中华烧伤杂志
中華燒傷雜誌
중화소상잡지
16
2010年
1期
41-44
,共4页
胡泉%胡森%柴家科%沈小鹏%车晋伟%盛志勇
鬍泉%鬍森%柴傢科%瀋小鵬%車晉偉%盛誌勇
호천%호삼%시가과%침소붕%차진위%성지용
烧伤%补液疗法%盐水,高渗%肠黏膜%内脏
燒傷%補液療法%鹽水,高滲%腸黏膜%內髒
소상%보액요법%염수,고삼%장점막%내장
Burns%Fluid therapy%Saline solution,hypertonic%Intestinal mucosa%Viscera
目的 了解烧伤犬休克期经肠道补充高渗盐糖溶液(HEGS)进行复苏后,肠道屏障及脏器功能的变化. 方法 将24只35%TBSAⅢ度烧伤犬按随机数字表法分为不补液(NF)组、静脉等渗补液(Ⅱ)组、肠内等渗补液(EI)组和肠内高渗补液(EH)组,每组6只.2个等渗补液组于伤后30 min分别通过静脉或肠道给予含50 g/L葡萄糖的生理盐水,24 h补液量为4 mL·kg~(-1)·%TBSA~(-1)(前8 h匀速输入总量的一半,后16 h匀速输入另一半);EH组经肠道输入HEGS(含18 g/L氯化钠、50 g/L葡萄糖),伤后24 h内补液量为2 mL·kg~(-1)·%TBSA~(-1),补液方式同前.测定各组犬肝肾功能指标[血清ALT、心肌型肌酸激酶同工酶(CK-MB)活性及肌酐、尿素氮水平]、血清二胺氧化酶(DAO)活性以及伤后24 h肠黏膜Na~+-K~+·ATP酶活性. 结果 各组犬血清ALT活性相近.3个补液组血肌酐、尿素氮水平普遍低于NF组;伤后2 h CK-MB活性均明显升高,EH组伤后2～8 h低于NF、Ⅱ组.Ⅱ、EI、EH组血清DAO活性于伤后4 h或6 h起逐渐降低,分别为(3.9±0.6)～(3.6±0.5)U/L、(4.8±0.4)～(2.8±0.8)U/L和(6.4±1.8)～(3.5±0.8)U/L,均显著低于NF组(12.5±0.4)～(9.7±1.1)U/L(EH组与NF组比较,伤后4、6、8、24 h t值分别为10.25、12.44、17.99、16.21,P值均小于0.05).伤后24 h各组肠黏膜Na~+-K~+-ATP酶活性从高到低依次为Ⅱ组、EH组、EI组、NF组(前3组与NF组比较,t值分别为10.09、8.32、4.96,F值为26.79,P值均小于0.05). 结论 HEGS对烧伤休克犬的肠黏膜屏障无明显不良影响.与NF比较,HEGS能显著改善伤犬心、肝、肾功能;减少1/2补液量,能达到与肠内或静脉输入等渗盐糖溶液相似的复苏效果.
目的 瞭解燒傷犬休剋期經腸道補充高滲鹽糖溶液(HEGS)進行複囌後,腸道屏障及髒器功能的變化. 方法 將24隻35%TBSAⅢ度燒傷犬按隨機數字錶法分為不補液(NF)組、靜脈等滲補液(Ⅱ)組、腸內等滲補液(EI)組和腸內高滲補液(EH)組,每組6隻.2箇等滲補液組于傷後30 min分彆通過靜脈或腸道給予含50 g/L葡萄糖的生理鹽水,24 h補液量為4 mL·kg~(-1)·%TBSA~(-1)(前8 h勻速輸入總量的一半,後16 h勻速輸入另一半);EH組經腸道輸入HEGS(含18 g/L氯化鈉、50 g/L葡萄糖),傷後24 h內補液量為2 mL·kg~(-1)·%TBSA~(-1),補液方式同前.測定各組犬肝腎功能指標[血清ALT、心肌型肌痠激酶同工酶(CK-MB)活性及肌酐、尿素氮水平]、血清二胺氧化酶(DAO)活性以及傷後24 h腸黏膜Na~+-K~+·ATP酶活性. 結果 各組犬血清ALT活性相近.3箇補液組血肌酐、尿素氮水平普遍低于NF組;傷後2 h CK-MB活性均明顯升高,EH組傷後2～8 h低于NF、Ⅱ組.Ⅱ、EI、EH組血清DAO活性于傷後4 h或6 h起逐漸降低,分彆為(3.9±0.6)～(3.6±0.5)U/L、(4.8±0.4)～(2.8±0.8)U/L和(6.4±1.8)～(3.5±0.8)U/L,均顯著低于NF組(12.5±0.4)～(9.7±1.1)U/L(EH組與NF組比較,傷後4、6、8、24 h t值分彆為10.25、12.44、17.99、16.21,P值均小于0.05).傷後24 h各組腸黏膜Na~+-K~+-ATP酶活性從高到低依次為Ⅱ組、EH組、EI組、NF組(前3組與NF組比較,t值分彆為10.09、8.32、4.96,F值為26.79,P值均小于0.05). 結論 HEGS對燒傷休剋犬的腸黏膜屏障無明顯不良影響.與NF比較,HEGS能顯著改善傷犬心、肝、腎功能;減少1/2補液量,能達到與腸內或靜脈輸入等滲鹽糖溶液相似的複囌效果.
