烧伤休克期不同液体复苏方案对猪血管通透性的影响
소상휴극기불동액체복소방안대저혈관통투성적영향
Effects on vascular permeability with different fluid resuscitation regimens during burn stage in swines
  • 万方数据
    中华医学杂志 중화의학잡지
    National Medical Journal of China
    2015年 12期 943-946 ,共4页

    黄文祥%薛迪建%陈炯%周建军%吴道义%邢楠

    황문상%설적건%진형%주건군%오도의%형남

    烧伤%休克%补液疗法%血管通透性%猪,雏型 燒傷%休剋%補液療法%血管通透性%豬,雛型
    소상%휴극%보액요법%혈관통투성%저,추형
    Burns%Shock%Fluid therapy%Vascular permeability%Swine,miniature
    目的 探讨烧伤休克期不同液体复苏方案对猪血管通透性的影响.方法 将24只广西巴马小型猪按随机数字表法分为琥珀酰明胶组、羟乙基淀粉(130/0.4)组、Parkland(乳酸林格氏液)组、异体血浆组各6只,建立重度烧伤休克模型,按照休克复苏方案的原则复苏,观察并记录各组猪伤前及伤后第1、2个24h的平均心率、血压、每小时每千克尿量、中心静脉压、肺毛细血管楔压、复苏液体量,分别于烧伤前及烧伤后4、8、24、48 h时相点抽取静脉血,检测血浆胶体渗透压;静脉注射伊文思蓝溶液30 min后处死,取肺组织测定血管通透性,并进行统计学分析.结果 烧伤前后各时相点血液动力学指标组间差异均无统计学意义(均P ＞0.05).琥珀酰明胶组、羟乙基淀粉组、Parkland组、异体血浆组各时相点血浆胶体渗透压(单位为mmHg,1 mmHg =0.133 kPa)分别为:(1)伤前:25.4±1.0、25.9±0.9、25.5±1.1、25.0±1.0;(2)伤后4 h:24.3±1.0、25.6 ±0.9、13.2±0.5、25.0±1.1;(3)伤后8 h:23.3 ±0.8、25.2±1.2、12.7 ±0.5、24.0±0.9;(4)伤后24 h:22.0 ±0.8、23.1 ±1.0、12.4±0.4、23.3±0.8;(5)伤后48 h:22.3±0.8、24.1 ±0.8、18.1 ±0.4、23.5 ±0.9;伤前组间差异均无统计学意义(均P ＞0.05);伤后8h羟乙基淀粉组显著高于异体血浆组,伤后4、8、24 h、48 h Parkland组均显著低于异体血浆组(均P＜0.05);琥珀酰明胶组伤后8、24、48 h、羟乙基淀粉组伤后8、24、48 h、Parkland组伤后4、8、24、48 h、异体血浆组伤后8、24、48 h均显著低于伤前(均P ＜0.05).伤后48 h琥珀酰明胶组、羟乙基淀粉组、异体血浆组肺血管通透性指数近似,且均显著低于Parkland组[(7.6±0.9)、(7.9±1.8)、(7.6±1.2)比(26.1±2.3) μg/g](均P＜0.05).结论 猪烧伤休克期采用晶胶体复苏方案的胶体无论采用天然胶体、人工胶体的羟乙基淀粉(130/0.4)或琥珀酰明胶对血管通透性的影响接近,显著优于早期应用乳酸钠林格液的Parkland公式复苏方案.
    목적 탐토소상휴극기불동액체복소방안대저혈관통투성적영향.방법 장24지엄서파마소형저안수궤수자표법분위호박선명효조、간을기정분(130/0.4)조、Parkland(유산림격씨액)조、이체혈장조각6지,건립중도소상휴극모형,안조휴극복소방안적원칙복소,관찰병기록각조저상전급상후제1、2개24h적평균심솔、혈압、매소시매천극뇨량、중심정맥압、폐모세혈관설압、복소액체량,분별우소상전급소상후4、8、24、48 h시상점추취정맥혈,검측혈장효체삼투압;정맥주사이문사람용액30 min후처사,취폐조직측정혈관통투성,병진행통계학분석.결과 소상전후각시상점혈액동역학지표조간차이균무통계학의의(균P ＞0.05).호박선명효조、간을기정분조、Parkland조、이체혈장조각시상점혈장효체삼투압(단위위mmHg,1 mmHg =0.133 kPa)분별위:(1)상전:25.4±1.0、25.9±0.9、25.5±1.1、25.0±1.0;(2)상후4 h:24.3±1.0、25.6 ±0.9、13.2±0.5、25.0±1.1;(3)상후8 h:23.3 ±0.8、25.2±1.2、12.7 ±0.5、24.0±0.9;(4)상후24 h:22.0 ±0.8、23.1 ±1.0、12.4±0.4、23.3±0.8;(5)상후48 h:22.3±0.8、24.1 ±0.8、18.1 ±0.4、23.5 ±0.9;상전조간차이균무통계학의의(균P ＞0.05);상후8h간을기정분조현저고우이체혈장조,상후4、8、24 h、48 h Parkland조균현저저우이체혈장조(균P＜0.05);호박선명효조상후8、24、48 h、간을기정분조상후8、24、48 h、Parkland조상후4、8、24、48 h、이체혈장조상후8、24、48 h균현저저우상전(균P ＜0.05).상후48 h호박선명효조、간을기정분조、이체혈장조폐혈관통투성지수근사,차균현저저우Parkland조[(7.6±0.9)、(7.9±1.8)、(7.6±1.2)비(26.1±2.3) μg/g](균P＜0.05).결론 저소상휴극기채용정효체복소방안적효체무론채용천연효체、인공효체적간을기정분(130/0.4)혹호박선명효대혈관통투성적영향접근,현저우우조기응용유산납림격액적Parkland공식복소방안.
