Parkland公式复苏对弹烧复合伤海水浸泡犬血气及酸碱平衡的影响  

Effects of resuscitation with Parkland formula on arterial blood-gas and acid-base balance in projectile-burn combined wound in dogs with seawater immersion

作　　者：陈强[1] 赖西南 葛衡江[1] 王正国[2] 

机构地区：[1]第三军医大学大坪医院野战外科研究所麻醉科,重庆400042 [2]第三军医大学创伤,烧伤,复合伤国家重点实验室战伤救治基础研究室第六研究室

出　　处：《中华航海医学与高气压医学杂志》2005年第2期81-83,共3页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

基　　金：全军"十五"重点课题(01-L011)

摘　　要：目的探讨Parkland公式复苏对犬弹烧复合伤并海水浸泡后血气及酸碱水平的影响。方法建立海水浸泡弹烧复合伤动物模型后,将14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)和Parkland公式复苏组(简称复苏组,n=6),动态监测伤前及伤后4,7,10,20,28h(共6个时相点)血气及酸碱水平的变化。结果(1)浸泡组动物在浸泡后出现进行性加重的、严重的代谢性酸中毒;Parkland公式复苏后,在实验早期改善了代谢性酸中毒,但在实验后期(伤后28h)代谢性酸中毒状况与浸泡组相同。(2)浸泡组动物在浸泡后动脉血氧分压明显下降,出水后略有回升,但仍明显低于伤前水平,复苏组与浸泡组动脉血氧分压在各时相点相差不显著。伤后4h测量点(浸泡后即刻)二氧化碳分压与伤前比较无明显差异。在伤后10h内,二氧化碳分压复苏组与浸泡组变化接近;但从伤后20h开始,则明显低于浸泡组。结论以Parkland公式为参照进行常规复苏时,在一定程度上可以纠正海水浸泡后进行性加重的、严重的代谢性酸中毒(伤后20h内),但这种改善作用不稳定,表现为代谢性酸中毒在伤后28h时进一步恶化,因此,复苏措施需要进一步改进。Objective To explore effects of resuscitation with Parkland formula on arterial blood-gas and acid-base balance in projectile-burn combined wound in dogs with seawater immersion. Methods Projectile-burn combined wound in dogs with seawater immersion was modelled,14 dogs were randomized into two groups: projectile-burn combined wound with seawater immersion group (immersion group),Parkland formula resuscitation group (resuscitation group).The changes of arterial blood-gas and acid-base balance were recorded before injure and 4,7,10,20,28 h after injure.Results 1. After seawater immersion, metabolic acidosis in immersion group aggravated progressively;in the Parkland formula resuscitation group, metabolic acidosis in resuscitation group were ameliorated at early stage, but aggravated again at 28 h after injure. 2. Blood partial pressure of oxygen(PaO2) declined significantly after seawater immersion , and then returned slightly but still lower compared with injured before. There was no significant change for PaO2 between two groups compared with every recording point. Blood partial pressure of carbon dioxide (PaCO2) in two groups was no difference between injure before and 4 h after injure. There were no significant changes compared with PaCO2 between two groups at every recording point during the period of before and 10 h after injury. After injured 20 h, PaCO2 in resuscitation group decline significantly in resuscitation group. Conclusions When fluid resuscitation in accordance with Parkland formula, the severe metabolic acidosis after immersion was remedied in certain degree during early period of the experiment; but the effect of amelioration was unstable, and metabolic acidosis deteriorated again in the later period of experiment; therefore, the way of fluid resuscitation need be improved.

关 键 词：海水浸泡 弹烧复合伤 动脉血气 酸碱平衡 液体复苏 Parkland公式 

分 类 号：R826[医药卫生—临床医学]