烧伤早期心肌力学的变化及延迟快速补液对其的影响  

Changes of myocardial dynamics in early stage of burn and effect of rapid fluid replacement in delayed resuscitation

作　　者：王德伟[1] 王长慧[1] 丁祥生[1] 裴永东[1] 朱世辉[2] 刘世康[2] 葛绳德[2] 

机构地区：[1]江苏省连云港市第一人民医院烧伤科,222002 [2]上海市长海医院烧伤中心

出　　处：《中国危重病急救医学》2005年第12期756-758,共3页Chinese Critical Care Medicine

基　　金：江苏省连云港市卫生局科技项目资助(200010)

摘　　要：目的 探讨烧伤早期心肌力学变化及延迟快速复苏对心脏功能的影响。方法 12只犬随机分 为对照组和烧伤组(n=6)。烧伤组动物制备35％总体表面积Ⅲ度烧伤模型,并从伤后6 h起用乳酸林格液进 行复苏．以尿量为1．0 ml·kg-1·h-1及心排血量(CO)为伤前值的70％-80％来调整输液速度和输液量,观 察伤后24 h内平均动脉压(MAP)、左心室收缩压(LVSP)、左心室内压最大上升／下降速率(±dp／dt max)及 心排血指数(CI)的变化。结果 烧伤后0．5 h,MAP、LVSP、±dp／dt max及CI就已明显降低,直至伤后6 h 即复苏前一直呈下降趋势;复苏后2 h内上述各种指标逐渐接近对照组水平,至复苏后4 h与对照组比较差 异无显著性(P均>0．05),其输液量为每1％烧伤面积(3．63±0．99)ml／kg。结论 在烧伤早期即有心脏功能 低下,快速复苏是恢复心肌功能的主要手段。Objective To investigate the changes in myocardial dynamics in early phases of burn shock of dogs and the effects of rapid fluid infusion in delayed resuscitation. Methods Twelve mongrel dogs were randomly divided into control （n=6） and burn （n=6） groups. The dogs in burn group were subjected to 35% total body surface area （TBSA） Ⅲ degree burn and were resuscitated with lactate Ringer’s solution 6 hours postburn. The volumes and rates of fluid infusion were controlled basically on the urinary output of 1.0ml·kg^-1·h^-1 and cardiac output （CO） of 70%-80% of preburn values. The mean arterial pressure （MAP）, left ventricular systolic pressure （LVSP）, maximum rate of intraventricular pressure rise/down （±dp/dt max） and cardiac index （CI） were determined at 0. 5, 1,2, 6, 7, 8, 10 and 24 hours postburn. Results The MAP, LVSP, ±dp/dt max and CI were significantly lowered from their baseline and those of control group at 0. 5 hour postburn, and they kept declining until 6 hours postburn. They showed a tendency of elevation and reached or approached the levels of that in control group within 2 hours of resuscitation, and the differences were not significant between the two groups 4 hours after burn （all P〉0.05）. The amount of infusion fluid within the first 4 hours of resuscitation was （3.63±0.99） ml/kg per 1% TBSA. Conclusion The myocardial dynamics is depressed in the early stage of burn, the effective way to improve it is to infuse a large amount of fluid rapidly when resuscitation is delayed.

关 键 词：烧伤 休克 心肌功能 延迟复苏 早期 心肌力学 补液 

分 类 号：R644[医药卫生—外科学] R441.9[医药卫生—临床医学]