中华烧伤杂志
中華燒傷雜誌
중화소상잡지
16
2015年
3期
211-215
,共5页
施剑武%黄文祥%施晓丽%周建军%邢楠%陈炯
施劍武%黃文祥%施曉麗%週建軍%邢楠%陳炯
시검무%황문상%시효려%주건군%형남%진형
烧伤%休克%补液疗法%胶体%氧代谢
燒傷%休剋%補液療法%膠體%氧代謝
소상%휴극%보액요법%효체%양대사
Burns%Shock%Fluid therapy%Colloid%Oxygen metabolism
目的 探讨对重度烧伤休克期猪应用不同胶体进行液体复苏对其氧代谢的影响.方法 将18只成年广西巴马小型猪造成背部约40％ TBSAⅢ度烧伤,按随机数字表法分成琥珀酰明胶组、羟乙基淀粉组、异体血浆组,每组6只;伤后2h开始进行液体复苏,胶体分别使用琥珀酰明胶60 g/L羟乙基淀粉130/0.4、异体血浆.记录各组猪伤前及伤后第1、2个24 h的血压、尿量、心率、中心静脉压(CVP),伤后第1、2个24 h复苏液体量,测定并计算伤前及伤后4、8、24、48 h的氧摄取量、氧供量、氧摄取率及血液中D-乳酸的含量.对数据行重复测量方差分析、单因素方差分析及LSD检验. 结果 各组猪各时相点血压、尿量、心率及CVP比较,差异均无统计学意义(P值均大于0.05).琥珀酰明胶组、羟乙基淀粉组、异体血浆组猪第1、2个24 h复苏液体量组间比较差异均无统计学意义(F值分别为0.239、2.023,P值分别为0.790、0.167).伤后48 h琥珀酰明胶组猪氧摄取量为(201±38)L· min-1·m-2,显著高于异体血浆组的(150 ±37)L· min-1·m-2,P ＜0.05;其余时相点3组猪氧摄取量水平差异无统计学意义(P值均大于0.05).琥珀酰明胶组猪伤后8h的氧供量为(484±63)L· min-1·m-2,低于异体血浆组的(652 ±65)L·min-1·m-2,P ＜0.01;而伤后24、48 h的氧供量分别为(903±132)、(1 028±98)L· min-1·m-2,分别显著高于异体血浆组的(686±72)、(720±75)L·min-1·m-2,P值均小于0.01.羟乙基淀粉组猪各时相点氧供量与异体血浆组相近(P值均大于0.05).各时相点琥珀酰明胶组、羟乙基淀粉组猪氧摄取率与异体血浆组相近(P值均大于0.05).伤后48 h时琥珀酰明胶组猪血液中D-乳酸含量为(69 ±9)mmol/L,显著高于异体血浆组的(52±4)mmol/L,P＜0.01;3组猪余各时相点D-乳酸含量相近(P值均大于0.05).结论 猪重度烧伤休克期应用不同胶体复苏对其氧代谢的影响中,天然胶体(异体血浆)优于人工胶体,而人工胶体中的60 g/L羟乙基淀粉130/0.4优于琥珀酰明胶.
目的 探討對重度燒傷休剋期豬應用不同膠體進行液體複囌對其氧代謝的影響.方法 將18隻成年廣西巴馬小型豬造成揹部約40％ TBSAⅢ度燒傷,按隨機數字錶法分成琥珀酰明膠組、羥乙基澱粉組、異體血漿組,每組6隻;傷後2h開始進行液體複囌,膠體分彆使用琥珀酰明膠60 g/L羥乙基澱粉130/0.4、異體血漿.記錄各組豬傷前及傷後第1、2箇24 h的血壓、尿量、心率、中心靜脈壓(CVP),傷後第1、2箇24 h複囌液體量,測定併計算傷前及傷後4、8、24、48 h的氧攝取量、氧供量、氧攝取率及血液中D-乳痠的含量.對數據行重複測量方差分析、單因素方差分析及LSD檢驗. 結果 各組豬各時相點血壓、尿量、心率及CVP比較,差異均無統計學意義(P值均大于0.05).琥珀酰明膠組、羥乙基澱粉組、異體血漿組豬第1、2箇24 h複囌液體量組間比較差異均無統計學意義(F值分彆為0.239、2.023,P值分彆為0.790、0.167).傷後48 h琥珀酰明膠組豬氧攝取量為(201±38)L· min-1·m-2,顯著高于異體血漿組的(150 ±37)L· min-1·m-2,P ＜0.05;其餘時相點3組豬氧攝取量水平差異無統計學意義(P值均大于0.05).琥珀酰明膠組豬傷後8h的氧供量為(484±63)L· min-1·m-2,低于異體血漿組的(652 ±65)L·min-1·m-2,P ＜0.01;而傷後24、48 h的氧供量分彆為(903±132)、(1 028±98)L· min-1·m-2,分彆顯著高于異體血漿組的(686±72)、(720±75)L·min-1·m-2,P值均小于0.01.羥乙基澱粉組豬各時相點氧供量與異體血漿組相近(P值均大于0.05).各時相點琥珀酰明膠組、羥乙基澱粉組豬氧攝取率與異體血漿組相近(P值均大于0.05).傷後48 h時琥珀酰明膠組豬血液中D-乳痠含量為(69 ±9)mmol/L,顯著高于異體血漿組的(52±4)mmol/L,P＜0.01;3組豬餘各時相點D-乳痠含量相近(P值均大于0.05).結論 豬重度燒傷休剋期應用不同膠體複囌對其氧代謝的影響中,天然膠體(異體血漿)優于人工膠體,而人工膠體中的60 g/L羥乙基澱粉130/0.4優于琥珀酰明膠.
