Volume replacement with hydroxyethyl starch (HES) 130/0.4 and ringer lactate solution in pigs after severe haemorrhage: A small bowel mucosa preliminary study

摘要

Background and goal of the study: Perioperative and intraoperative hypovolemia may cause intestinal hypoperfusion and postoperative complications1. The objective of this study is to analyse the effect on the small bowel mucosa of HES 130/0.4 and Ringer solutions used for volume replacement after severe haemorrhage in pigs.Materials and methods: Six Large White pigs under TIVA w ith propofol 15 mg/kg/h and remifentanil 0.3 ug/kg/h; 25 ml/kg of arterial blood was removed during 20 minutes f rom each pig. Blood volume w as replaced at 999 ml/h, 20 minutes af ter the end of the bleeding as follow s: Gr1- three pigs,volume was replaced w ith 25 ml/kg Ringer; Gr2- three pigs, the volume was replaced w ith 20 ml/kg HES 130/0.4. Pigs w ere maintained under the same TIVA for an additional one hour beforeeuthanasia w ith 40 mEq of KCl. Small bowel samples w ere collected and a) semiquantitative parameters oedema, congestion, hyperaemia, haemorrhage, inf lammatory infiltration, cellular degeneration and necrosis, and b) the epithelial detachment w ere evaluated and classified in a specif ic scale f rom 0 to 32, and 0 to 53,4, respectively. The quantitative morphological assessment to mucosal loss (ML) percentage and crypt:interstitium ratio (C:I) w as also analysed. Mean arterial pressure (MAP) and heart rate (HR) were analysed.Results and Discussion: Gr1- MAP decreased 60% f rom baseline (69.3±3.8 mmHg to 27.7±4.2mmHg); ML percentage was 2.18±0.46% (duodenum), 0.62±1.07% (jejunum) and 0.45±0.77% ileum); the C:I w as 0.5±0.06% (duodenum), 0.49±0.02% (jejunum) and 0.46±0.09% (ileum). Gr2-MAP decreased 71% from baseline (78.7±18.9 mmHg to 22.7±0.1 mmHg); ML percentage w as0.75±1.3% (duodenum), 0.0±0.0% (jejunum) and 0.0±0.0% (ileum); the C:I was 0.73±0.28%(duodenum), 0.48±0.11% (jejunum) and 0.43±0.12% (ileum). C:I ratio did not presented relevant differences among the Groups. There were no signif icant changes in HR in both groups.Conclusions: Volume replacement w ith HES 130/0.4 may reduce the ML in the small bowel after severe haemorrhage, w hen compared to using Ringer Lactate. Duodenum mucosa seems to be more sensitive to hypoperfusion than jejunum and ileum mucosa.