title: Protection against intestinal injury from hemorrhagic shock by direct peritoneal resuscitation with pyruvate in rats.
abstract: OBJECTIVE
  We explored the effects of direct peritoneal resuscitation with pyruvate-peritoneal dialysis solution (PDS) following intravenous resuscitation (VR) on intestinal ischemia-reperfusion injury in rats with hemorrhagic shock (HS).
  
  
  METHODS
  Fifty rats were randomly assigned equally to five groups. In group sham, a surgical operation was performed on rats without shock or resuscitation. In group VR, rats were subjected only to VR. In groups NS, LA, and PY, direct peritoneal resuscitation was performed with normal saline (NS), lactate-based PDS (Lac-PDS), and pyruvate-based PDS (Pyr-PDS), respectively, after VR. Mean arterial pressure was monitored in the right common carotid artery. Two hours after resuscitation, the lactate level in arterial blood and the wet weight/dry weight ratio of the intestine were determined. The intestinal mucosal damage index was estimated, and ultrastructural changes in the intestinal mucosa were observed. Malondialdehyde, myeloperoxidase, nitric oxide, and tumor necrosis factor α levels were also measured.
  
  
  RESULTS
  Two hours after HS and resuscitation, the increase in arterial blood lactate and intestinal wet weight/dry weight ratio declined significantly in rats from Groups LA and PY compared with groups VR and NS, whereas group PY was more advantageous in the changes of these parameters. The intestinal mucosal damage index and ultrastructural changes were also improved in groups LA and PY when compared with groups VR and NS. Protection was more apparent with Pyr-PDS than Lac-PDS. Hemorrhagic shock resulted in a significant increase in malondialdehyde levels and myeloperoxidase activity and was accompanied by overexpression of tumor necrosis factor α and a reduction in nitric oxide levels. These changes were significantly attenuated by Lac-PDS and Pyr-PDS at 2 h after resuscitation, and Pyr-PDS showed more effective protection for the intestine than Lac-PDS.
  
  
  CONCLUSIONS
  Direct peritoneal resuscitation with Lac-PDS and Pyr-PDS after VR alleviated intestinal injury from HS in rats, and Pyr-PDS was superior to Lac-PDS in its protective effect. Mechanisms of action might include the elimination of free oxygen radicals, reduction of neutrophil infiltration, inhibition of the inflammatory response, and regulation of intestinal mucosal blood flow and barrier function.
authors: Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
authors: Jing-Jing
authors: JJ
authors: Zhang
authors: Zong-Ze
authors: ZZ
authors: Zhang
authors: Jian-Juan
authors: JJ
authors: Ke
authors: Xiang-Hu
authors: XH
authors: He
authors: Jia
authors: J
authors: Zhan
authors: Dong-Ling
authors: DL
authors: Chen
authors: Yi-Peng
authors: YP
authors: Wang
authors: Yan-Lin
authors: YL
authors: Wang
mesh_terms: D000818:Animals; D015314:Dialysis Solutions / Q000627:therapeutic use; D004353:Drug Evaluation, Preclinical / Q000379:methods; D005440:Fluid Therapy / Q000379:methods; D018836:Inflammation Mediators / Q000378:metabolism; D007413:Intestinal Mucosa / Q000098:blood supply / Q000378:metabolism / Q000648:ultrastructure; D007421:Intestine, Small / Q000098:blood supply* / Q000378:metabolism / Q000648:ultrastructure; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008854:Microscopy, Electron; D019289:Pyruvic Acid / Q000627:therapeutic use*; D017207:Rats, Sprague-Dawley; D017382:Reactive Oxygen Species / Q000378:metabolism; D015427:Reperfusion Injury / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D015314:Dialysis Solutions; D018836:Inflammation Mediators; D017382:Reactive Oxygen Species; D014409:Tumor Necrosis Factor-alpha; D019344:Lactic Acid; D019289:Pyruvic Acid