早期口服补液对50％体表面积烧伤犬休克期脏器功能和病死率的影响  

Effects of early oral fluid resuscitation on organ functions and survival during shock stage in dogs with a 50% total body surface area full-thickness burn

作　　者：胡森[1] 车晋伟[1] 王海滨[2] 于勇[2] 田易军[1] 盛志勇[1] 

机构地区：[1]解放军总医院第一附属医院全军烧伤研究所休克与多器官功能障碍实验室,北京100037 [2]解放军总医院第一附属医院实验室,北京100037

出　　处：《中华医学杂志》2008年第44期3149-3152,共4页National Medical Journal of China

基　　金：军队医学科研计划专项课题基金资助项目（062055）

摘　　要：目的研究50％体表面积（TBSA）烧伤休克早期口服补液对脏器功能和伤后72h病死率的影响。方法成年雄性Beagle犬18只，采用凝固汽油燃烧法造成（51．2±2．6）％TBSA Ⅲ度烧伤。随机分为不补液组、口服补液组和静脉补液组，每组6只。不补液组伤后24h内无治疗；口服补液组和静脉补液组于伤后30min开始分别从胃管和静脉输注葡萄糖-电解质溶液，补液量和速率依据Parkland公式确定，伤后24h起各组动物均实施静脉补液。记录各组动物伤后72h病死率。测定伤前和伤后72h内不同时间点平均动脉压（MAP）、血浆容量（PV）、红细胞压积（HCT）、血浆丙氨酸氨基转移酶（ALT）、肌酐（Cr）、磷酸肌酸激酶同工酶（CK-MB）水平和尿量。结果伤后72h病死率不补液组为6／6（均在22h内死亡），口服补液组3／6，静脉补液组为0。不补液组伤后8hMAP、PV降至最低，分别为（34．4±9．1）mmHg、（32．7±3．5）ml／kg；HCT、ALT、Cr和CK—MB升至最高，分别为（61．7±2．7）％、（121．1±4．8）U／L、（91．0±6．1）μmol／L、（13891±297）U／L；8h内6只犬中4只无尿，2只的尿量分别为1．2和2．1ml／kg。两补液组上述指标逐渐恢复，伤后8h口服补液组MAP[（84．3±17．1）mmHg]、PV[（41．7±3．6）ml／kg]和尿量[（2．62±1．8）ml／kg]均明显高于不补液组（均P〈0．05），但均低于静脉补液组[分别为（113．0±10．0）mmHg、（50．3±5．2）ml／kg、（7．0±1．9）ml／kg，均P〈0．05）；血浆ALT[（81．4±10．8）U／L]低于不补液组（P〈0．05），但高于静脉补液组[（66．3±7．6）U／L，P〈0．05]；其他各时间点ALT水平以及伤后各时间点Cr和CK—MB水平均高于静脉补液组（均P〈0．05）。伤后72h，两补液组MAP、PV、HCT和尿量恢复至伤前水平，但ALT、Cr和CK-MB水平仍明显高于伤前（P〈0．05）。结论50％TBSA烧伤休克早期口�Objective To investigate the effects of early oral fluid resuscitation on organ functions and survival in severe burn shock. Methods Eighteen male Beagle dogs were surgically prepared for measurement, subjected to 50% total body surface area （TBSA） full-thickness flame injury 24 hours later, and then randomly divided into 3 equal groups： oral fluid resuscitation group（ OR group） undergoing gastric infusion of glucose-electrolyte solution（GES） according to Parkland formula 0. 5 hour after burn with the dose of 4 ml · kg^-1 · %TBSA^-1 ,1/2 being given in the first 8 h and 1/2 in the latter 16 h . Intravenous （IV） resuscitation of GES group （VR group） undergoing IV infusion of GES with the same dose as mentioned above, and no fluid resuscitation （NR） group given with GES during the first 24 h. In the second 24 hours all dogs received IV fluid resuscitation. At the end of 72-hours-period experiment, the mortality was recorded. The mean arterial pressure （ MAP）, plasma blood volume （ PV ）, hematocrit （ HCT）, urinary output, alanine aminotransferase （ALT）, creatinine （Cr）, and MB isoenzyme of creatine kinase （CK-MB）were examined before injury and at 2, 4, 8, 24, 48 and 72 hours after injury. Results At the end of 72- hours-period experiment, all dogs died in the NR group, 3 dogs died in the OR group, and no dog died in the VR group. The MAP and PV were significantly reduced after burn compared with those before-injury in the NR group, with the lowest levels of （34 ± 9 ） mm Hg and （ 32.7 ± 3. 5 ） ml/kg （ both P 〈 0. 05 ） 8 h after burn, and the HCT, ALT, Cr, and CK-MB levels of the NR group peaked 8 h after burn to the levels of （61.7 ± 2. 7）%, （121.1 ± 4. 8） U/L, （91, 0 ± 6. 1） μmol/L, and （13 891 ± 297） U/L respectively. Eight hours after burn 4 dogs of the NR group showed anuria, and the rest two had the urine volume of 1.2 and 2. 1 ml/kg respectively. Eight hours after burn the MAP, PV, and urinary output levels of the OR group

关 键 词：烧伤 休克 补液疗法 死亡率 

分 类 号：R686[医药卫生—骨科学]