Effect of methylprednisolone on reperfusion injury in severe oncontrolled hemorrhagic shock

Abstract

Objective: To study the effect of methylprednisolone (MP) on reperfusion injury in severe uncontrolled hemorrhagic shock and explore the possible mechanism involved. Methods: Twelve dogs were randomly divided into two groups, control group (Group I, n = 6) and MP group (Group II, n = 6). The animals were bled continuously from a femoral artery catheter to produce uncontrolled hemorrhagic shock models. Resuscitation with lactated Ringer's (LR) solution was initiated when mean arterial pressure (MAP) decreased to 20 mm Hg, and MAP was maintained at 30-40 mm Hg. MP (4 mg/kg) was injected intravenously in Group II when resuscitation began. While in Group I, normal saline (NS) was injected instead. The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) were measured before exsanguination (T1), when MAP decreased to 20 mm Hg (T2), 60 min (T3) and 120 min (T4) after resuscitation. Heart rate, MAP and cardiac output (CO) levels were recorded concomitantly. Results: Infusion volume and hemorrhage volume shed from the superior mesenteric artery in Group I were higher than those in Group II (P < 0.01 and P < 0.05). After reperfusion, blood SOD levels decreased progressively and MDA levels increased rapidly in Group I. In Group II, blood SOD levels at T3 and T4 decreased as compared with that at T1 but a stepwise increase was present. At T4, blood SOD level was significantly higher in Group II than in Group I (P < 0.01). At T3 and T4, MDA levels were markedly lower in Group II than in Group I. During reperfusion, MAP was more steady in Group II than in Group I and survival rate after 120 min (at T4) was higher in Group II than in Group I (P < 0.05). Conclusions: MP has a protective effect on severe uncontrolled hemorrhagic shock and subsequent reperfusion injury. The mechanism mainly involves the anti-lipid peroxidation activity of MP.