两种复苏措施对弹烧复合伤海水浸泡犬血液流变性的影响  

Comparsion of Resuscitation with Parkland Formula and with Improved Protocol on Hemorheologics in Projectile-Burn Combined Wound in Dogs with Seawater Immersion

作　　者：陈强[1] 赖西南 葛衡江[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所,重庆400042

出　　处：《中国微循环》2005年第3期157-159,共3页Journal of Chinese Microcirculation

基　　金：全军"十五"重点课题(01-L011)

摘　　要：目的比较标准Parkland公式复苏与改良液体复苏对犬弹烧复合伤后海水浸泡血液流变性的影响。方法建立海水浸泡弹烧复合伤模型后,将20只成年杂种犬随机分为海水浸泡弹烧复合伤组(简称浸泡组,n=8只)、标准Parkland公式复苏组(简称标准组,n=6)与改良液体复苏组(改良组,n=6),动态监测伤前、伤后4、7、10、20、28h共6个时相点血液流变学指标。结果①三组动物血浆黏度(PV)与伤前比较变化均不明显;②标准组不能纠正全血高切黏度(HBV)及红细胞聚集指数(AI)浸泡后较伤前恶化的情况,而改良组对这种变化有明显改善作用;③两复苏组对降低红细胞比容(HCT)有相同的应用价值;④标准组对于改善全血低切黏度(LBV)、红细胞变形指数(DI)有一定价值,而改良组对这些指标改善有更好的应用价值。结论改良液体复苏与Parkland公式复苏比较,更能有效改善血液流变学指标,从而改善组织微循环、改善组织器官灌注,具有更好的复苏效果。Objective To compare hemorheologic effects of resuscitation with parkland formula or with the improved protocol on projectile-burn combined wound in dogs with seawater immersion. Methods After createing a model of projectile-burn combined wound in dogs with seawater immersion, then twenty dogs were randomized into three groups: Immersion group (IG:projectile-burn combined wound with seawater immersion, n=8), Parkland formula resuscitation group (PFRG: lactated Ringer’s solution 4 ml/kg/%burn for 24 hours ,n=6), Improved protocol resuscitation group (IPRG: lactated Ringer’s solution 2.5 ml/kg/%burn plus colloid solution 6% hetastarch 0.5 ml/kg/%burn for 24 hours ,n=6 ) .Recording the changes of hemorheology before injury,4,7,10,20,28h after injury. Results 1.There was no significant change for plasma viscosity among three groups compared to pre-wounded value ; 2.It can not rectify significantly the aggravation of HBV (high shear blood viscosity) and AI ((erythrocyte) aggregation index) in PFRG. HBV and AI in IPRG were better than those in PFRG. 3. There were the same values on lowering Hct (haematocrit) in PFRG and in IPRG .4.It can rectify significantly the aggravation of LBV (low shear blood viscosity) and DI ((erythrocyte) distortion index) in PFRG. The LBV and DI in IPRG ameliorated better than those in PFRG. Conclusion Fluid resuscitation according to the improved protocol is more suitable for projectile-burn combined wound in dogs with seawater immersion than resuscitation with parkland formula.

关 键 词：复苏 海水浸泡 弹烧复合伤血液流变学 

分 类 号：R846.2[医药卫生—航空、航天与航海医学] R331[医药卫生—临床医学]