中华烧伤杂志
中華燒傷雜誌
중화소상잡지
16
2013年
3期
272-276
,共5页
游小恩%陈炯%周建军%邢楠%施剑武%苏国良
遊小恩%陳炯%週建軍%邢楠%施劍武%囌國良
유소은%진형%주건군%형남%시검무%소국량
烧伤%休克%肺水肿%胶体
燒傷%休剋%肺水腫%膠體
소상%휴극%폐수종%효체
Burns%Shock%Pulmonary edema%Colloid
目的 观察比较应用人工胶体与天然胶体对重度烧伤猪休克期肺水肿的影响. 方法 将12只广西巴马小型猪造成背部约40％ TBSAⅢ度烧伤,按随机数字表法分为天然胶体组和人工胶体组,每组6只,于伤后2h开始补液.电解质液以乳酸林格液为主,胶体分别为猪血浆和羟乙基淀粉130/0.4.记录2组猪伤前及伤后48 h内每小时心率、血压、尿量、中心静脉压(CVP)和肺动脉楔压(PAWP),计算伤后第1、2个24 h的平均心率、血压、每小时每千克尿量、CVP、PAWP、复苏液体量和液体入出量比.于伤后48 h,行肺组织病理学观察并计算肺脏含水率.对数据行单因素方差分析、重复测量方差分析、LSD检验和独立样本t检验. 结果 (1)2组伤前及伤后第1、2个24 h的心率、血压、尿量比较,差异均无统计学意义(P值均大于0.05)；伤后第1个24 h,人工胶体组CVP、PAWP均明显高于天然胶体组(P值均小于0.05).与伤前比较,2组伤后第1、2个24 h的心率均明显加快、CVP及PAWP显著升高(P＜0.05或P＜0.01)；天然胶体组伤后第1个24 h的尿量减少(P＜0.05),人工胶体组无明显变化(P＞0.05),2组伤后第2个24 h尿量虽均呈增加趋势,但差异均无统计学意义(P值均大于0.05)；2组伤后第1、2个24 h的血压与伤前比较差异均无统计学意义(P值均大于0.05).(2)天然胶体组与人工胶体组伤后第1、2个24 h复苏液体量及液体入出量比比较,差异均无统计学意义(P值均大于0.05).(3)2组肺组织切片均可见肺泡间隔不同程度增宽,肺间质内大量水肿液积聚及炎性细胞浸润.(4)天然胶体组猪肺脏含水率为(71±10)％,与人工胶体组的(79±4)％比较,差异无统计学意义(t=-1.753,P＞0.05). 结论 在重度烧伤猪休克期选用天然胶体或人工胶体(羟乙基淀粉130/0.4)行液体复苏,对肺组织水肿的影响程度基本相同.
目的 觀察比較應用人工膠體與天然膠體對重度燒傷豬休剋期肺水腫的影響. 方法 將12隻廣西巴馬小型豬造成揹部約40％ TBSAⅢ度燒傷,按隨機數字錶法分為天然膠體組和人工膠體組,每組6隻,于傷後2h開始補液.電解質液以乳痠林格液為主,膠體分彆為豬血漿和羥乙基澱粉130/0.4.記錄2組豬傷前及傷後48 h內每小時心率、血壓、尿量、中心靜脈壓(CVP)和肺動脈楔壓(PAWP),計算傷後第1、2箇24 h的平均心率、血壓、每小時每韆剋尿量、CVP、PAWP、複囌液體量和液體入齣量比.于傷後48 h,行肺組織病理學觀察併計算肺髒含水率.對數據行單因素方差分析、重複測量方差分析、LSD檢驗和獨立樣本t檢驗. 結果 (1)2組傷前及傷後第1、2箇24 h的心率、血壓、尿量比較,差異均無統計學意義(P值均大于0.05)；傷後第1箇24 h,人工膠體組CVP、PAWP均明顯高于天然膠體組(P值均小于0.05).與傷前比較,2組傷後第1、2箇24 h的心率均明顯加快、CVP及PAWP顯著升高(P＜0.05或P＜0.01)；天然膠體組傷後第1箇24 h的尿量減少(P＜0.05),人工膠體組無明顯變化(P＞0.05),2組傷後第2箇24 h尿量雖均呈增加趨勢,但差異均無統計學意義(P值均大于0.05)；2組傷後第1、2箇24 h的血壓與傷前比較差異均無統計學意義(P值均大于0.05).(2)天然膠體組與人工膠體組傷後第1、2箇24 h複囌液體量及液體入齣量比比較,差異均無統計學意義(P值均大于0.05).(3)2組肺組織切片均可見肺泡間隔不同程度增寬,肺間質內大量水腫液積聚及炎性細胞浸潤.(4)天然膠體組豬肺髒含水率為(71±10)％,與人工膠體組的(79±4)％比較,差異無統計學意義(t=-1.753,P＞0.05). 結論 在重度燒傷豬休剋期選用天然膠體或人工膠體(羥乙基澱粉130/0.4)行液體複囌,對肺組織水腫的影響程度基本相同.
