丙酮酸钠林格液对50％总体表面积烧伤休克犬静脉补液时血流动力学和器官功能的影响  

The effects of sodium pyruvate Ringer solution on hemodynamic and organ functions during shock stage in dogs with a 50% total body surface area full-thickness burn

作　　者：孟祥熙[1] 李娟[1] 白晓东[2] 胡森[1] 盛志勇 

机构地区：[1]解放军总医院第一附属医院烧伤研究所休克与多器官障碍实验室,北京100048 [2]解放军武警总医院烧伤整形科 [3]不详

出　　处：《中华危重病急救医学》2014年第4期244-248,共5页Chinese Critical Care Medicine

基　　金：全军医学科研“十一五”计划项目（06Z055）;国家发明专利（201210074342.9）

摘　　要：目的 比较丙酮酸钠林格液和乳酸钠林格液对烧伤休克犬血流动力学及器官功能的影响.方法 28只Beagle犬制备成50％总体表面积（TBSA）Ⅲ度烧伤模型,按随机数字表法分为3组：单纯烧伤组（NR组,n=8）伤后不补液;乳酸钠林格液组（RL组,n=10）和丙酮酸钠林格液组（RP组,n=10）于伤后30 min根据Parkland公式经颈外静脉分别输注乳酸钠林格液或丙酮酸钠林格液.在动物清醒状态下,观察伤前和伤后2、6、8、12、24 h血流动力学、器官功能指标及生存情况.结果 伤后24 h,NR组动物全部死亡,RL组、RP组全部存活.与伤前比较,NR组、RL组、RP组伤后2h平均动脉压（MAP）、心排血指数（CI）、左心室内压最大变化速率即显著降低[MAP （mmHg,1 mmHg=0.133 kPa）：45.33±7.78比141.67±5.98,91.33±10.25比142.33±6.16,98.67±9.54比142.83±5.47;CI（mL· s-1·m-2）：8.17±0.83比48.34±3.33,16.84±2.17比47.34±1.67,19.00±1.50比47.34±1.33;左心室内压最大变化速率（mmHg/s）：426.83±51.91比1 372.50±39.61,594.00±88.23比1 363.83±44.92,645.00±66.82比1 395.83±19.49,均P＜ 0.05],外周血管阻力（SVR）及丙氨酸转氨酶（ALT）、血肌酐（Cr）、血清肌酸激酶同工酶（CK-MB）、二胺氧化酶（DAO）等器官功能指标均显著升高[SVR（kPa·s· L-1）：1 322.50±36.37比281.45±8.84,777.50±41.84比289.72±6.70,571.40±40.01比286.27±8.66;ALT （U/L）：89.50± 4.11比40.57±3.63,89.25±4.88比37.92±2.62,86.30±5.61比38.47±3.50;Cr（μmol/L）：75.62±4.61比41.58±2.78,77.00±5.92比46.55 ±3.17,74.13 ±2.56比45.65±1.83;CK-MB （kU/L）：13.122±0.282比1.557±0.009,8.885±0.272比1.497±0.009,8.692±0.180比1.490±0.005; DAO（kU/L）：2.26±0.14比0.25±0.02,1.50±0.07比0.25±0.01,1.37±0.07比0.25±0.02,均P＜0.05].烧伤后NR组各指标持续恶化,直至死亡.两静脉补液组血流动力学及器官功能指标逐渐恢复,其中RP组CI、SVR、DAO于伤后2h起即显著优于RL组（均P＜0.0Objective To compare the effect of intravenous resuscitation with sodium pyruvate （Pyr） Ringer solution against lactated Ringer solution on hemodynamic and organ functions during shock stage in dogs with burn.Methods 28 Beagle dogs were subjected to 50％ total body surface area （TBSA） burn,and they were divided into three groups：burn injury without fluid resuscitation （N R,n =8）,Ringer lactate solution（RL,n =10）,and Pyr Ringer solution （RP,n =10）.They were given intravenous fluid resuscitation according to Parkland formula 30 minutes after burn.The hemodynamics,organ functions and mortality were observed in conscious state before burn injury,and 2,6,8,12,24 hours after burn injury.Results Within 24 hours after burn,all the dogs in NR group died,and those in RL and RP groups were all alive.At 2 hours after burn,the mean arterial pressure （MAP）,cardiac index （CI）,dp/dt max of left ventricular contractility were significantly reduced in NR,RL and RP groups compared with those before injury [MAP（mmHg,1 mmHg =0.133 kPa）：45.33 ± 7.78 vs.141.67 ± 5.98,91.33 ± 10.25 vs.142.33 ± 6.16,98.67 ± 9.54 vs.142.83 ±5.47; CI （mL·s-1·m-2）：8.17 ±0.83 vs.48.34 ±3.33,16.84 ±2.17 vs.47.34 ± 1.67,19.00 ± 1.50 vs.47.34 ± 1.33; dp/dt max （mmHg/s）：426.83 ± 51.91 vs.1 372.50 ± 39.61,594.00 ± 88.23 vs.1 363.83 ± 44.92,645.00 ±66.82 vs.1 395.83 ± 19.49,all P＜0.05],and the systemic vascular resistance （SVR） and alanine transaminase （ALT）,creatinine （Cr）,serum MB isoenzyme of creatine kinase （CK-MB）,diamine oxidase （DAO） were significantly higher [SVR （kPa·s ·L-1）：1 322.50 ±36.37 vs.281.45 ± 8.84,777.50 ±41.84 vs.289.72 ± 6.70,571.40 ±40.01 vs.286.27 ±8.66; ALT （U/L）：89.50 ±4.11 vs.40.57 ±3.63,89.25 ±4.88 vs.37.92 ± 2.62,86.30 ±5.61 vs.38.47 ±3.50; Cr （μmol/L）：75.62 ±4.61 vs.41.58 ±2.78,77.00 ±5.92 vs.46.55 ± 3.17,74.13 ±2.56 vs.45.65 ± 1.83; CK-MB （kU/L）：13.122 ±0.282 vs.1.557 ±0.009,8.885 ±0.272 vs.1.497 �

关 键 词：烧伤 液体复苏 丙酮酸 血流动力学 器官功能 

分 类 号：R644[医药卫生—外科学]