목적 료해소상견휴극기경장도보충고삼염당용액(HEGS)진행복소후,장도병장급장기공능적변화. 방법 장24지35%TBSAⅢ도소상견안수궤수자표법분위불보액(NF)조、정맥등삼보액(Ⅱ)조、장내등삼보액(EI)조화장내고삼보액(EH)조,매조6지.2개등삼보액조우상후30 min분별통과정맥혹장도급여함50 g/L포도당적생리염수,24 h보액량위4 mL·kg~(-1)·%TBSA~(-1)(전8 h균속수입총량적일반,후16 h균속수입령일반);EH조경장도수입HEGS(함18 g/L록화납、50 g/L포도당),상후24 h내보액량위2 mL·kg~(-1)·%TBSA~(-1),보액방식동전.측정각조견간신공능지표[혈청ALT、심기형기산격매동공매(CK-MB)활성급기항、뇨소담수평]、혈청이알양화매(DAO)활성이급상후24 h장점막Na~+-K~+·ATP매활성. 결과 각조견혈청ALT활성상근.3개보액조혈기항、뇨소담수평보편저우NF조;상후2 h CK-MB활성균명현승고,EH조상후2～8 h저우NF、Ⅱ조.Ⅱ、EI、EH조혈청DAO활성우상후4 h혹6 h기축점강저,분별위(3.9±0.6)～(3.6±0.5)U/L、(4.8±0.4)～(2.8±0.8)U/L화(6.4±1.8)～(3.5±0.8)U/L,균현저저우NF조(12.5±0.4)～(9.7±1.1)U/L(EH조여NF조비교,상후4、6、8、24 h t치분별위10.25、12.44、17.99、16.21,P치균소우0.05).상후24 h각조장점막Na~+-K~+-ATP매활성종고도저의차위Ⅱ조、EH조、EI조、NF조(전3조여NF조비교,t치분별위10.09、8.32、4.96,F치위26.79,P치균소우0.05). 결론 HEGS대소상휴극견적장점막병장무명현불량영향.여NF비교,HEGS능현저개선상견심、간、신공능;감소1/2보액량,능체도여장내혹정맥수입등삼염당용액상사적복소효과.
Objective To study the change in intestinal barrier and organ functions of burned dog after enteral administration of hypertonic electrolyte glucose solution (HEGS) in shock stage. Methods Twenty-four Beagle dogs inflicted with 35% TBSA full-thickness burn were divided into no-fluid group (NF), intravenous infusion with isotonic electrolyte glucose solution (IEGS) group (Ⅱ group), enteral in-fusion with lEGS group (EI), and enteral infusion with HEGS group (EH) according to the random number table, with 6 dogs in each group. Saline, containing 50 g/L glucose, was intravenously or enterally infused into dogs in Ⅱ group and EI group respectively 0.5 hour post injury (PIH) for resuscitation. Total infusion volume within PIH 24 was 4 mL·kg~(-1)·% TBSA~(-1) (half of the total volume was infused in the first 8 hours in a constant speed, the other half volume was infused in the rest 16 hours in a constant speed). HEGS,containing 18 g/L NaCI and 50 g/L glucose, was enterally infused into dogs in EH group. Total infusion vol-ume within PIH 24 was 2 mL·kg~(-1)· % TBSA~(-1) , with the same infusion speed as that in Ⅱ and EI groups.Liver and kidney function indexes [activity of ALT and CK-MB, expression levels of creatinine and blood u-rea nitrogen (BUN) in serum], activity of diamine oxidase (DAO), and activity of Na~+ - K~+- ATPase in intestinal mucosa at PIH 24 were determined. Results ALT activity in each group was close to one anoth-er. Serum levels of creatinine and BUN in Ⅱ, EI, and EH groups were significantly lower than those in NF group. CK-MB activity obviously increased at PIH 2 in every group. CK-MB activity in EH group at PIH 2 to 8 was respectively lower than that in NF and Ⅱ groups. DAO activity in serum in Ⅱ, EI, and EH groups de-creased since PIH 4 or PIH 6, respectively from (3.9±0.6) U/L to (3.6±0.5) U/L, (4.8±0.4) U/L to (2.8±0.8) U/L, (6.4±1.8) U/L to (3.5±0.8) U/L, all were significantly lower than those in NF group [from (12.5±0.4) U/L to (9.7±1.1) U/L, comparison between EH group and NF group, t value at PIH 4, 6, 8, 24 was respectively 10.25, 12.44, 17.99, 16.21, P values all below 0.05]. The order of Na~+-k~+-ATPase activity in intestinal mucosa at PIH 24 in each group from high to low was Ⅱ group, EH group, EI group, and NF group (comparison between former 3 groups and NF group, t value was respectively 10.09, 4.96, 8.32, F value was 26.79, P values all below 0.05). Conclusions HEGS does not cause significant harm to the barrier function of intestinal mucosa of shock dog after burn. Compared with NF,HEGS can significantly improve functions of heart, liver, and kidney, and it can achieve the same resuscita-tion effect as enteral or intravenous infusion of IEGS with only half of the solution volume.
