Selda ATEŞ, Oğuz ATEŞ, Gülce HAKGÜDER, Erol GÖKEL, Çimen OLGUNER, Mustafa OLGUNER, Zahide ELAR, SERPİL PAKSOY, Şerafettin CANDA, Feza M. AKGÜR

Hemorajik şok sonrası farklı resüsitasyon sıvılarının no-reflow fenomenine etkileri

Amaç: Hemorajik şok, dolaşımdaki kan volümünün azalması ile meydana geür. Vücuttaki tüm organlarda doku hipoperfüzyonuna ve hipoksisine sebep olur. Uzamış iskemi sonrası organların kan dolaşımında en önemli fonksiyon bozukluğu, reperfüzyon başladığında kapiller kan akımındaki azalmadır ve kapiller no-reflon> olarak adlandırılır. Hemorajik şokta amaç sadece zamanında hacmi yerine koymak değil, organlardaki iskemi reperfüzyon (İ/R) sonrası no-reflow fenomenini engellemeye yönelik olmalıdır. Reperfüzyon amacıyla kullanılan sıvıların organlarda no-reflow fenomenini engellemeye yönelik etkinliklerini belirlemek amacıyla çalışma planlanmıştır. Yöntem: Bu çalışmada hemorajik şok oluşturulan ratlara (ortalama arteriyel basıncı 40 mmHg'ye azalıncaya kadar kontrollü kanatılarak) 60 dk sonra grup 2 (n=5) de % 0,9 NaCl sıvısı, grup 3 (n=5) de jelatin sıvısı, grup 4 (n=5) de hidroksi etil nişasta (hydroxyethyl starch, 130 kD) sıvısı ve grup 5 (n=5) de dekstran 40 sıvısı ile resüsitasyon yapıldı. Grup 1 (n=3) kontrol grubu olarak kullanıldı ve tüm grupların çeşitli organlarında (karaciğer, akciğer, böbrek, beyin, bağırsak ve kalp) resüsitas-yondan 60 dakika sonra çini mürekkebi ile perfüze olan kapiller sayıları histopatolojik inceleme ile belirlendi. Bulgular: Kalp, akciğer, karaciğer, bağırsak ve beyin dokularında HES 130 kD ve dekstran 40 resüsitasyonunda perfüze olan kapiller sayısının, %0,9 NaCl ve jelatin resüsitasyonuna göre istatiksel olarak anlamlı fazla olduğu saptandı. Sonuç: Çini mürekkebi perfüzyon yöntemi kullanarak hemorajik şokta İ/R sonrası no-reflow fenomenini, kalp, akciğer, karaciğer, bağırsak ve beyin dokularında jelatin ve %0,9 NaCl sıvısının engellemediği, HES 130 kD'nin ve dekstran 40 sıvılarının ise no-reflow fenomenini engellediği saptandı.

Anahtar Kelimeler:

Sıçanlar, Mikrosirkülasyon, Canlandırma, Şok, kanama

Effects of different resuscitation fluids on no-reflow phenomenon after the hemorrhagic shock

Objective: Hemorrhagic shock is caused by a decrease in the circulating blood - volume. It causes hypoperfusion and hypoxia of the tissues in all organs of the body. The principal functional impairment in circulation of these organs is reduction of capillary blood flow at establishment of reperfusion and it is called the "no-reflow phenomenon". The objective of treatment in hemorrhagic shock should not solely be institution of volume on time but to prevent no-reflow phenomenon after ischemia-reperfusion (I/R) of the organs. This study was planned to investigate the efficiency of several resuscitation fluids on prevention of no-reflow phenomenon in the organs. lllethod: In this study, rats were resuscitated with saline in group 2 (n=5), gelatine solution in group 3 (n=5), hydroxyethyl starch, 130 kD (HES 130 kD) in group 4 (n^5) and dextran 40 in group 5 (n=5) after formation of hemorrhagic shock (corifitolled bleeding till a mean arterial pressure of 40 mm Hg is reached). Group 1 (n—3) constituted the control group. The number of ink perfused capillaries were counted hystopathologically in the organs (liver, lungs, kidney, brain, colon and heart) in all groups^ 60 minutes following resuscitationin. Indian drawing ink was used for this purpose. Results: In comparison with the saline and gelatine groups, capillary perfusion ir the heart, lung, liver, colon and brain tissues were found to be significantly improved in HES 130 kD and dextran 40 groups. Conclusions: It was concluded that using the ink perfusion method, the no-reflow phenomenon was not prevented with saline and gelatine resuscitation in the heart lung, liver, colon and brain tissues following IR in hemorrhagic shock, while no reflow phenomenon was prevented with HES 130 kD and dextran 40 resuscitation.

Keywords:

Rats, Microcirculation, Resuscitation, Shock, Hemorrhagic,

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