口服补液对犬50%TBSA烧伤休克期循环氧动力学指标的影响

目的 研究口服补液对50%TBSA烧伤休克期循环氧动力学指标的影响,为提高烧伤休克口服补液的复苏效果提供依据.方法 成年雄性Beagle犬18只,先期无菌手术行颈动、静脉置管,24 h后用凝固汽油燃烧法造成50%体表面积Ⅲ度烧伤.随机分为不补液组(n=6)、口服补液组(n=6)和静脉补液组(n=6).伤后第一个24 h不补液组无治疗,口服补液组和静脉补液组根据Parkland公式分别从胃内或静脉输注葡萄糖-电解质溶液;伤后24 h起三组均实施延迟静脉补液.测定动物非麻醉状态下的平均动脉压(MAP)、红细胞压积(HCT)和血乳酸(LAC)含量,抽取动脉和混合静脉血测定动、静脉氧分压和血氧含量.计算氧供量(DO2)、氧耗量(VO2)和氧摄取(Oext),并统计3 d死亡率.结果 不补液组伤后8 h MAP比伤前降低77.1%,HCT和血乳酸分别升高48.5%和533.7%;DO2,VO2和Oext水平伤后进行性降低,24 h内动物全部死亡.两补液组上述指标逐渐恢复,伤后72 hMAP和HCT恢复至伤前(P＞0.05),但血乳酸水平仍显著高于伤前(P＜0.01).伤后24 h内同期比较,口服补液组MAP,DO2,VO2和Oext水平显著高于不补液组(P＜0.01),但低于静脉补液组;血乳酸低于不补液组,但高于静脉补液组(P＜0.01).伤后24 h起Do2与静脉补液组差异无统计学意义(P＞0.05),但VO2和Oext仍显著低于静脉补液组(P＜0.01).72 h死亡率:不补液组100%、口服补液组50%(3/6),而静脉补液组为零.结论 50%TBSA烧伤休克期采用口服补液能显著改善动物循环氧动力学指标,减轻高乳酸血症,降低动物的病死率.

Effects of oral fluid resuscitation on circulatory oxygen dynamic parameters in dogs with burn shock

Objective To investigate the effect of oral fluid resuscitation on circulatory oxygen dynamic parameters in dogs with burn shock.Method Eighteen male Beagle dogs were surgically prepared for the cannulation of carotid cartery and jugular vein,subjected to flame injury 50%total body surface area(TBSA)with fullthick ness 24 hours later,and they then randomly divided into 3 equal groups.The oral fluid resuscitation group (OR group)was intragastrieally injected with infusion of glucose-electrolyte solution(GES)according to parkland formula 0.5h after burn with a dose of 4mL·kg-1·% TBSA-1.Intravenous (IV) GES resuscitation group (VR group)was intravenously injected with infusion of GES as the same dose as OR group,and no-fluid resuscitation (NR)group did not receive any treatment during the first 24 hotrs.In the second 24 hours,all dogs received Ⅳ fluid resuscitation.At the end of 72 hours of injury.the mortality in each group was recorded.The mean arterial arterial pressure(MAP),hematocrit(HCT)and blood lactic acid(LAC)were determined,and blood gas analysis was evaluated for oxygen delivery(DO2),oxygen consumption(VO2)and oxygen uptake(O2ext)before injury and 2,4,8,24,48 and 72 hours after injury.Results Burn injury resulted in a 77.1%decrease in MAP,and a 48.5% increase in HCT and 533.7%increase in LAC in NR group,followed by pngressively lowering of DO2,VO2 and Oext till all animals died with in 24 hours after burn.MAP and HCT levels oftwo resuscitation groups gradually returned to the pre-injury levels within 72 hours after burn,but the LAC levels sill remained significantly higher than the pte-injury levels(P＜0.01).The MAPs of OR group were higher at corresponding intervals within 24 hours post burn than those of NR group(P＜0.01),but they were lower than those of VR group(P＜0.01).The serum LAC in OR group was markedly lowered than that in NR group,but it was higher than that in VR group.Twenty-four hours after burn injury,the DO2 level in OR group showed no significant differences compared with that of the VR group,but the levels of the VO2 and Oext were still much lower than those of VR group (P＜0.01).At the end of 72 hours,3 dogs of NR group died and none of IV group died.Caadusions Oral fluid resuscitation improves oxygen dynamic,alleviates hyperlactacidemia and reduces the mortality of animals with severe burn shock.