| Summary: | 博士 === 慈濟大學 === 醫學研究所 === 97 === Hemorrhagic shock (HS) is one of the major causes of death in trauma patient and during surgical procedures. Therapeutic modulation of the inflammatory immune response would be probably constitute the next generation of therapy except fluid resuscitation and blood replacement in HS. Fluvastatin is used extensively in clinic. Recent studies suggest that it has effect of inflammation immune modulation, however, it has not been proved that whether fluvastatin has therapeutic modulation of the inflammatory immune response in HS. In the other hand, hot water immersion is a common nursing intervention that used before surgery to decrease insomnia and anxiety, but it is not known whether heat stress causes negative effects during surgery. In this study, we study and compare the pathophysiological effects of invasive pretreatment (fluvastatin) and non-invasive pretreatment (hot water immersion) in HS. In the invasive pretreatment, we studied the pathophysiological effects of the pretreatment with Fluvastatin (1mg/kg) in HS. HS was produced by bleeding from a femoral arterial catheter to remove 60% of total blood volume (6ml/ 100g BW) over 30 min. In the results, we found that HS significantly increased heart rate (HR), blood glutamic oxaloacetic transminase (GOT), glutamic pyruvic transaminase (GPT), blood urea nitrogen (BUN), creatinine, lactic dehydrogenase (LDH), creatine phosphokinase (CPK), lactate, TNF-α and IL-10 level, and it also induced metabolic acidosis and decreased mean arterial pressure (MAP) in rats. Pre-treatment with fluvastatin suppressed the release of TNF-α, increased IL-10 production and decreased the levels of markers of organ injury after induction of HS in rats. In the non-invasive pretreatment, we used conscious animal model, rat took hot water immersion in 42℃ for 15 minutes to achieve effect of thermotherapy but no cause of mortality. We investigated into the different physiological responses between occasional and regular hot water immersion. In the results, we found that occasional hot water immersion could lead to disadvantage physiological responses due to heat stress, that include elevation of hematocrit, platelet number, white blood count, plasma osmolality, lactate, TNF-α, IL-6 and IL-10 level. In contrast, regular hot water immersion had no such physiological responses due to heat acclimation. Occasional hot water immersion caused significant elevation of blood sugar and could not produce protective effects to intestine ischemia/ reperfusion cause of severe HS. Opposite to occasional hot water immersion, regular hot water immersion could significantly produce cross tolerance protective effects to intestine ischemia/ reperfusion cause of severe HS, that include the drop level of HR and MAP, decrease the rise level in lactate, TNF-α, IL-6, IL-10 and reduce the level of intestinal damage.
These results prove that fluvastatin has effects on modulation of inflammatory immune response and attenuates the organ injury on HS. Likewise, regular hot water immersion have cross tolerance protection to ischemia/ reperfusion insult of HS, but occasional hot water immersion may cause heat stress and has no cross tolerance protection to ischemia/ reperfusion insult of HS. Therefore, nursing staff could educate the client about safety of hot water immersion in clinic that they should pay attention with occasional hot water immersion. Nurses should assess the security and appropriateness of hot water immersion especially in patients who will receive surgery 3 to 5 days recently.
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