中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2009年
5期
286-289
,共4页
胡森%车晋伟%包呈梅%盛志勇
鬍森%車晉偉%包呈梅%盛誌勇
호삼%차진위%포정매%성지용
烧伤%休克%补液疗法%卡巴胆碱%血管通透性%肺水肿
燒傷%休剋%補液療法%卡巴膽堿%血管通透性%肺水腫
소상%휴극%보액요법%잡파담감%혈관통투성%폐수종
burn%shock%fluid therapy%carbachol%vascular permeability%pulmonary edema
目的 研究卡巴胆碱(CAR)对犬50%总体表面积(TBsA)烧伤休克期口服补液时肺血管通透性和肺组织含水量的影响.方法 成年雄性Beagle犬12只,先行颈动、静脉置管,24 h后造成50%TBSAⅢ度烧伤.伤后24 h随机分为口服补液组和口服补液+CAR组,每组6只,从胃内分别输注葡萄糖一电解质溶液(GES)和含CAR的GES液(20 gg/kg CAR溶于GES),伤后24 h起实施静脉延迟补液,补液量和速率均根据Parkland公式确定.于伤前(0)及伤后2、4、8、24、48和72 h测定各组犬呼吸频率(RR)、动脉血氧分压(PaO2)、血管外肺水指数(ELWI)和肺血管通透性指数(PVPI);于伤后72 h处死动物,取肺组织测定髓过氧化物酶(MPO)活性、丙二醛(MDA)含量以及肺组织含水量.结果 烧伤后两组动物RR、ELWI和PVPI较伤前均显著增加,PaO2显著降低(P均<0.01);伤后72 h PaO2恢复至伤前水平.口服补液+CAR组伤后4、8和24 h RR、ELWI和PVPI显著低于口服补液组,伤后8、24、48 h PaO2显著高于口服补液组(P<0.05或P<0.01),但伤后72 h两组间上述指标差异均无统计学意义(P均>0.05).伤后72 h口服补液+CAR组肺组织MPO活性、MDA含量及肺组织含水量均显著低于口服补液组[(2.64±0.38)U/mg比(4.12±0.46)U/rag,P<0.01;(3.60±0.54)μtmol/mg比(5.14±0.62)μmol/mg,P<0.01;(77.40±0.56)%比(78.30±0.54)%,P<0.01].结论 50%TBSA烧伤口服补液时给予CAR能抑制肺组织炎症反应和过氧化损伤,减轻烧伤休克引起的肺血管通透性增加和肺水肿.
目的 研究卡巴膽堿(CAR)對犬50%總體錶麵積(TBsA)燒傷休剋期口服補液時肺血管通透性和肺組織含水量的影響.方法 成年雄性Beagle犬12隻,先行頸動、靜脈置管,24 h後造成50%TBSAⅢ度燒傷.傷後24 h隨機分為口服補液組和口服補液+CAR組,每組6隻,從胃內分彆輸註葡萄糖一電解質溶液(GES)和含CAR的GES液(20 gg/kg CAR溶于GES),傷後24 h起實施靜脈延遲補液,補液量和速率均根據Parkland公式確定.于傷前(0)及傷後2、4、8、24、48和72 h測定各組犬呼吸頻率(RR)、動脈血氧分壓(PaO2)、血管外肺水指數(ELWI)和肺血管通透性指數(PVPI);于傷後72 h處死動物,取肺組織測定髓過氧化物酶(MPO)活性、丙二醛(MDA)含量以及肺組織含水量.結果 燒傷後兩組動物RR、ELWI和PVPI較傷前均顯著增加,PaO2顯著降低(P均<0.01);傷後72 h PaO2恢複至傷前水平.口服補液+CAR組傷後4、8和24 h RR、ELWI和PVPI顯著低于口服補液組,傷後8、24、48 h PaO2顯著高于口服補液組(P<0.05或P<0.01),但傷後72 h兩組間上述指標差異均無統計學意義(P均>0.05).傷後72 h口服補液+CAR組肺組織MPO活性、MDA含量及肺組織含水量均顯著低于口服補液組[(2.64±0.38)U/mg比(4.12±0.46)U/rag,P<0.01;(3.60±0.54)μtmol/mg比(5.14±0.62)μmol/mg,P<0.01;(77.40±0.56)%比(78.30±0.54)%,P<0.01].結論 50%TBSA燒傷口服補液時給予CAR能抑製肺組織炎癥反應和過氧化損傷,減輕燒傷休剋引起的肺血管通透性增加和肺水腫.