    Objective To explore the effects of different fluid resuscitation regimens on vascular permeability during burn stage in swines.Methods A total of 24 Guangxi-BAMA miniature swines were numbered from 1 to 24 and randomly divided by EXCEL 2007 into 4 groups of succinylated gelatin,hydroxyethyl starch (HES 130/0.4),Parkland (lactated Ringer's solution) and allogeneic plasma (n =6 each).The model of severe burn shock was established.And fluid resuscitation therapy was applied according to the established regimens of burn shock fluid resuscitation.The parameters of heart rate,blood pressure,urine volume,central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) were recorded.Blood samples were collected prior to burns and at intervals of 4,8,24 and 48 h post-burns.The plasma colloidal osmotic pressure was measured.Evens blue was intravenously injected at 30 min before sacrificing.Then lung tissue samples were obtained and pulmonary vascular permeability index (PMPI) was measured.Statistical analyses were performed.Results All swines survived shock stage.The inter-group comparison revealed no statistical difference in heart rate,blood pressure,urine volume,CVP or PCWP.The plasma colloidal osmotic pressures (mmHg,1 mmHg =0.133 kPa) of four groups at each interval were as follows:(1) pre-burn:25.4±1.0,25.9±0.9,25.5±1.1,25.0±1.0;(2) 4 h:24.3±1.0,25.6±0.9,13.2±0.5,25.0±1.1;(3) 8 h:23.3 ±0.8,25.2±1.2,12.7 ±0.5,24.0 ±0.9;(4) 24 h:22.0±0.8,23.1 ± 1.0,12.4±0.4,23.3 ±0.8;(5) 48 h:22.3 ±0.8,24.1 ±0.8,18.1 ±0.4,23.5 ± 0.9.No statistically significant differences existed at the intervals of pre-burn between four groups (all P ＞ 0.05).The HES 130/0.4 group at 8 h was significantly higher than that of allogeneic plasma group at the same interval (P ＜ 0.05).The Parkland group at 4,8,24,48 h were significantly lower than those of allogeneic plasma group (all P ＜ 0.05).The succinylated gelatin group at 8,24,48 h,the HES 130/ 0.4 group at 8,24,48 h,the Parkland group at 4,8,24,48 h and allogeneic plasma at 8,24,48 h decreased versus those at pre-burns (all P ＜ 0.05).No statistically significant differences existed in pulmonary vascular permeability between the groups of succinylated gelatin (7.6 ± 0.9) μg/g,HES 130/0.4 (7.9 ±1.8) μg/g,and allogeneic plasma (7.6 ± 1.2) μg/g,but all lower than the Parkland group (26.1 ± 2.3) μg/g (all P ＜ 0.05).Conclusions Natural colloid or artificial colloid (HES 130/0.4 or succinylated gelatin) have similar effects on vascular permeability in swines with severe burns during shock stage.Both are superior to the Parkland group.
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