严重烧伤抗休克时胃肠粘膜内缺血的研究  

Mechanisms of early gastro-intestinal ischemia after burn:hemodynamic and hemorrheologic features

作　　者：崔晓林[1] 盛志勇[1] 郭振荣[1] 贺立新[1] 赵军 任晓文 孙世荣[1] 姜良松 

机构地区：[1]解放军第三○四医院烧伤研究所,北京100037 [2]牡丹江解放军第二○九医院

出　　处：《中华整形烧伤外科杂志》1998年第4期262-265,共4页

摘　　要：目的探讨烧伤早期胃肠缺血(pHi 降低)的发生规律。方法采用模拟临床的 TBSA30％Ⅲ度烧伤小型猪模型,从血流动力学、胃肠缺血、血液流变学等方面探讨烧伤早期胃肠缺血的发生规律及相关因素。伤后1小时开始复苏,按 Parkland 公式补充平衡液。结果烧伤后平均动脉压(MAP)无明显变化,但右房压(RAP)、平均肺动脉压(MPAP)、肺动脉楔压(PAWP)及心排指数(CI)等均显著下降,于伤后48小时降至谷值,经复苏后于24小时恢复正常。胃肠 pHi 于伤后1小时就迅速下降,并且恢复缓慢,伤后72小时仍未达到正常。门脉血流量也呈类似变化,并且与肠 pHi 呈显著正相关。门脉全血粘度及血浆粘度均在伤后有明显的提高。结论①胃肠缺血发生早、恢复慢。②与血流动力学变化不一致。③常规液体复苏疗法不易纠正。④门脉血液流变学变化可能加重胃肠缺血损伤。Objective To study the mechanisms of early gastro-intestinal ischemia developed in acute burn period and its relationships with hemodynamic and hemorrheologie changes.Methods Twelve pigs were randomly allocated into two groups:group C,a sham group that was subjected to all surgical procedures except burn;group B,30%TBSA cutaneous thermal injury,and was resuscitated with Parkland formula one hour after burn.Results MAP remained stable after burn,but RAP, MPAP,PAWP and CI decreased significantly to the lowest level 4～8 hours after burn,and recovered after resuscitation 24 hours postburn.Intramucosal pH declined immediately(1 hour after burn)and re- mained abnormal throughout observation period.Portal venous blood flow demonstrated similar changes as pHi ,and correlated well with intestinal pHi.Whole blood viscosity and plasma viscosity in portal ve- nous blood elevated obviously after burn.Conclusions ①GI ischemia occurred early and recovered slowly during burn shock phase with conventional resuscitation regime.②GI ischemia correlated signifi- cantly with portal venous blood flow,but did not with systemic hemodynamic variables.③Hemorheolog- ic changes in portal venous blood may exaggerate ischemia injuries.

关 键 词：烧伤 血流动力学 粘膜内PH 休克 胃肠粘膜缺血 

分 类 号：R644.06[医药卫生—外科学] R605.971[医药卫生—临床医学]