To investigate the effects of direct peritoneal resuscitation with pyruvate-peritoneal dialysis solution (Pyr-PDS) of different concentrations combined with intravenous resuscitation on acid–base imbalance and intestinal ischemia reperfusion injury in rats with hemorrhagic shock. Sixty rats were randomly assigned to group SHAM, group intravenous resuscitation, and four direct peritoneal resuscitation groups combined with intravenous resuscitation: group NS, LA, PY1, and PY2, that is, normal saline, lactate-PDS (Lac-PDS), lower concentration Pyr-PDS (Pyr-PDS1), and higher concentration Pyr-PDS (Pyr-PDS2), respectively. Two hours after hemorrhagic shock and resuscitation, the pH, oxygen partial pressure, carbon dioxide partial pressure (PCO₂), base excess, and bicarbonate ion concentration (HCO₃⁻) of the arterial blood were measured. The intestinal mucosal damage index and intercellular adhesion molecule 1 (ICAM-1), tumor necrosis factor-α, interleukin-6, zonula occludens-1, claudin-1, and occludin levels in intestinal issues were detected. Two hours after resuscitation, group PY2 had higher mean arterial pressure, pH, oxygen partial pressure, and base excess and lower PCO₂ of arterial blood than group PY1 (P < 0.05). Tumor necrosis factor-α and interleukin-6 levels in group PY2 were significantly lower than those in group PY1 (P < 0.05). Zonula occludens-1, claudin-1, and occludin expression levels were significantly higher in group PY2 than in group PY1 (P < 0.05). Direct peritoneal resuscitation with Pyr-PDS2 combined with intravenous resuscitation enhanced the hemodynamics, improved the acid–base balance, and alleviated intestinal ischemia reperfusion injury from hemorrhagic shock and resuscitation in rats. The mechanisms might include correction of acidosis, inhibition of inflammatory response, enhancement of systemic immune status, regulation of intestinal epithelial permeability, and maintenance of intestinal mucosal barrier function.

Impact statement

Hemorrhagic shock is a life-threatening condition after trauma or during surgery. Acid–base imbalance and intestinal ischemia reperfusion injury are two significant causes in the pathogenetic process and multiple organ dysfunction. As a result, it is urgent and necessary to find an effective method of resuscitation in order to reverse the acid–base imbalance and protect organ function. This current study confirmed the protection against hypoxic acidosis and intestinal ischemia reperfusion injury by peritoneal resuscitation with pyruvate combined with intravenous resuscitation in rats with hemorrhagic shock. And the peritoneal dialysis solution with pyruvate of high concentration plays a crucial role in the process. It provided a new idea and possible direction of fluid resuscitation for alleviating organ injuries, protecting organ functions, and improving clinical prognosis after hemorrhagic shock and resuscitation.

中文翻译：

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不同丙酮酸浓度的腹膜透析液对肠道损伤的影响。

探讨不同浓度丙酮酸-腹膜透析液（Pyr-PDS）直接腹膜复苏与静脉复苏对失血性休克大鼠酸碱平衡和肠缺血再灌注损伤的影响。60只大鼠随机分为SHAM组，静脉复苏组和四个直接腹膜复苏联合静脉复苏组：NS，LA，PY1和PY2组，即生理盐水，乳酸-PDS（Lac-PDS），较低浓度分别为Pyr-PDS（Pyr-PDS1）和较高浓度的Pyr-PDS（Pyr-PDS2）。失血性休克和复苏后两小时，其pH，氧分压，二氧化碳分压（PCO ₂），碱过量和碳酸氢根离子浓度（HCO _3）^-）测量了动脉血。检测肠道粘膜损伤指数和细胞间黏附分子1（ICAM-1），肿瘤坏死因子-α，白细胞介素-6，小带闭合蛋白-1，claudin-1和闭合蛋白水平。复苏后两小时，PY2组的平均动脉压，pH，氧分压，碱过量和动脉血PCO ₂均高于PY1组（P  <  0.05）。PY2组的肿瘤坏死因子-α和白细胞介素-6水平明显低于PY1组（P  <  0.05）。PY2组的Zonula occludens-1，claudin-1和occludin的表达水平显着高于PY1组（P  < 0.05）。用Pyr-PDS2进行直接腹膜复苏与静脉内复苏相结合，可增强血液动力学，改善酸碱平衡，并减轻大鼠失血性休克和复苏引起的肠缺血再灌注损伤。其机制可能包括纠正酸中毒，抑制炎症反应，增强全身免疫状态，调节肠上皮通透性以及维持肠粘膜屏障功能。

影响陈述

出血性休克是创伤后或手术过程中危及生命的疾病。酸碱失衡和肠缺血再灌注损伤是致病过程和多器官功能障碍的两个重要原因。因此，迫切需要找到一种有效的复苏方法，以逆转酸碱失衡并保护器官功能。这项当前的研究证实了失血性休克大鼠腹膜复苏联合丙酮酸联合静脉复苏对防止缺氧性酸中毒和肠缺血再灌注损伤的保护作用。高浓度丙酮酸的腹膜透析液在该过程中起着至关重要的作用。它为减轻器官损伤，保护器官功能，