CAJ | 학술논문

目的探讨与单纯烧伤相比,烧冲复合伤休克补液量变化对疗效的影响.方法将24只比格犬随机均分入常量补液(N)组、减量补液(D)组和增量补液(Ⅰ)组等3个实验组,常量组补液量按Parkland公式计算得出,增、减量组则分别在其基础上增加或减少20％补液量.利用比格犬烧冲复合伤模型,通过测量各组伤后4、8、24、48 h尿量、血红蛋白浓度(HB)、心输出量(CI)、胸腔内血容量(ITBV)、血管外肺水指数(ELWI)、氧供量(DO2)、氧耗量(VO2)等指标变化,比较不同补液量下,各组犬复苏状况优劣,进而确定补液量应如何改变.结果伤后4h时,N、I、D3组尿量分别为(0.41 ±0.13)、(0.77 ±0.17)、(0.30±0.13) ml· kg-1· h-1,(P ＜0.001);24 h时为(0.59 ±0.05)、(0.88±0.05)、(0.53 ±0.06) ml·kg-1·h-1,(P＜0.001).伤后4h和8h时,Ⅰ组CO高于N组和D组[分别为(1.57 ±0.19) L/min比(1.25±0.17)、(1.05 ±0.17) L/min;(1.87±0.20)L/min比(1.57±0.24)、(1.20 ±0.19) L/min],P＜0.05;ITBV亦显著高于N组和D组[分别为(169±16) ml比(140±12)、(121±12) ml;(161±14) ml比(135±22)、(112±12) ml],P＜0.05.伤后24 h时,Ⅰ组VO2高于N组[(129±10)比(106± 12) ml· min-1·m-2],P＜0.05.伤后全部时间点Ⅰ组DO2和VO2均高于D组,P＜0.05.3组伤后所有时间点ELWI差异均无统计学意义,均P＞0.05.结论增加补液量可以更迅速地补充有效循环容量,减轻心输出量的降低,进而维持组织脏器的灌注水平,提高组织氧合功能,最终更好的改善组织缺氧状态.
목적 탐토여단순소상상비,소충복합상휴극보액량변화대료효적영향.방법 장24지비격견수궤균분입상량보액(N)조、감량보액(D)조화증량보액(Ⅰ)조등3개실험조,상량조보액량안Parkland공식계산득출,증、감량조칙분별재기기출상증가혹감소20％보액량.이용비격견소충복합상모형,통과측량각조상후4、8、24、48 h뇨량、혈홍단백농도(HB)、심수출량(CI)、흉강내혈용량(ITBV)、혈관외폐수지수(ELWI)、양공량(DO2)、양모량(VO2)등지표변화,비교불동보액량하,각조견복소상황우렬,진이학정보액량응여하개변.결과 상후4h시,N、I、D3조뇨량분별위(0.41 ±0.13)、(0.77 ±0.17)、(0.30±0.13) ml· kg-1· h-1,(P ＜0.001);24 h시위(0.59 ±0.05)、(0.88±0.05)、(0.53 ±0.06) ml·kg-1·h-1,(P＜0.001).상후4h화8h시,Ⅰ조CO고우N조화D조[분별위(1.57 ±0.19) L/min비(1.25±0.17)、(1.05 ±0.17) L/min;(1.87±0.20)L/min비(1.57±0.24)、(1.20 ±0.19) L/min],P＜0.05;ITBV역현저고우N조화D조[분별위(169±16) ml비(140±12)、(121±12) ml;(161±14) ml비(135±22)、(112±12) ml],P＜0.05.상후24 h시,Ⅰ조VO2고우N조[(129±10)비(106± 12) ml· min-1·m-2],P＜0.05.상후전부시간점Ⅰ조DO2화VO2균고우D조,P＜0.05.3조상후소유시간점ELWI차이균무통계학의의,균P＞0.05.결론 증가보액량가이경신속지보충유효순배용량,감경심수출량적강저,진이유지조직장기적관주수평,제고조직양합공능,최종경호적개선조직결양상태.
Objective To explore the efficacies of resuscitation fluid volume after combined burnblast injury versus a simple burn.Methods A total of 24 beagle dogs were randomly assigned into 3 groups of normal volume (N),decreased volume (D) and increased volume (Ⅰ).Fluid volume for group N was calculated with the Parkland formula while groups D and I decreased or increased by 20％ respectively.Urinary output (UOP),hemoglobin concentration (HB),cardiac output (CO),intrathoracic blood volume (ITBV),extravascular lung water index (ELWI),oxygen delivery (DO2) and oxygen consumption (VO2) were determined before and 4,8,24,48 h after injury to evaluate the sufficiency of resuscitation in each group and examine the superiority.Results UOP were [(0.41 ± 0.13),(0.77 ± 0.17),(0.30 ±0.13)] ml · kg-1 · h-1 at 4 h post-injury in groups N,I and D respectively.Group Ⅰ was significantly higher than groups N and D (P ＜0.001).It were [(0.59 ±0.05),(0.88 ±0.05),(0.53 ± 0.06)] ml · kg-1 · h-1 at 24 h post-injury in groups N,I and D respectively.Group Ⅰ was significantly higher than groups N and D (P ＜0.001).CO in group Ⅰ was remarkably higher than those in groups N and D at 4 h and 8 h post-injury [(1.57 ±0.19) vs (1.25 ±0.17),(1.05 ±0.17) L/min;(1.87 ±0.20) vs (1.57 ± 0.24),(1.20 ± 0.19) L/min respectively] (P ＜ 0.05);ITBV also significantly increased in group Ⅰ than two other groups at4 h and 8 h post-injury [(169 ±16) vs (140 ±12),(121 ±12) ml;(161 ± 14) vs (135 ± 22),(112 ± 12) ml] (P ＜ 0.05).VO2 in group Ⅰ was significantly higher than that in group N at 24 h post-injury [(129 ± 10) vs (106 ± 12) ml · rmin-1 · m-2] (P ＜ 0.05).No differences were detected among 3 group in ELWI (P ＞ 0.05).Conclusion Larger fluid volume may compensate circulatory volume loss sooner,alleviate declining cardiac output better,maintain adequate organ perfusion,promote tissue oxygenation and improve anti-hypervolemia and anti-hypoxia.