烧伤休克期不同液体复苏方案对猪血管通透性的影响  

Effects on vascular permeability with different fluid resuscitation regimens during burn stage inswines

作　　者：黄文祥[1] 薛迪建 陈炯[1] 周建军[1] 吴道义[1] 邢楠[1] 

机构地区：[1]温州医科大学附属第三医院烧伤及皮肤修复外科,浙江省瑞安市325200

出　　处：《中华医学杂志》2015年第12期943-946,共4页National Medical Journal of China

基　　金：浙江省科技计划（20LOC33009）

摘　　要：目的探讨烧伤休克期不同液体复苏方案对猪血管通透性的影响。方法将24只广西巴马小型猪按随机数字表法分为琥珀酰明胶组、羟乙基淀粉（130／0．4）组、Parkland（乳酸林格氏液）组、异体血浆组各6只，建立重度烧伤休克模型，按照休克复苏方案的原则复苏，观察并记录各组猪伤前及伤后第1、2个24h的平均心率、血压、每小时每千克尿量、中心静脉压、肺毛细血管楔压、复苏液体量，分别于烧伤前及烧伤后4、8、24、48h时相点抽取静脉血，检测血浆胶体渗透压；静脉注射伊文思蓝溶液30min后处死，取肺组织测定血管通透性，并进行统计学分析。结果烧伤前后各时相点血液动力学指标组间差异均无统计学意义（均P〉0．05）。琥珀酰明胶组、羟乙基淀粉组、Parkland组、异体血浆组各时相点血浆胶体渗透压（单位为mmHg，1mmHg=0．133kPa）分别为：（1）伤前：25．4±1．0、25．94±0．9、25．54±1．1、25．04±1．0；（2）伤后4h：24．34±1．0、25．64±0．9、13．24±0．5、25．0±1．1；（3）伤后8h：23．3±0．8、25．2±1．2、12．7±0．5、24．04±0．9；（4）伤后24h：22．04±0．8、23．14±1．0、12．44±0．4、23．34±0．8；（5）伤后48h：22．34±0．8、24．14±0．8、18．14±0．4、23．5±0．9；伤前组间差异均无统计学意义（均P〉0．05）；伤后8h羟乙基淀粉组显著高于异体血浆组，伤后4、8、24h、48hParkland组均显著低于异体血浆组（均P〈0．05）；琥珀酰明胶组伤后8、24、48h、羟乙基淀粉组伤后8、24、48h、Parkland组伤后4、8、24、48h、异体血浆组伤后8、24、48h均显著低于伤前（均P〈0．05）。伤后48h琥珀酰明胶组、羟乙基淀粉组、异体血浆组肺血管通透性指数近似，且均显著低于Parkland组[（7．6±0．9）、（7．94-1．8）、（7．64±1．2）比（26．1±2．3）μ/g]（均P〈0．05）。结论猪Objective To explore the effects of different fluid resuscitation regimens on vascular permeability during burn stage in swines. Methods A total of 24 Guangxi-BAMA miniature swines were numbered from 1 to 24 and randomly divided by EXCEL 2007 into 4 groups of succinylated gelatin, hydroxyethyl starch （HES 130/0. 4） , Parkland （lactated Ringer＇s solution） and allogeneic plasma （n = 6 each）. The model of severe burn shock was established. And fluid resuscitation therapy was applied according to the established regimens of burn shock fluid resuscitation. The parameters of heart rate, blood pressure, urine volume, central venous pressure （CVP） and pulmonary capillary wedge pressure （PCWP） were recorded. Blood samples were collected prior to burns and at intervals of 4, 8, 24 and 48 h post-burns. The plasma colloidal osmotic pressure was measured. Evens blue was intravenously injected at 30 rain before sacrificing. Then lung tissue samples were obtained and pulmonary vascular permeability index （PMPI） was measured. Statistical analyses were performed. Results All swines survived shock stage. The inter-group comparison revealed no statistical difference in heart rate, blood pressure, urine volume, CVP or PCWP. The plasma colloidal osmotic pressures （mmHg, 1 mmHg = 0. 133 kPa） of four groups at each interval wereas follows： （1） pre-burn： 25.4-±1.0, 25.9-±0.9, 25.5 -±1.1, 25.0-±1.0; （2） 4 h： 24.3 -±1.0, 25.6-±0.9, 13.2-±0.5, 25.0-±1.1; （3） 8 h： 23.3-±0.8, 25.2-±1.2, 12.7~0.5, 24.0-±0.9; （4） 24 h： 22.0 -±0. 8, 23.1 -±1.0, 12.4-±0.4, 23.3 -±0.8; （5） 48 h： 22.3 -±0.8, 24. 1 -±0.8, 18. 1 -±0.4, 23.5 ± 0. 9. No statistically significant differences existed at the intervals of pre-burn between four groups （ all P 〉 0. 05 ）. The HES 130/0. 4 group at 8 h was significantly higher than that of allogeneic plasma group at the same interval （ P 〈 O. 05 ）. The Parkland group at 4, 8, 24, 48 h were significantly lower than those of allogeneic

关 键 词：烧伤 休克 补液疗法 血管通透性 猪 雏型 

分 类 号：R644[医药卫生—外科学]