不同复苏方案对猪烧伤休克期血液流变学的影响  

Effects of different fluid resuscitation methods on hemorheology in pigs during burn shock stage

作　　者：陈炯 邢楠 周建军 黄文祥 薛迪建 Chen Jiong;Xing Nan;Zhou Jianjun;Huang Wenxiang;Xue Dijian(Ruian Burns Research Institute,the Third Affiliated Hospital of Wenzhou Medical University,Ruian 325200,China;Burn Department of Weihai Municipal Hospital,Weihai 250021,China)

机构地区：[1]温州医科大学附属第三医院瑞安市烧伤研究所,瑞安325200 [2]山东省威海市立医院烧伤科,威海250021

出　　处：《中华医学杂志》2019年第18期1421-1426,共6页National Medical Journal of China

基　　金：浙江省科技计划(2010C33009).

摘　　要：目的比较不同复苏方案对猪烧伤休克期血液流变学的影响。方法运用表格随机法将24只健康雌性广西巴马小香猪随机分为四组(琥珀酰明胶组、羟乙基淀粉组、Parkland组及异体血浆组),每组6只。采用凝固汽油燃烧法建立重度烧伤休克稳定模型,伤后2h,琥珀酰明胶组、羟乙基淀粉组以及异体血浆组按照国内通用烧伤休克复苏公式进行休克复苏治疗,Parkland组则按照Parkland公式进行液体休克复苏治疗,复苏输液过程中,通过Solar 8000i多功能监护仪密切观察伤前及伤后各项生命体征的变化,并依据心率、血压、尿量及中心静脉压等的变化适时调整输液速度。分别于烧伤前、烧伤后4、8、24及48h抽取静脉血样标本,测定各组小型猪的红细胞压积(HCT)、血浆黏度(ηp)、红细胞刚性指数(IR)、红细胞聚集指数(RCA)及红细胞电泳时间(EFT),并进行统计学分析。结果(1)HCT:羟乙基淀粉组、Parkland组伤后8h显著高于同组伤前[(0.395±0.047)比(0.333±0.042);(0.379±0.026)比(0.352±0.019)](均P<0.05);羟乙基淀粉组伤后48h(0.232±0.021)显著低于伤前,Parkland组伤后24、48h(0.277±0.021,0.241±0.029)均显著低于伤前(均P<0.05)。(2)ηp:Parkland组伤后4、8、24h均显著低于伤前[(1.61±0.07)、(1.55±0.07)、(1.63±0.07)比(1.73±0.04)mPa·s](均P<0.05)。(3)IR:琥珀酰明胶组伤后24、48h均显著低于异体血浆组[(1.10±0.05)比(1.26±0.07)、(1.11±0.05)比(1.32±0.05)](均P<0.05)。(4)RCA:琥珀酰明胶组伤后4h显著高于伤前[(6.80±0.87)比(5.92±0.43)],羟乙基淀粉组在伤后8h显著高于伤前[(6.73±0.56)比(6.03±0.53)](均P<0.05)。(5)EFT:羟乙基淀粉组、Parkland组伤后48h均显著低于伤前[(15.5±1.4)比(17.3±1.3)s,(13.4±1.2)比(16.4±1.5)s];琥珀酰明胶组伤后4h显著高于异体血浆组[(19.5±2.3)比(16.5±1.6)s],伤后24h显著低于异体血浆组[(12.0±5.7)比(16.2±1.4)s](均P<0.05)。结论在猪烧伤休克期复苏中,使用人�Objective To investigate the impact of different methods of fluid resuscitation on hemorheology during burn shock stage.Methods Twenty four miniature swines were randomly divided into four groups with 6 in each group (succinylated gelatin group,hydroxyethyl starch group,Parkland group and allogeneic plasma group).Severe burn shock model was established by burning miniature swine with napalm.Two hours after injury,succinylated gelatin,hydroxyethyl starch (130/0.4) and swine allogenic plasma were used as colloid (alternative colloid) in fluid resuscitation according to the burn shock fluid resuscitation formula which is commonly accepted in the field of Burns Surgery.In Parkland group,miniature swines received liquid recovery according to Parkland Formula.The vital signs before and within 48 h after burn were observed by Solar 8000i electrocardiomonitor during the process of transfusion.The infusion speed was adjusted based on the heart rate,blood pressure,urine volume and central venous pressure.The level of hematocrit (HCT),viscosity of plasma (ηp),index of rigidity (IR),red cell assembling index (RCA) and erythrocyte electrophoresis time (EFT) were measured at the time of pre-injury as well as 4,8,24 and 48 h post-injury and statistical analysis was performed.Results HCT in hydroxyethyl starch group and Parkland group at 8 h post-injury were significantly higher than pre-injury [(0.395±0.047) vs (0.333±0.042),(0.379±0.026) vs (0.352±0.019)](both P<0.05).And compared with pre-injury,HCT in hydroxyethyl starch (130/0.4) group at 48 h decreased significantly (0.232±0.021) vs (0.333±0.042)(P<0.05).HCT in Parkland group at 24,48 h post-injury were lower than pre-injury [(0.277±0.021),(0.241±0.029) vs (0.352±0.019)](both P<0.05).Compared with pre-injury,the levels of ηp in Parkland group decreased substantially at 4,8 and 24 h post-injury [(1.61±0.07),(1.55±0.07) and (1.63±0.07) vs (1.73±0.04) mPa·s](all P<0.05).Compared with allogeneic plasma group,IR decreased in succinylated gelatin group at 24,48 h

关 键 词：烧伤 休克 人工胶体 羟乙基淀粉 血液流变学 

分 类 号：R644[医药卫生—外科学]