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卡巴胆碱对烧伤休克犬口服补液时胃排空和胃黏膜二氧化碳分压的影响
引用本文:田易军,胡森,杜颖,车晋伟,耿世佳,吴静,盛志勇.卡巴胆碱对烧伤休克犬口服补液时胃排空和胃黏膜二氧化碳分压的影响[J].中国危重病急救医学,2008,20(3):172-175.
作者姓名:田易军  胡森  杜颖  车晋伟  耿世佳  吴静  盛志勇
作者单位:1. 解放军总医院第一附属医院全军烧伤研究所,北京,100037
2. 内蒙古医学院基础医学部,010059
摘    要:目的 研究卡巴胆碱对烧伤犬休克早期口服补液时胃排空和胃黏膜二氧化碳分压(PgCO2)的影响.方法 将24只成年雄性Beagle犬随机分为4组:35%总体表面积(TBSA)烧伤后口服葡萄糖一电解质液(GES)组及其卡巴胆碱干预组(35%TBSA GES组和35%TBSA GES/CAR组);50%TBSA烧伤后口服GES液组及其卡巴胆碱干预组(50%TBSA GES组和50%TBSA GES/CAR组),每组6只.采用凝固汽油燃烧法分别造成颈背部35%TBSA Ⅲ度烧伤和颈背部+胸腹部50%TBSA Ⅲ度烧伤.各组于烧伤后0.5 h开始按Parkland公式量和速率(4 ml·kg-1·1%TBSA-1,前8 h内补1/e量,后16 h内补另1/2量)口服补液;GES/CAR组于伤后0.5 h口服卡巴胆碱(20 μg/kg溶于GES中).烧伤后2、4、8和24 h测定胃排空率和PgCO2,并观察胃不耐受症状.结果 烧伤后各组犬胃排空率均显著低于伤前(P均<0.05),伤后2 h 35%TBSA GES组降至51.5%.伤后4 h 50%TBSA GES组降至39.2%,之后逐渐恢复,但伤后24 h仍显著低于伤前(P均<0.05).35%TBSA GES/CAR组伤后各时间点胃排空率均显著高于同烧伤面积GES组(P均<0.05),平均提高15.0%,伤后8 h恢复至伤前水平;50%TBSA GES/CAR组于8 h起胃排空率显著高于同烧伤面积GES组,但伤后24 h仍低于伤前水平(P<0.05).伤后各组犬PgCO2均较伤前显著升高(P均<0.05),35%TBSA GES/CAR组伤后各时间点显著低于同烧伤面积GES组,50%TBSA GES/CAR组伤后4 h起显著低于同烧伤面积GES组(P均<0.05).伤后各组犬出现呕吐等胃不耐受症状情况比较:50%TBSA GES组(83.3%,5/6)>50%TBSA GES/CAR组(50.0%,3/6)>35% TBSA GES组(16.7%,1/6)>35%TBSA GES/CAR组(0,0/6).结论 卡巴胆碱能显著改善Beagle犬烧伤休克早期胃对GES的排空,降低PgCO2,提高口服液体复苏的效果.

关 键 词:烧伤  卡巴胆碱  胃排空  胃黏膜二氧化碳分压

Effect of carbachol on gastric emptying and gastric mucosa partial pressure of carbon dioxide in oral resuscitation of burn shock with a glucose-electrolyte solution in dogs
TIAN Yi-jun,HU Sen,DU Ying,CHE Jin-wei,GENG Shi-jia,WU Jing,SHENG Zhi-yong.Effect of carbachol on gastric emptying and gastric mucosa partial pressure of carbon dioxide in oral resuscitation of burn shock with a glucose-electrolyte solution in dogs[J].Chinese Critical Care Medicine,2008,20(3):172-175.
Authors:TIAN Yi-jun  HU Sen  DU Ying  CHE Jin-wei  GENG Shi-jia  WU Jing  SHENG Zhi-yong
Institution:Laboratory of Shock and Organ Dysfunction, Burns Institute, First Affiliated Hospital of PLA General Hospital, Beijing 100037, China.
Abstract:OBJECTIVE: To investigate the effect of carbachol (CAR) on gastric emptying and gastric mucosa partial pressure of carbon dioxide (PgCO2) in the resuscitation of burn shock with oral administration of glucose-electrolyte solution (GES) in dogs. METHODS: Twenty-four adult male Beagle dogs were randomly divided into 4 groups: 35% total body surface area (TBSA) III degree burn resuscitated with oral GES (35% TBSA GES, n=6), 35% TBSA III degree burn with oral GES containing 20 microg/kg of CAR (35% TBSA GES/CAR, n=6), 50% TBSA III degree burn with oral GES (50% TBSA GES, n=6) and 50% TBSA III degree burn with oral GES containing 20 microg/kg of CAR (50% TBSA GES/CAR, n=6). Dogs were subjected to 35% TBSA or 50% TBSA full-thickness flame injury respectively. Thirty minutes after burn, dogs were given GES or GES containing CAR according to Parkland formula (1/2 of 4 mlxkg(-1)x1% TBSA(-1) within 8 hours post burn, and the remaining 1/2 within next 16 hours post burn) by gavage. The gastric emptying rate, PgCO2 and intolerance symptoms were determined at 2, 4, 8 and 24 hours post burn. RESULTS: The gastric emptying rate was significantly decreased in all groups after the burn (P<0.05), and it was 51.5% at 2 hours after burn in 35% TBSA GES group and 39.2% at 4 hours after burn in 50% TBSA GES group. It was gradually ameliorated, but still much lower than pre-injury levels (both P<0.05). The gastric emptying rate in GES/CAR group were significantly higher at all time points after injury than those in 35% GES group (P<0.05), and it was higher than that in 50% GES group at 8 hours and 24 hours (both P<0.05). The gastric emptying rate restored to pre-injury levels (P>0.05) in 35% GES/CAR group, and it was still lower than pre-injury level in 50% GES/CAR group (P<0.05). The PgCO2 were significantly elevated in all groups post burn (all P<0.05), and could not return to pre-injury levels. The PgCO2 in GES/CAR group were significantly higher at all time points after injury than those in 35% GES group (P<0.05), and it was higher than that in 50% GES group at 4 hours and 24 hours (P<0.05). The degree of gastric intolerance symptoms could be ranked as follows: 50%TBSA GES group (83.3%, 5/6)>50% TBSA GES/CAR group (50.0%, 3/6)>35%TBSA GES group (16.7%, 1/6)>35%TBSA GES/CAR group (0, 0/6). CONCLUSION: The results indicate that CAR has a significant effect in improving gastric emptying and gastric ischemia during oral resuscitation of burn shock with a glucose electrolyte solution.
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