목적 관찰비교응용인공효체여천연효체대중도소상저휴극기폐수종적영향. 방법 장12지엄서파마소형저조성배부약40％ TBSAⅢ도소상,안수궤수자표법분위천연효체조화인공효체조,매조6지,우상후2h개시보액.전해질액이유산림격액위주,효체분별위저혈장화간을기정분130/0.4.기록2조저상전급상후48 h내매소시심솔、혈압、뇨량、중심정맥압(CVP)화폐동맥설압(PAWP),계산상후제1、2개24 h적평균심솔、혈압、매소시매천극뇨량、CVP、PAWP、복소액체량화액체입출량비.우상후48 h,행폐조직병이학관찰병계산폐장함수솔.대수거행단인소방차분석、중복측량방차분석、LSD검험화독립양본t검험. 결과 (1)2조상전급상후제1、2개24 h적심솔、혈압、뇨량비교,차이균무통계학의의(P치균대우0.05)；상후제1개24 h,인공효체조CVP、PAWP균명현고우천연효체조(P치균소우0.05).여상전비교,2조상후제1、2개24 h적심솔균명현가쾌、CVP급PAWP현저승고(P＜0.05혹P＜0.01)；천연효체조상후제1개24 h적뇨량감소(P＜0.05),인공효체조무명현변화(P＞0.05),2조상후제2개24 h뇨량수균정증가추세,단차이균무통계학의의(P치균대우0.05)；2조상후제1、2개24 h적혈압여상전비교차이균무통계학의의(P치균대우0.05).(2)천연효체조여인공효체조상후제1、2개24 h복소액체량급액체입출량비비교,차이균무통계학의의(P치균대우0.05).(3)2조폐조직절편균가견폐포간격불동정도증관,폐간질내대량수종액적취급염성세포침윤.(4)천연효체조저폐장함수솔위(71±10)％,여인공효체조적(79±4)％비교,차이무통계학의의(t=-1.753,P＞0.05). 결론 재중도소상저휴극기선용천연효체혹인공효체(간을기정분130/0.4)행액체복소,대폐조직수종적영향정도기본상동.
Objective To observe and compare the effects of natural colloid and artificial colloid on pulmonary edema of swine during shock stage of severe burn injury.Methods Twelve Guangxi Bama miniature swine were inflicted with 40％ TBSA full-thickness burn on the back,and then they were divided into natural colloid group (N) and artificial colloid group (A) according to the random number table,with six swine in each group.At post injury hour (PIH) 2,fluid resuscitation was begun.The main part of electrolyte was lactic acid Ringer's solution.The colloids included swine plasma and hydroxyethyl starch 130/0.4.Before injury and at every hour within PIH 48,heart rate,blood pressure,urine volume,central venous pressure (CVP),and pulmonary arterial wedge pressure (PAWP) were recorded.The mean heart rate,blood pressure,urine volume per hour per kg of body weight,CVP,PAWP,resuscitation liquid volume,and the ratio of fluid intake to output during the first and second PIH 24 were calculated.At PIH 48,lung tissue was harvested for histopathological observation and calculation of lung water ratio.Data were processed with one-way analysis of variance,analysis of variance of repeated measurement,LSD test and independent sample t test.Results (1) There were no statistically significant differences between two groups in heart rate,blood pressure,and urine volume before injury and during the first and second PIH 24 (P values all above 0.05) ; during the first PIH 24,the CVP and PAWP of group A were significantly higher than those of group N (P values all below 0.05).Compared with those before injury,the heart rate,CVP and PAWP of two groups during the first and second PIH 24 were significantly higher (P ＜ 0.05 or P ＜ 0.01) ;the urine volume of group N was decreased during the first PIH 24 (P ＜ 0.05),while there was no significant change in group A (P ＞ 0.05) ; the urine volumes of two groups during the second PIH 24 were increased,while no statistically significant differences were observed (P values all above 0.05).There were no statistically significant differences in blood pressure of two groups between the first,second PIH 24 and before injury (P values all above 0.05).(2) There were no statistically significant differences in the resuscitation liquid volume and fluid intake to output ratio between two groups during the first and second PIH 24(P values all above 0.05).(3) The alveolar septum was found widened in varying degrees,and there were edema fluid accumulating and inflammatory cell infiltrating within the pulmonary interstitial of lung tissue sections in both two groups.(4) The lung water ratio of group N [(71 ± 10) ％] was not statistically significant different from that of group A [(79±4)％,t =-1.753,P ＞0.05].Conclusions The natural colloid or artificial colloid (hydroxyethyl starch 130/0.4) applied during shock stage had similar effects on pulmonary edema in swine with severe burn.