목적 연구잡파담감(CAR)대견50%총체표면적(TBsA)소상휴극기구복보액시폐혈관통투성화폐조직함수량적영향.방법 성년웅성Beagle견12지,선행경동、정맥치관,24 h후조성50%TBSAⅢ도소상.상후24 h수궤분위구복보액조화구복보액+CAR조,매조6지,종위내분별수주포도당일전해질용액(GES)화함CAR적GES액(20 gg/kg CAR용우GES),상후24 h기실시정맥연지보액,보액량화속솔균근거Parkland공식학정.우상전(0)급상후2、4、8、24、48화72 h측정각조견호흡빈솔(RR)、동맥혈양분압(PaO2)、혈관외폐수지수(ELWI)화폐혈관통투성지수(PVPI);우상후72 h처사동물,취폐조직측정수과양화물매(MPO)활성、병이철(MDA)함량이급폐조직함수량.결과 소상후량조동물RR、ELWI화PVPI교상전균현저증가,PaO2현저강저(P균<0.01);상후72 h PaO2회복지상전수평.구복보액+CAR조상후4、8화24 h RR、ELWI화PVPI현저저우구복보액조,상후8、24、48 h PaO2현저고우구복보액조(P<0.05혹P<0.01),단상후72 h량조간상술지표차이균무통계학의의(P균>0.05).상후72 h구복보액+CAR조폐조직MPO활성、MDA함량급폐조직함수량균현저저우구복보액조[(2.64±0.38)U/mg비(4.12±0.46)U/rag,P<0.01;(3.60±0.54)μtmol/mg비(5.14±0.62)μmol/mg,P<0.01;(77.40±0.56)%비(78.30±0.54)%,P<0.01].결론 50%TBSA소상구복보액시급여CAR능억제폐조직염증반응화과양화손상,감경소상휴극인기적폐혈관통투성증가화폐수종.
Objective To investigate the effects of carbachol(CAR)on pulmonary vascular perme-ability and pulmonary water content during oral fluid resuscitation of burn shock.Methods Twelve male Beagle dogs with intubation of carotid artery and jugular vein for 24 hours were subjected to a 50%total body surface area(TBSA)full-thickness burn,then they were equally divided into oral resuscitation(OR)and OR plus CAR groups(OR+CAR).Dogs were given either a glucose-electrolyte solution(GES)in OR group or GES containing CAR(20 μg/kg)in OR+CAR group by gavage within 24 hours after burn.Dogs in each group were given intravenous fluid resuscitation after 24 post burn hour(PBH).The delivery rate and volume of GES was in accordance with that of Parkland formula.Respiratory rate(RR),arterial partial pressure of oxygen(PaO2),extravascular lung water index(ELWI)and pulmonary vascular permeability index(PVPI)were determined before burn(0 hour),and at 2,4,8,24,48 and 72 PBH.At 72 PBH or before death,dogs were sacrificed to collect lung tissue for evaluation of myeloperoxidase(MPO), malondialdehvde(MDA),and assessment of the tissue water content by dry to wet weight.Results Compared with those before burn,RR,ELWI and PVPI were greatly increased,and PaO2 obviously decreased in two groups after burn(all P<0.01).At 72 PBH,PaO2 returned to preburn level,while RR, ELWI and PVPI were still higher than preburn levels.RR,ELWI and PVPI at 4,8 and 24 PBH,and PaO2 at 8,24,48 PBH in OR+CAR group were respectively lower or higher than those in OR group(P<0.05 or P<0.01),but those measurements showed no statistical differences between two groups at 72 PBH(all P> 0.05).MPO,MDA and lung water contents in OR+CAR group were significantly lower than those in OR group at 72 PBH[(2.64±0.38)U/mg VS.(4.12±0.46)U/mg,P<0.01;(3.60±0.54)/μmol/mg vs. (5.14±0.62)μmol/mg,P<0.01;(77.40±0.56)%vs.(78.30±0.54)%,P<0.01].Conclusion The results indicate that CAR inhibits inflammatory response and oxidative damage in lung tissue,and alleviates pulmonary vascular permeability and lung edema during oral fluid resuscitation of burn shock.
