50% TBSA Ⅲ度烧伤犬静脉补液时丙酮酸钠林格液对循环血容量和血乳酸水平的影响  

Effects of sodium pyruvate Ringer's solution on the lactic acidosis and plasma volume during intravenous resuscitation in dogs with 50% TBSA degree Ⅲ full thickness burn injury

作　　者：高明娟[1] 李娟[1] 王晓娜[1] 胡森[2] 盛志勇[2] 张慧萍[2] 白晓东[1] 

机构地区：[1]武警总医院烧伤整形科,北京100039 [2]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

出　　处：《武警医学》2016年第1期51-54,共4页Medical Journal of the Chinese People's Armed Police Force

基　　金：军队十一五科研专项课题(06Z055);发改委卫星示范项目(2014号)

摘　　要：目的研究烧伤犬静脉补液时丙酮酸钠林格液对循环血容量和血乳酸水平的影响。方法采用雄性Beagle犬,预先施行颈总动脉和颈外静脉置管,24 h后用凝固汽油燃烧法制成犬50%总体表面积(TBSA)Ⅲ度烧伤模型。将犬随机分为3组:不补液组(NR组,n=8)、乳酸钠林格液静脉补液组(VL组,n=10)和丙酮酸钠林格液静脉补液组(VP组,n=10)。两静脉补液组于伤后30 min依据Parkland公式经颈静脉分别输注丙酮酸钠林格液或乳酸钠林格液。动物在清醒状态下测定平均动脉压、循环血浆容量、动脉血气和血乳酸水平。结果伤后2 h,NR组、VL组和VP组动物平均动脉压分别为(45.3±7.8)、(91.3±10.2)和(98.7±9.5)mm Hg,较伤前值(141.7±6.0)、(142.3±6.1)和(142.8±5.5)mm Hg明显降低(P均<0.05);循环血浆容量、动脉p H值和Pa O2变化趋势与平均动脉压相似,但血乳酸浓度较伤前明显降低(P<0.05)。伤后4 h起NR组各项指标均持续恶化,直至死亡;而静脉补液组各指标逐渐恢复。两静脉补液组比较,VP组优于VL组,在烧伤补液后6 h差别尤为明显(P均<0.05)。结论 50%TBSAⅢ度烧伤犬静脉补液时,丙酮酸钠林格液改善循环血容量和乳酸性酸中毒的效果优于常用的乳酸林格液。Objective To study the effects of sodium pyruvate Ringer＇ s solution on lactic acidosis and plasma volume during intravenous resuscitation in dogs with 50% TBSA degree II1 full thickness burn injury. Methods Beagle dogs with intubation of the carotid artery and jugular vein for 24 h were subjected to a 50% TBSA degree 111 burns, and were divided into three groups ： burn inju- ry without fluid resuscitation （NR, n=8 ）, burn injury with fluid Lac-Ringer （VL, n = 10）, and with fluid Pry-Ringer （VP, n = 10）. The two intravenous fluid resuscitation began at 30 minutes after burn with volume and rate consistent with the Parkland Formula. The arterial and venous blood were sampled at different time points after injury, and then mean arterial pressure, circulating plasma volume, artery blood gas analysis and lactic acid were measured at conscious state. Results Two hours after burn, the mean arterial pressures in NR, VL and VP groups were （45.3± 7.8 ）mmHg, （91.3 ± 10.2）mmHg and（98.7 ± 9.5 ）mmHg, respectively, which were signifi- cantly reduced（ all P 〈 0.05 ） compared with those before injury（41.7 ± 6.0） mmHg, （ 142.3 ± 6.1 ） mmHg and （ 142.8 ± 5.5 ） mm- Hg, the change in plasma volume, pH value, PaOz had the same trend as the mean arterial pressure, blood lactate level significantly re- duced （P 〈 0.05）. All measurements in NR group kept worsening, and all died within 24 h after burn; while those of two intravenous resuscitation groups improved gradually, VP group was significantly superior to VL group at 6 hour after rususcitation （ all P 〈 0.05 ）. Conclusions The Pyr-Ringer may be superior to the standard Lac-Ringer in the improvement of lactic acidosis and plasma volume during intravenous resuscitation in dogs with 50% TBSA full thickness burn injury.

关 键 词：烧伤 休克 静脉补液 丙酮酸盐 循环血容量 乳酸性酸中毒 

分 类 号：R644[医药卫生—外科学]