肠内输入高渗电解质葡萄糖液对犬35%TBSA烧伤早期血流动力学的影响

目的 观察肠内补充高渗电解质葡萄糖溶液对犬35%TBSAⅢ度烧伤早期血流动力学的影响,从而研究其复苏效果.方法 Beagle犬18只,采用凝固汽油燃烧法制作35%TBSA Ⅲ度烧伤模型,随机分为对照组、肠内高渗液组和静脉等渗液组.肠内高渗液组于伤后0.5 h通过肠道给予1.8%高渗氯化钠葡萄糖液,24 h补液总量按2 ml/(kg·1%TBSA),前8 h匀速输入总量的一半,后16 h匀速输入另一半;静脉等渗液组于烧伤后通过静脉补充0.9%氯化钠葡萄糖液,24 h补液总量按4 ml/(kg·1%TBSA),其他同高渗液组;对照组烧伤后不给予液体.测定各组犬的平均动脉压、心排量指数、胸腔内血容量指数和全身外周血管阻力指数等血流动力学指标.结果烧伤后各组心排量均明显下降,两补液组伤后2 h逐渐回升,明显高于不补液组(P<0.05);烧伤后各组平均动脉压均先升高后逐渐下降,两补液组高于不补液组(P<0.05);烧伤后各组的胸腔内血容量均明显降低,肠内补高渗液组烧伤后2 h逐渐回升,高于其它2组(P<0.05);同时烧伤后各组全身外周血管阻力指数显著增高(P<0.05),肠内补高渗液组于烧伤后2 h则逐渐回落,低于其他两组(P<0.05).结论 35%TBSA烧伤早期肠内补充1.8%高渗电解质葡萄糖液在减少1/2补液量的前提下,可以显著改善血流动力学指标,达到一定的复苏效果.

The effect of hemodynamics on 1.8 % hypertonic electrolyte glucose solution in enteral resuscitation of burn shock

Objective To study the resuscitative effect of hypertonic electrolyte glucose solution (HEGS) on the haemodynamics pa-rameters in enteral resuscitation of burn shock. Methods Eighteen beagle dogs with 35% TBSA third degree burned were used in this stud-y. They were random divided into no-resuscitation group (NR group), enteral resuscitation with HEGS group (EH group) and intravenous resuscitation with isotonic electrolyte glucose solution (lEGS) group (Ⅱ group). The fluid resuscitation was given from half an hour after TBSA). The haemodynamics parameters (cardiac index, mean arterial pressure, intrathoracic blood volume index, and systemic vascular re-sistance index) were continuously assessed by PICCO. Result The cardiac output index reduced markedly after bum in the three groups, and then returned after 2h in two resuscitation groups, which were higher than that in the NR group( P<0.05). The mean arterial pressure reduced in the three groups, which was higher in the two resuscitation groups than that in NR group(P < 0.05). The intrathoracic blood volume index was rapidly reduced in the three groups. It returned in EH group from 2 hours after burned, which was still higher than that in the other two groups (P < 0.05). Meanwhile the systemic vascular resistance index was increased quickly. It was reduced in EH group from 2 hours after burned, which was lower than that in the other two groups (P < 0.05). Conclusion The results show that it was feasible for 35% TBSAⅢ° burn-injury dogs to be resuscitated with 1.8% hypertonic electrolyte-glucose solution by enteral, which can markedly reduce liquid quantity needed.