不同补液量对重度烧冲复合伤犬脏器功能的影响  

Effects of resuscitating fluid volume changes on internal organ functions after burn-blast combined injury

作　　者：张东海[1,2] 柴家科[2] 李百玲[2] 张旭龙[2] 胡泉[2] 马丽[2] 郁永辉[2] 刘玲英[2] 

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一附属医院烧伤整形科,北京100048

出　　处：《中华损伤与修复杂志（电子版）》2015年第1期31-35,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：军事医学创新专项计划重点项目(13CXZ026)

摘　　要：目的探讨烧冲复合伤休克期不同补液量对机体脏器功能的影响,从而明确烧冲复合伤休克期补液适当的补液量。方法将32只健康雄性比格犬建立Ⅲ度烧伤35%总体表面积并中度冲击伤的烧冲复合伤模型后,随机分为对照组、增量10%组、增量20%组、增量30%组,每组8只。对照组按Parkland公式进行补液治疗,增量10%组、增量20%组、增量30%组则分别在Parkland公式补液量基础上增加10%、20%、30%补液量,其补液速度亦相应分别提升10%、20%、30%,各时间段匀速补液。在伤前及伤后4、8、24、48 h时,分别通过Pi CCO心肺容量监护仪测量心输出量、血管外肺水指数;通过生化检验测量血清谷丙转氨酶、血肌酐、血尿素氮等;通过快速血气分析检测动脉血氧分压。通过尿路置管记录伤后24 h尿量,并计算尿输出量。结果伤后4 h,对照组、增量10%组、增量20%组和增量30%组尿输出量依次为(0.39±0.11)、(0.55±0.13)、(0.77±0.17)、(0.98±0.19)m L·kg-1·h-1,增量20%组和增量30%组均高于对照组(t=5.308、7.601)和增量10%组(t=2.908、5.283),差异均有统计学意义(均P<0.05);伤后24 h,四组尿量依次为(0.59±0.05)、(0.70±0.07)、(0.88±0.05)、(1.21±0.09)m L·kg-1·h-1,两两比较差异均有统计学意义(均P<0.05)。对照组、增量10%组、增量20%组和增量30%组伤后心输出量较伤前降低,4 h时分别为(1.25±0.17)、(1.36±0.17)、(1.57±0.19)、(1.72±0.19)L/min,增量20%组和增量30%组高于对照组,差异均有统计学意义(t=3.550、5.214,均P<0.05);伤后24 h,四组心输出量依次为(2.63±0.24)、(2.64±0.21)、(2.76±0.18)、(2.40±0.19)L/min,增量20%组高于增量30%组,差异具有统计学意义(t=3.890,P<0.05)。伤后对照组和增量30%组谷丙转氨酶高于增量20%组,伤后24 h(t=2.745、3.864)、48 h(t=5.080、6.869)和72 h(t=4.195、5.143),差异均有统计学意义(P<0.05)。伤后4 h和8 h时,增量20%组、增量30%组血尿素氮低于对照组,伤�Objective To figure out an optimal resuscitating fluid volume after burn-blast combined injury by determining effects of gradient volume changes on internal organ functions. Methods Thirty-two healthy male beagle dogs were subjected to a burn-blast combined injury （35% total body surface area full thickness burn combined with middle severity blast injury） and randomLy assigned into 4 groups, namely, the controlled group, volume increasing group 10% , 20% and 30% , with 8 dogs in each group. The controlled group was resuscitated with the Parkland formula, while additional 10%, 20%, 30% fluid were given to the increasing group 10% , 20% , 30% , respectively, and their infusing rates were also increased by 10% , 20% , 30% , respectively. Cardiac output, extravascular lung water index were determined with PiCC0（Pulse indicated Continuous Cardiac Output）device pre and 4, 8, 24, 48 h post injury. Serum alanine aminotransferase, creatinine, blood urea nitrogen were determined through biochemical arrays pre and 4, 8, 24, 48, 72 h post injury. Arterial oxygen pressure were determined with blood gas analysis pre and 4, 8, 24, 48 h post injury. Urinary volume was recorded throughout 24 h post injury to calculate the urinary output 4, 8, 24 h post injury. Results Urinary output in the controlled group and volume increasing group 10%, 20%, 30% at4 h post injury were （0.39±0. 11）, （0.55±0. 13）, （0.77±0. 17）, （0.98±0.19）mL·kg-1·h-1, respectively. Volume increasing group 20% and 30% were both remarkably higher than either the controlled group （t = 5. 308,7. 601, P 〈 0.05 ）or volume increasing group 10% （t = 2. 908,5. 283, P 〈 0.05 ）. They were （0.59±0.05 ）, （0.70±0.07 ）, （0.88±0.05 ）, （1.21±0.09） mL·kg^-1·h^-1 at 24 h post injury. Significant differences exist between every two groups （P 〈 0.05）. Cardiac output decreased considerably to （ 1.25±0.17 ）, （ 1.36±0.17 ）, （ 1.57±0. 19）, （1.72±0.19） L/min at 4 h post injury, respectively. Volume i

关 键 词：烧伤 补液疗法 休克 创伤性 烧冲复合伤 Parkland公式 

分 类 号：R644[医药卫生—外科学]