丙酮酸盐-糖液对50％总体表面积烧伤休克犬口服补液时血液动力学和脏器功能的影响  

Effects of oral fluid resuscitation with pyruvate-oral rehydration solution on the hemodynamic parameters 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] 周方强 

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]武警总医院烧伤整形科 [3]美国芝加哥费森尤斯透析中心

出　　处：《中华外科杂志》2014年第6期450-454,共5页Chinese Journal of Surgery

基　　金：军队十一五医学科研专项课题基金资助项目（06Z055）

摘　　要：目的 研究丙酮酸盐-糖液对烧伤休克犬口服补液时血流动力学、脏器功能及生存率的影响.方法 28只雄性Beagle犬施行颈总动脉、颈外静脉、胃及空肠置管术,24 h后造成50％总体表面积（TBSA）Ⅲ°烧伤.实验动物随机分为3组：单纯烧伤组（NR组,n=8）、NaHCO3盐-糖液组（OH组,n=10）和丙酮酸盐-糖液组（OP组,n=10）.NR组不予补液治疗;补液组于伤后30 min根据Parkland公式经胃造口分别输注NaHCO3-葡萄糖电解质液或丙酮酸盐-葡萄糖电解质液.在动物清醒状态下测定伤前和伤后2、6、8、12、24 h血流动力学指标及脏器功能,并记录伤后24 h生存率.结果 伤后2h,NR组、OH组和OP组动物平均动脉压分别为（45±8）、（57-±8）和（80±9）mmHg（1 mmHg =0.133 kPa）,较伤前[分别为（142 ±6）、（144±6）和（142±6）mmHg]明显降低（t=16.967、14.595、10.100,均P＜0.05）,心输出量、左心室内压最大变化速率、小肠黏膜血流量变化趋势与平均动脉压相同.各组动物伤后各时间点外周血管阻力及脏器功能指标（血肌酐、血清肌酸肌酶同工酶、ALT、二胺氧化酶）较术前显著升高（t=-46.894～-2.465,均P＜0.05）.NR组各项指标持续恶化,直至死亡;口服补液组血流动力学及脏器功能指标逐渐恢复（F =0.001 ～ 1.600,均P＜0.05）,OP组显著优于OH组（F=0.013 ～0.466,均P＜0.05）.伤后24 h OP组存活6只（6/10）,OH组存活4只（4/10）,NR组全部死亡（0/8）.结论 50％ TBSA烧伤犬口服补液复苏过程中,丙酮酸盐-糖液在改善血流动力学指标、减轻脏器功能损伤中显著优于标准NaHCO3盐-糖液.Objective To study the effect of oral fluid resuscitation with pyruvate sodium-glucoseelectrolyte solution （PGES） on hemodynamics,organ functions and mortalities during shock stage in dogs with burn.Methods In comparison of oral pyruvate sodium-glucose-electrolyte solution （PGES） with NaHCO3-glucose-electrolyte solution （HGES）,beagle dogs with intubation of the carotid artery,jugular vein and jejunum for 24 hours were subjected to a 50％ total body surface area （TBSA）burn,and were divided into three groups：pure burn without fluid resuscitation （NR,n =8）,and two oral fluid resuscitation （each n =10）,in which dogs were given with Pry-GES （OP） or NaHCO3-GES （OH） according to Parkland formula.The hemodynamic and organ functions were measured serially before burn and 2,6,8,12 and 24 hours after burn at no anaesthesia state A.Twenty-four hours mortality rate following burn was also recorded.Results Two hours after burn,the mean arterial pressure of NR,OH and OP group was （45 ± 8）,（57±8） and （80±9） mmHg（1 mmHg =0.133 kPa） respectively,which were significantly reduced （t =16.967,14.595 and 10.100,all P ＜0.05） compared with those before iniury （（42 ±6）,（144 ±6） and （142 ± 6） mmHg respectively）,the change of cardiac output,dp/d of left ventricular contractility and intestinal mucosal blood flow had the same trend as the mean arterial pressure.The systemic vascular resistance and organ parameters （Cr,CK-MB,ALT and DAO） in all groups increased obviously （t =-46.894--2.465,all P ＜ 0.05）.All measurements of NR group kept worsening,and all died within 24 hours after burn; while those of two oral resuscitation groups had improved gradually （F =0.001-1.600,all P ＜ 0.05）,OP group was significantly superior to OH group （F =0.013-0.466,P ＜ 0.05）.At 24 hours after burn,6 （6/10） survived in OP group,4 （4/10） in OH group and 0 （0/8） in NR group.Conclusion The Pyr-GES may be superior to the standard NaHCO3-GES in the improvem

关 键 词：烧伤 口服补液 丙酮酸盐类 血流动力学 脏器功能 

分 类 号：R644[医药卫生—外科学]