中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2014年
6期
450-454
,共5页
孟祥熙%李娟%白晓东%胡森%周方强
孟祥熙%李娟%白曉東%鬍森%週方彊
맹상희%리연%백효동%호삼%주방강
烧伤%口服补液%丙酮酸盐类%血流动力学%脏器功能
燒傷%口服補液%丙酮痠鹽類%血流動力學%髒器功能
소상%구복보액%병동산염류%혈류동역학%장기공능
Burn%Oral fluid resuscitation%Pyruvates%Hemodynamics%Organ functions
目的 研究丙酮酸盐-糖液对烧伤休克犬口服补液时血流动力学、脏器功能及生存率的影响.方法 28只雄性Beagle犬施行颈总动脉、颈外静脉、胃及空肠置管术,24 h后造成50％总体表面积(TBSA)Ⅲ°烧伤.实验动物随机分为3组:单纯烧伤组(NR组,n=8)、NaHCO3盐-糖液组(OH组,n=10)和丙酮酸盐-糖液组(OP组,n=10).NR组不予补液治疗;补液组于伤后30 min根据Parkland公式经胃造口分别输注NaHCO3-葡萄糖电解质液或丙酮酸盐-葡萄糖电解质液.在动物清醒状态下测定伤前和伤后2、6、8、12、24 h血流动力学指标及脏器功能,并记录伤后24 h生存率.结果 伤后2h,NR组、OH组和OP组动物平均动脉压分别为(45±8)、(57-±8)和(80±9)mmHg(1 mmHg =0.133 kPa),较伤前[分别为(142 ±6)、(144±6)和(142±6)mmHg]明显降低(t=16.967、14.595、10.100,均P＜0.05),心输出量、左心室内压最大变化速率、小肠黏膜血流量变化趋势与平均动脉压相同.各组动物伤后各时间点外周血管阻力及脏器功能指标(血肌酐、血清肌酸肌酶同工酶、ALT、二胺氧化酶)较术前显著升高(t=-46.894～-2.465,均P＜0.05).NR组各项指标持续恶化,直至死亡;口服补液组血流动力学及脏器功能指标逐渐恢复(F =0.001 ～ 1.600,均P＜0.05),OP组显著优于OH组(F=0.013 ～0.466,均P＜0.05).伤后24 h OP组存活6只(6/10),OH组存活4只(4/10),NR组全部死亡(0/8).结论 50％ TBSA烧伤犬口服补液复苏过程中,丙酮酸盐-糖液在改善血流动力学指标、减轻脏器功能损伤中显著优于标准NaHCO3盐-糖液.
目的 研究丙酮痠鹽-糖液對燒傷休剋犬口服補液時血流動力學、髒器功能及生存率的影響.方法 28隻雄性Beagle犬施行頸總動脈、頸外靜脈、胃及空腸置管術,24 h後造成50％總體錶麵積(TBSA)Ⅲ°燒傷.實驗動物隨機分為3組:單純燒傷組(NR組,n=8)、NaHCO3鹽-糖液組(OH組,n=10)和丙酮痠鹽-糖液組(OP組,n=10).NR組不予補液治療;補液組于傷後30 min根據Parkland公式經胃造口分彆輸註NaHCO3-葡萄糖電解質液或丙酮痠鹽-葡萄糖電解質液.在動物清醒狀態下測定傷前和傷後2、6、8、12、24 h血流動力學指標及髒器功能,併記錄傷後24 h生存率.結果 傷後2h,NR組、OH組和OP組動物平均動脈壓分彆為(45±8)、(57-±8)和(80±9)mmHg(1 mmHg =0.133 kPa),較傷前[分彆為(142 ±6)、(144±6)和(142±6)mmHg]明顯降低(t=16.967、14.595、10.100,均P＜0.05),心輸齣量、左心室內壓最大變化速率、小腸黏膜血流量變化趨勢與平均動脈壓相同.各組動物傷後各時間點外週血管阻力及髒器功能指標(血肌酐、血清肌痠肌酶同工酶、ALT、二胺氧化酶)較術前顯著升高(t=-46.894～-2.465,均P＜0.05).NR組各項指標持續噁化,直至死亡;口服補液組血流動力學及髒器功能指標逐漸恢複(F =0.001 ～ 1.600,均P＜0.05),OP組顯著優于OH組(F=0.013 ～0.466,均P＜0.05).傷後24 h OP組存活6隻(6/10),OH組存活4隻(4/10),NR組全部死亡(0/8).結論 50％ TBSA燒傷犬口服補液複囌過程中,丙酮痠鹽-糖液在改善血流動力學指標、減輕髒器功能損傷中顯著優于標準NaHCO3鹽-糖液.
