrhagic shock model in rats. Material and Methods: Twenty, six-month-old Sprague-Dawley rats were included in the study and divided into four groups. There was no hemorrhage in the Control Group. The others were randomized into hemorrhage without volume replacement (Group H), hemorrhage and gelatin (Group G), and hemorrhage and HES (Group V). Blood samples for thromboelastogram (TEG) and Annexin 5 values were obtained before bleeding (T1) and after resuscitation (T2). Results: In the Control Group, the reaction time(R-value) (16.18±2.74) and the kinetic time (K value) (5.8±1.1) were significantly higher than all groups (p=0.001), TEG alpha angle was 39.54±5.94, which was found to be significantly lower than Control Group (p=0.001). In Group V, the TEG MA value was found to be significantly lower at 30.54±8.89 (p=0.001). Annexin A5 value was significantly higher in Group H, Group V, and Group G than in the Control Group and was highest in Group H (p=0.001). The lung Damage Score measurement was 0.60±0.19 in the Control Group, higher than Gelatin and HES groups (p=0.001). Conclusions: Lung tissue damage, apoptosis, and coagulation were positively affected by HES or gelatin resuscitation. A reduction in clot formation in the HES group might be observed due to the possible negative effect on platelets. Therefore, we concluded that the use of gelatin may be advantageous until blood transfusion is initiated in traumatic hemorrhagic shock.