CAJ | 학술논문

目的了解口服补液对烧伤休克犬肺组织含水量和血管通透性的影响.方法雄性Beagle犬18只,行颈动、静脉置管后24 h造成50%TBSAⅢ度烧伤.伤后随机分为不补液组、口服补液组和静脉补液组,每组6只.伤后第1个24 h不补液组不作任何治疗,口服补液组和静脉补液组分别经胃管或静脉输注葡萄糖-电解质溶液;伤后24 h起3组犬均给予静脉补液.统计各组犬伤后72 h内的死亡率.测定3组犬伤前、伤后30 min和4、8、24、48、72 h非麻孵状态下的平均动脉压(MAP)、呼吸频率(RR)、PaO2、血管外肺水指数(ELWI)和肺血管通透性指数(PVPI),于伤后72 h或犬濒死前测定肺组织含水率.结果不补液组6只犬均在伤后9～22 h死亡,口服补液组中3只犬伤后25～47 h死亡,静脉补液组犬无一死亡.不补液组伤后8 h RR为(44.0±5.0)次/min、ELWI(10.3±0.6)mL/kg、PVPI 6.6±0.6,比伤前大幅增加;PaO2和MAP均明显低于伤前(P<0.05).口服补液组伤后8 h RR为(33.0±4.0)次/min、ELWI(8.9±0.3)mL/kg、PVPI 5.7±0.4,显著低于不补液组(P<0.05),但高于静脉补液组[(26.0±3.0)次/min、(8.2±0.3)mL/kg、4.2±0.4,P<0.05];口服补液组PaO2和MAP均高于不补液组(P<0.05).两补液组肺组织含水率相近(P>0.05),均低于不补液组(P<0.05).结论早期口服补液对烧伤犬肺的保护作用虽不如静脉补液,但与不补液相比能显著改善休克期肺血管通透性,减轻肺水肿,减少肺脏并发症.
목적 료해구복보액대소상휴극견폐조직함수량화혈관통투성적영향.방법 웅성Beagle견18지,행경동、정맥치관후24 h조성50%TBSAⅢ도소상.상후수궤분위불보액조、구복보액조화정맥보액조,매조6지.상후제1개24 h불보액조불작임하치료,구복보액조화정맥보액조분별경위관혹정맥수주포도당-전해질용액;상후24 h기3조견균급여정맥보액.통계각조견상후72 h내적사망솔.측정3조견상전、상후30 min화4、8、24、48、72 h비마부상태하적평균동맥압(MAP)、호흡빈솔(RR)、PaO2、혈관외폐수지수(ELWI)화폐혈관통투성지수(PVPI),우상후72 h혹견빈사전측정폐조직함수솔.결과 불보액조6지견균재상후9～22 h사망,구복보액조중3지견상후25～47 h사망,정맥보액조견무일사망.불보액조상후8 h RR위(44.0±5.0)차/min、ELWI(10.3±0.6)mL/kg、PVPI 6.6±0.6,비상전대폭증가;PaO2화MAP균명현저우상전(P<0.05).구복보액조상후8 h RR위(33.0±4.0)차/min、ELWI(8.9±0.3)mL/kg、PVPI 5.7±0.4,현저저우불보액조(P<0.05),단고우정맥보액조[(26.0±3.0)차/min、(8.2±0.3)mL/kg、4.2±0.4,P<0.05];구복보액조PaO2화MAP균고우불보액조(P<0.05).량보액조폐조직함수솔상근(P>0.05),균저우불보액조(P<0.05).결론 조기구복보액대소상견폐적보호작용수불여정맥보액,단여불보액상비능현저개선휴극기폐혈관통투성,감경폐수종,감소폐장병발증.
Objective To investigate the effect of oral fluid resuscitation on pulmonary vascular per-meability and lung water content in burn dogs during shock stage. Methods Eighteen male Beagle dogs with catheterization of carotid artery and jugular vein for 24 hours were subjected to 50% TBSA full-thickness burn, then they were divided into non-fluid resuscitation(NR), oral fluid resuscitation (OR), intravenous fluid resuscitation (IR) groups, with 6 dogs in each group. Dogs in OR and IR groups were given glucose-electrolyte solution (GES) by gastric tube or intravenous infusion according to Parkland formula within 24 hours after burn, while those in NR group were not given any treatment. Dogs in each group were then given intravenous fluid for further resuscitation after 24 post burn hours(PBH). Deaths were recorded within 72 hours after burn. Mean arterial pressure(MAP) , respiratory rate (RR) , PaO2, extravascular lung water in-dex (ELWI) and pulmonary vascular permeability index (PYPI) were determined before burn and at 30 mins and 4, 8, 24, 48, 72 PBH with the aid of PICCO. Dogs were sacrificed to collect lung tissue for deter-mination of water content at 72 PBH or just before death. Results All dogs died during 9-22 PBH in NR group, 3 dogs died during 25-47 PBH in OR group, and all dogs survived within 72 PBH in IR groups. Com-pared with those before burn, RR (44.0±5.0) times/min, ELWI (10.3±0.6) mL/kg and PVPI (6.6± 0.6) were markedly increased in NR group at 8 PBH, but PaO2 and MAP were obviously decreased (P<0.05). In OR group, RR (33.0±4.0) times/min, ELWI (8.9±0.3) mL/kg and PVPI (5.7±0.4) were significantly lower than those of NR group (P<0.05) , but higher than those of IR group [ RR (26.0± 3.0) times/min, ELWI (8.2±0.3) mL/kg, PVPI (4.2±0.4), P <0.05] at 8 PBH. PaO2 and MAP in OR group were higher than that in NR group (P<0.05). Lung water content showed no statistically signifi-cant difference between OR ang IR groups (P>0.05), which were lower than that in NR group ( P < 0.05). Conclusions Although the protective effect of oral fluid resuscitation with GES on the lung of burn dog at shock stage was inferior to intravenous fluid, it still can decrease pulmonary vascular permeabili-ty, alleviate pulmonary edema, and reduce pulmonary complication compared with no resuscitation with fluids.