CAJ | 학술논문

目的建立一个烧伤休克早期口服补液复苏的动物模型,为战争、事故或灾害现场烧伤休克口服补液研究提供实验基础.方法成年雄性Beagle犬(11～13 ks),实施动静脉和小肠造口置管术.术后24 h犬苏醒且各项指标稳定后,用凝固汽油燃烧法造成颈背部35%TBSAⅢ度烧伤.伤后第1个24 h依据是否补液分为不补液组和口服补液组,每组8只.不补液组烧伤后不治疗,口服补液组依据Parkland公式向胃内输注葡萄糖-电解质溶液.第2个24 h起两组犬均给予延迟静脉补液,从伤后72 h起实施静脉营养支持.在犬清醒状态下监测血流动力学和胃肠组织灌流指标,测定胃排空率、肠吸收率和循环血浆容量(PV),并记录伤后5 d的病死率.结果烧伤后两组犬平均动脉压、心输出量、左室内压最大变化速率和血浆容量均显著降低(P<0.05),胃肠组织灌流显著减少,但口服补液组心输出量和PV在伤后4,8和24 h均显著高于不补液组(P<0.05).血流动力学指标在口服补液组于伤后48 h恢复至伤前水平,不补液组伤后72 h才恢复至伤前水平;口服补液组胃肠组织灌流指标伤后72 h恢复至伤前水平,而不补液组伤后120 h仍显著低于伤前(P<0.05).伤后口服液的胃排空率和肠吸收速率显著下降,伤后4 h最低,仅为伤前的42%和37%,直至伤后8 h仍低于伤前(P<0.05).不补液组伤后5 d的病死率为25%(2/8),口服补液组犬全部存活.结论本模型模拟了战场、事故或灾害现场烧伤休克口服液复苏的实际情况,为研究休克口服补液时血流动力学、组织灌流及胃肠功能的监测提供了实用和可靠的技术方法.
목적 건립일개소상휴극조기구복보액복소적동물모형,위전쟁、사고혹재해현장소상휴극구복보액연구제공실험기출.방법 성년웅성Beagle견(11～13 ks),실시동정맥화소장조구치관술.술후24 h견소성차각항지표은정후,용응고기유연소법조성경배부35%TBSAⅢ도소상.상후제1개24 h의거시부보액분위불보액조화구복보액조,매조8지.불보액조소상후불치료,구복보액조의거Parkland공식향위내수주포도당-전해질용액.제2개24 h기량조견균급여연지정맥보액,종상후72 h기실시정맥영양지지.재견청성상태하감측혈류동역학화위장조직관류지표,측정위배공솔、장흡수솔화순배혈장용량(PV),병기록상후5 d적병사솔.결과 소상후량조견평균동맥압、심수출량、좌실내압최대변화속솔화혈장용량균현저강저(P<0.05),위장조직관류현저감소,단구복보액조심수출량화PV재상후4,8화24 h균현저고우불보액조(P<0.05).혈류동역학지표재구복보액조우상후48 h회복지상전수평,불보액조상후72 h재회복지상전수평;구복보액조위장조직관류지표상후72 h회복지상전수평,이불보액조상후120 h잉현저저우상전(P<0.05).상후구복액적위배공솔화장흡수속솔현저하강,상후4 h최저,부위상전적42%화37%,직지상후8 h잉저우상전(P<0.05).불보액조상후5 d적병사솔위25%(2/8),구복보액조견전부존활.결론 본모형모의료전장、사고혹재해현장소상휴극구복액복소적실제정황,위연구휴극구복보액시혈류동역학、조직관류급위장공능적감측제공료실용화가고적기술방법.
Objective To establish an animal model for study on early oral fluid resuscitation of burn shock so as to provide experimental basis for oral fluid resuscitation of burn shock in wars, accidents or disasters. Methods Male Beagle dogs weighing 11-13 kg were used in the study and the carotis, jugular and duodenum were cannulated respectively for measurement of homodynamics, tissue perfusion and gastrointestinal function. Dogs were subjected to a 35% TBSA full thickness flame injury with 10-mi-nute anesthesia by intravenous injection of propofol 24 hours later, and then randomly and equally divided into two groups(8 dogs in each group) : no fluid resuscitation group (NR group) undergoing no treatment in the first 24 hours post burn and oral fluid resuscitation group ( OR group) undergoing gastric infusion of glucose electrolyte solution (GES) according to Parkland formula. From the second 24 hours post burn, animals in two groups were given delayed Ⅳ fluid resuscitation, and then intravenous nutritional support was initiated at the 72nd hour. The mean arterial pressures (MAP), cardiac output (CO), dp/dt max of left ventricular contractility (dp/dtmax) and plasma volume (PV) were monitored continuously. The pa-rameters of gastrointestinal tissue peffusion, the rates of gastric emptying and intestinal absorption of GES were determined, the morbidity was also recorded at the end of 5-day experiment. Results After 35% TBSA burn injury, MAP, CO,dp/dt max and PV dropped markedly and gastrointestinal tissue perfusion reduced obviously. CO and PV in OR group were significantly higher than those in NG group at 4, 8 and 24 hours after burn. Homodynamic parameters and gastrointestinal tissue perfusion in OR group were pro-moted to pre-injury level at 48 and 72 hours respectively, while homodynamic parameters in NR group did not return to pre-injury level till 72 hours, and gastrointestinal tissue perfusion kept lower than pre-injury till 120 hours post burn. Rates of gastric emptying and intestinal absorption of GES significantly reduced to the lowest level (42% and 37% of pre-injury) at about 4 hours post bum, but did not return to pre-in-jury level till eight hours post bum. Over five days, two out of eight dogs (25%) died in NG group but none in OR group. Conclusions The animal model can exactly simulate the actual circumstance, where oral resuscitation is superior to Ⅳ resuscitation in some aspects in treating early bum shock in wars, accidents and disasters, and provide practical and reliable method for measurement of homodynamic parameters, tissue perfusion, gastric emptying and intestinal absorptive function.