목적 연구병동산염-당액대소상휴극견구복보액시혈류동역학、장기공능급생존솔적영향.방법 28지웅성Beagle견시행경총동맥、경외정맥、위급공장치관술,24 h후조성50％총체표면적(TBSA)Ⅲ°소상.실험동물수궤분위3조:단순소상조(NR조,n=8)、NaHCO3염-당액조(OH조,n=10)화병동산염-당액조(OP조,n=10).NR조불여보액치료;보액조우상후30 min근거Parkland공식경위조구분별수주NaHCO3-포도당전해질액혹병동산염-포도당전해질액.재동물청성상태하측정상전화상후2、6、8、12、24 h혈류동역학지표급장기공능,병기록상후24 h생존솔.결과 상후2h,NR조、OH조화OP조동물평균동맥압분별위(45±8)、(57-±8)화(80±9)mmHg(1 mmHg =0.133 kPa),교상전[분별위(142 ±6)、(144±6)화(142±6)mmHg]명현강저(t=16.967、14.595、10.100,균P＜0.05),심수출량、좌심실내압최대변화속솔、소장점막혈류량변화추세여평균동맥압상동.각조동물상후각시간점외주혈관조력급장기공능지표(혈기항、혈청기산기매동공매、ALT、이알양화매)교술전현저승고(t=-46.894～-2.465,균P＜0.05).NR조각항지표지속악화,직지사망;구복보액조혈류동역학급장기공능지표축점회복(F =0.001 ～ 1.600,균P＜0.05),OP조현저우우OH조(F=0.013 ～0.466,균P＜0.05).상후24 h OP조존활6지(6/10),OH조존활4지(4/10),NR조전부사망(0/8).결론 50％ TBSA소상견구복보액복소과정중,병동산염-당액재개선혈류동역학지표、감경장기공능손상중현저우우표준NaHCO3염-당액.
Objective To study the effect of oral fluid resuscitation with pyruvate sodium-glucoseelectrolyte solution (PGES) on hemodynamics,organ functions and mortalities during shock stage in dogs with burn.Methods In comparison of oral pyruvate sodium-glucose-electrolyte solution (PGES) with NaHCO3-glucose-electrolyte solution (HGES),beagle dogs with intubation of the carotid artery,jugular vein and jejunum for 24 hours were subjected to a 50％ total body surface area (TBSA)burn,and were divided into three groups:pure burn without fluid resuscitation (NR,n =8),and two oral fluid resuscitation (each n =10),in which dogs were given with Pry-GES (OP) or NaHCO3-GES (OH) according to Parkland formula.The hemodynamic and organ functions were measured serially before burn and 2,6,8,12 and 24 hours after burn at no anaesthesia state A.Twenty-four hours mortality rate following burn was also recorded.Results Two hours after burn,the mean arterial pressure of NR,OH and OP group was (45 ± 8),(57±8) and (80±9) mmHg(1 mmHg =0.133 kPa) respectively,which were significantly reduced (t =16.967,14.595 and 10.100,all P ＜0.05) compared with those before iniury ((42 ±6),(144 ±6) and (142 ± 6) mmHg respectively),the change of cardiac output,dp/d of left ventricular contractility and intestinal mucosal blood flow had the same trend as the mean arterial pressure.The systemic vascular resistance and organ parameters (Cr,CK-MB,ALT and DAO) in all groups increased obviously (t =-46.894--2.465,all P ＜ 0.05).All measurements of NR group kept worsening,and all died within 24 hours after burn; while those of two oral resuscitation groups had improved gradually (F =0.001-1.600,all P ＜ 0.05),OP group was significantly superior to OH group (F =0.013-0.466,P ＜ 0.05).At 24 hours after burn,6 (6/10) survived in OP group,4 (4/10) in OH group and 0 (0/8) in NR group.Conclusion The Pyr-GES may be superior to the standard NaHCO3-GES in the improvement of hemodynamics and organ functions during oral resuscitation in dogs with 50％ TBSA full thickness burn.