목적 탐토대중도소상휴극기저응용불동효체진행액체복소대기양대사적영향.방법 장18지성년엄서파마소형저조성배부약40％ TBSAⅢ도소상,안수궤수자표법분성호박선명효조、간을기정분조、이체혈장조,매조6지;상후2h개시진행액체복소,효체분별사용호박선명효60 g/L간을기정분130/0.4、이체혈장.기록각조저상전급상후제1、2개24 h적혈압、뇨량、심솔、중심정맥압(CVP),상후제1、2개24 h복소액체량,측정병계산상전급상후4、8、24、48 h적양섭취량、양공량、양섭취솔급혈액중D-유산적함량.대수거행중복측량방차분석、단인소방차분석급LSD검험. 결과 각조저각시상점혈압、뇨량、심솔급CVP비교,차이균무통계학의의(P치균대우0.05).호박선명효조、간을기정분조、이체혈장조저제1、2개24 h복소액체량조간비교차이균무통계학의의(F치분별위0.239、2.023,P치분별위0.790、0.167).상후48 h호박선명효조저양섭취량위(201±38)L· min-1·m-2,현저고우이체혈장조적(150 ±37)L· min-1·m-2,P ＜0.05;기여시상점3조저양섭취량수평차이무통계학의의(P치균대우0.05).호박선명효조저상후8h적양공량위(484±63)L· min-1·m-2,저우이체혈장조적(652 ±65)L·min-1·m-2,P ＜0.01;이상후24、48 h적양공량분별위(903±132)、(1 028±98)L· min-1·m-2,분별현저고우이체혈장조적(686±72)、(720±75)L·min-1·m-2,P치균소우0.01.간을기정분조저각시상점양공량여이체혈장조상근(P치균대우0.05).각시상점호박선명효조、간을기정분조저양섭취솔여이체혈장조상근(P치균대우0.05).상후48 h시호박선명효조저혈액중D-유산함량위(69 ±9)mmol/L,현저고우이체혈장조적(52±4)mmol/L,P＜0.01;3조저여각시상점D-유산함량상근(P치균대우0.05).결론 저중도소상휴극기응용불동효체복소대기양대사적영향중,천연효체(이체혈장)우우인공효체,이인공효체중적60 g/L간을기정분130/0.4우우호박선명효.
Objective To explore the effects of resuscitation with different kinds of colloids on oxygen metabolism of swine during shock stage of burn injury.Methods Eighteen Guangxi Bama miniature swine were inflicted with 40％ TBSA full-thickness burn on the back.And then they were divided into succinylated gelatin group (S),hydroxyethyl starch group (H),and allogeneic plasma group (A) according to the random number table,with 6 swine in each group.The fluid resuscitation was begun at post injury hour (PIH) 2.The colloids used in groups S,H,and A were respectively succinylated gelatin,60 g/L hydroxyethyl starch 130/0.4,and allogeneic plasma.The blood pressure,urine volume,heart rate,and central venous pressure (CVP) were recorded before injury and at the first and second PIH 24.The volume of resuscitation fluid was recorded at the first and second PIH 24.The changes in oxygen delivery,oxygen consumption,oxygen extraction ratio and D-lactate were determined and calculated before injury and at PIH 4,8,24,and 48.Data were processed with analysis of variance of repeated measurement,one-way analysis of variance,and LSD test.Results There were no statistically significant differences among the three groups in blood pressure,urine volume,heart rate,and CVP at each time point (with P values above 0.05).There were no statistically significant differences in resuscitation fluid volume among the three groups at the first and second PIH 24 (with F values respectively 0.239 and 2.023,P values respectively 0.790 and 0.167).The oxygen consumption of swine in group S was (201 ± 38) L · min-1 · m-2 at PIH 48,which was significantly higher than that in group A [(150 ±37) L · min 1 · m-2,P ＜0.05],and the oxygen consumption was similar among the three groups at the rest time points (with P values above 0.05).The oxygen delivery of swine in group S was (484 ±63) L · min 1 · m-2 at PIH 8,and it was significantly lower than that in group A [(652 ± 65) L · min-1 · m-2,P ＜ 0.01].The oxygen delivery of swine in group S reached (903 ± 132) and (1 028 ± 98) L · min-1 · m-2 at PIH 24 and 48,respectively,and they were significantly higher than those in group A [(686±72) and (720±75) L· min-1 · m-2,with P values below0.01].Oxygen delivery in group H was similar to that of group A at each time point (with P values above 0.05).The oxygen extraction ratio in group S or group H was close to that of group A at each time point (with P values above 0.05).The D-lactate level in group S was (69 ± 9) mmol/L,and it was significantly higher than that in group A [(52±4) mmol/L,P ＜ 0.01] at PIH 48.The D-lactate level was similar among the three groups at the rest time points (with P values above 0.05).Conclusions According to the changes in oxygen metabolism of swine during shock stage of burn injury resuscitated with different kinds of colloids,it is found that allogeneic plasma is better than artificial colloid,and 60 g/L hydroxyethyl starch 130/0.4 is superior to succinylated gelatin.
