高渗晶胶复合液静脉补液在犬烧伤早期防治休克疗效观察

目的研究应用高渗晶胶复合液快速静脉补液对35%TBSA烧伤犬伤后早期休克的防治作用及对血流动力学的影响。方法 Beagle犬12只,采用凝固汽油燃烧法制作Ⅲ度烧伤面积35%TBSA模型,随机分为常规补液组(A组)和高渗补液组(B组)。A组按照4ml/(kg.1%TBSA)输入乳酸钠林格氏液,在前8h输入总量的一半,B组采用高渗氯化钠羟乙基淀粉40注射液,按照8ml/kg快速补液后终止补液。分别于伤前、伤后1h、2h、4h、6h、8h进行血流动力学检测,测定各组犬的胸腔内血容量指数(ITBI)、血管外肺水量(EVLW)、血容量(PV)及血浆渗透压。结果烧伤后两组ITBI均呈逐步降低趋势,B组经高渗补液后,伤后1h其ITBI降低与A组相比差异无统计学意义(P0.05),至伤后2h开始明显降低,4h后显著低于A组,两组相比差异有统计学意义(P0.05);A组EVLW显示伤后渗出增多,而B组经高渗补液,EVLW显示伤后2们h内血管外渗出较伤前差异无统计学意义(P0.05),渗出量显著低于A组,两组相比差异有统计学意义(P0.05);伤后A组PV明显降低,B组经高渗补液,PV在伤后1、2、4h降低缓慢,且PV明显高于A组,两组相比差异有统计学意义(P0.05),伤后4h后PV迅速减少,并显著低于A组,两组相比差异有统计学意义(P0.05);伤后A组血浆渗透压有所降低,B组经高渗补液,血浆渗透压在伤后1、2h较伤前增高,且显著高于A组(P0.05),两组相比差异有统计学意义,伤后4h后逐步降低,至伤后8hB组显著低于A组,两组相比差异有统计学意义(P0.05)。结论烧伤早期快速静脉补充高渗晶胶复合液,在4h内能够有效维持血流动力学指标稳定,并减少组织渗出,从而起到大大减少补液量、节约医疗资源、降低并发症、提高复苏疗效的作用,适于危重烧伤早期院外现场急救。

Therapeutic effect of hypertonic sodium chloride hydroxyethyl starch 40 injection on burn shock prevention of 35%TBSA burn injury in Beagle dogs

Objective To investigate the effect of hypertonic sodium chloride hydroxyethyl starch 40 injection on hemodynamics during burn shock stage in Beagle dogs,and the resuscitative effect on burn shock prevention.Methods Twelve male Beagle dogs（12.37±1.42）kg were subjected to a 35% total body surface area（TBSA）full-thickness flame injury.The dogs were randomly divided into two groups：resuscitation with traditional treatment group（group A）and resuscitation with hypertonic sodium chloride hydroxyethyl starch 40 injection group（group B）.The intrathoracic blood volume index（ITBI）,extravascular lung water（EVLW）,plasma volume（PV）and osmotic pressure of plasma were continuously assessed.Results The ITBI reduced markedly after burn in the two groups,and it was obviously lower in group B after 4 hours resuscitation treatment（P0.05）.The EVLW in group A was obviously higher than in group B（P0.05）.The plasma volume and osmotic pressure of plasma in group A reduced rapidly than group B in 2 hours after burn（P0.05）.Conclusions Excellent results were got for the dogs in early stage of burn shock after hypertonic sodium chloride hydroxyethyl starch 40 fast injection,no shock occurred in four hours post burn injury,demonstrating it can markedly reduce liquid quantity,which is a very useful treatment for burn shock in prehospital first aid.