不同复苏方案对猪烧伤休克期组织氧代谢的影响  

Effects of resuscitation by different formulation on oxygen metabolism during shock stage of burninjury in swine

作　　者：吴道义[1] 黄文祥[1] 陈炯[1] 薛迪建 周建军[1] 卢学勉[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》2016年第12期975-978,共4页National Medical Journal of China

基　　金：基金项目：浙江省科技计划项目（2010C33009）

摘　　要：目的探讨不同复苏方案对猪烧伤休克期组织氧代谢的影响。方法将12只小型猪按随机数字表法均分为Parkland组与晶胶体组，建立烧伤休克模型；烧伤后2h，Parkland组按Parkland公式要求复苏，晶胶体组按国内通用的晶胶体复苏公式要求复苏，动态监测液体复苏相关指标（心率、血压、尿量、中心静脉压、肺毛细血管楔压）、液体进出量，同时监测烧伤前及伤后4、8、24、48h不同时相点组织氧代谢情况（氧摄取量、供氧量、氧摄取率）及D-乳酸水平，两组数据进行统计分析。结果液体复苏相关指标组间比较差异均无统计学意义（均P〉0．05）；液体复苏量均符合国内的共识范畴。伤后8h，Parkland组和晶胶体组氧摄取量均显著高于伤前[（149±33）比（85±15）L·min^-1·m^-2和（190±29）比（83±42）L·min^-1·m^-2，均P〈0．05]，且Parkland组显著低于晶胶体组（P〈0．05）；Parkland组伤后24h供氧量显著高于晶胶体组[（853±81）比（686±72）L·min^-1·m^-2，P〈0．05]；而两组氧摄取率在各个时相点差异均无统计学意义（均P〉0．05）；Parkland组伤后8h的D哥L酸显著低于晶胶体组[（45±6）比（53±4）mmol／L，P〈0．05]。结论猪重度烧伤休克期应用晶胶体方案与Parkland方案进行液体复苏，对组织氧代谢的影响近似。Objective To explore the effects of different fluid resuscitation regimens on oxygen metabolism during shock stage of bum injury in swine. Methods Twelve Bama miniature swines were divided into crystal and colloid group （Group 1 ） and Parkland group （Group 2） according to the random number table. The swine models of bums shock were established. The fluid resuscitation was begun at post injury hour （PIH） 2 according to Chinese formulation or Parkland＇s formulation, respectively. The blood pressure, urine volume, heart rate, central venous pressure （CVP）, pulmonary capillary wedge pressure （PCWP） were recorded. The liquid volume was calculated at the first and second PIH 24. The changes in oxygen delivery （ DO2 ）, oxygen consumption （ VO2 ）, oxygen extraction （ O2Ext） and D-lactate （D-LA） were determined before injury and at PIH 4, 8, 24, and 48. Statistical analyses were performed. Results There were no statistical differences between the two groups in blood pressure, urine volume, heart rate, CVP, PCWP in every interval （ all P 〉 0. 05）. The resuscitation liquid volume in the two groups during the first and second PIH 24 conformed to the domestic consensus. The VO2 at PIH 8 was significantly higher than that of pre-bum in both groups [ （ 190 ±29） vs （83 ~42） L·min^-1·m^-2, （ 149 ±33） vs （85 ± 15）L·min^-1·m^-2, both P 〈 0. 05 ] , and the VOz at PIH 8 was significantly higher in Group 1 than that in Group 2 （ P 〈 0. 05 ）. The DO/at PIH 24 in Group 1 was significantly lower than that in Group 2 [ （686 ± 72） vs （853 ±81） L·min^-1·m^-2, P 〈 0. 05]. There were no signifieant differences between the two groups in 02 Ext at any time points （ all P 〉 0.05 ）. The D-LA at PIH 8 was significantly higher in Group 1 than that in Group 2 [ （53 ± 4） vs （45 ± 6 ） mmol/L, P 〈 0.05 ]. Conclusion There are no significant differences in the resuscitation effects of the crystal and colloid resuscitation regimen and Parkland＇ s

关 键 词：烧伤 休克 补液疗法 氧代谢 猪 雏型 

分 类 号：R644[医药卫生—外科学]