早期口服补液对50%体表面积烧伤犬休克期脏器功能和病死率的影响

目的 研究50%体表面积(TBSA)烧伤休克早期口服补液对脏器功能和伤后72 h病死率的影响.方法 成年雄性Beagle犬18只,采用凝固汽油燃烧法造成(51.2±2.6)%TBSA Ⅲ度烧伤.随机分为不补液组、口服补液组和静脉补液组,每组6只.不补液组伤后24 h内无治疗;口服补液组和静脉补液组于伤后30 min开始分别从胃管和静脉输注葡萄糖-电解质溶液,补液量和速率依据Parkland公式确定,伤后24 h起各组动物均实施静脉补液.记录各组动物伤后72 h病死率.测定伤前和伤后72 h内不同时间点平均动脉压(MAP)、血浆容量(PV)、红细胞压积(HCT)、血浆丙氨酸氨基转移酶(ALT)、肌酐(Cr)、磷酸肌酸激酶同工酶(CK-MB)水平和尿量.结果 伤后72 h病死率不补液组为6/6(均在22 h内死亡),口服补液组3/6,静脉补液组为0.不补液组伤后8 h MAP、PV降至最低,分别为(34.4±9.1)mm Hg、(32.7±3.5)ml/kg;HCT、ALT、Cr和CK-MB升至最高,分别为(61.7±2.7)%、(121.1±4.8)U/L、(91.0±6.1)μmol/L、(13 891±297)U/L;8 h内6只犬中4只无尿,2只的尿量分别为1.2和2.1 ml/kg.两补液组上述指标逐渐恢复,伤后8 h口服补液组MAP(84.3±17.1)mm Hg]、PV(41.7±3.6)ml/kg]和尿量(2.62±1.8)ml/kg]均明显高于不补液组(均P<0.05),但均低于静脉补液组分别为(113.0±10.0)mm Hg、(50.3±5.2)ml/kg、(7.0±1.9)ml/kg,均P<0.05);血浆ALT(81.4±10.8)U/L]低于不补液组(P<0.05),但高于静脉补液组(66.3±7.6)U/L,P<0.05];其他各时间点ALT水平以及伤后各时间点Cr和CK-MB水平均高于静脉补液组(均P<0.05).伤后72 h,两补液组MAP、PV、HCT和尿量恢复至伤前水平,但ALT、Cr和CK-MB水平仍明显高于伤前(P<0.05).结论 50%TBSA烧伤休克早期口服葡萄糖-电解质溶液能有效提高MAP和PV,改善脏器功能,降低早期病死率,有潜力成为战争或突发事故及灾害时救治烧伤休克的液体复苏途径.

Effects of early oral fluid resuscitation on organ functions and survival during shock stage in dogs with a50% total body surface area full-thickness burn

Objective To investigate the effects of early oral fluid resuscitation on organ functions and survival in severe burn shock. Methods Eighteen male Beagle dogs were surgically prepared for measurement, subjected to 50% total body surface area (TBSA) full-thickness flame injury 24 hours later, and then randomly divided into 3 equal groups: oral fluid resuscitation group(OR group) undergoing gastric infusion of glucose-electrolyte solution(GES) according to Parkland formula 0. 5 hour after burn with the dose of 4 ml·kg-1 %TBSA-1 ,1/2 being given in the first 8 h and 1/2 in the latter 16 h . Intravenous (Ⅳ) resuscitation of GES group (VR group) undergoing Ⅳ infusion of GES with the same dose as mentioned above, and no fluid resuscitation (NR) group given with GES during the first 24 h. In the second 24 hours all dogs received Ⅳ fluid resuscitation. At the end of 72-hours-period experiment, the mortality was recorded. The mean arterial pressure (MAP), plasma blood volume (PV), hematocrit (HCT), urinary output, alanine aminotransferase (ALT) , creatinine (Cr), and MB isoenzyme of creatine kinase (CK-MB) were examined before injury and at 2, 4, 8, 24, 48 and 72 hours after injury. Results At the end of 72-hours-period experiment, all dogs died in the NR group, 3 dogs died in the OR group, and no dog died in the VB group. The MAP and PV were significantly reduced after burn compared with those before-injury in the NR group, with the lowest levels of (34±9) mm Hg and (32. 7±3.5) ml/kg (both P < 0. 05) 8 h after burn, and the HCT, ALT, Cr, and CK-MB levels of the NR group peaked 8 h after burn to the levels of (61.7±2.7)%, (121.1±4.8) U/L, (91.0±6. 1) μmol/L, and (13 891±297) U/L respectively. Eight hours after burn 4 dogs of the NB group showed anuria, and the rest two had the urine volume of 1.2 and 2. 1 mL/kg respectively. Eight hours after burn the MAP, PV, and urinary output levels of the OR group were (84. 3±17.1)mm Hg, (41.7±3.6) ml/kg, and (2. 6±1.8) ml/kg respectively, all significantly higher than those of the NR group (all P < 0. 05), but significantly lower than those of the VR group (113.0±10.0)mm Hg, (50.3±5.2)ml/kg, and (7.0±1.9) ml/kg respectively, all P<0.05]. The plasma ALT level of the OR group was (81.4±10. 8) U/L, significantly lower than that of the NR group (P < 0. 05), but significantly higher than that of the VB group (66.3±7.6) U/L, P < 0. 05]. The levels of plasma ALT at other time points, as well as the Cr and CK-MB levels at all time points of the OR group were all significantly higher than those of the VB group (all P <0. 05). The MAP, PY, HCT and urinary output levels of the two resuscitation groups returned to the pre-injury levels 72 h after burn, but the ALT, Cr, and CK-MB levels were still significantly higher than the pre-injury levels. Conclusions Although oral resuscitation with GES is not as efficient as Ⅳ resuscitation in 50% TBSA burn, it still can maintain the MAP and PV, protect the organ functions and reduce the mortality comparing to no resuscitation. Oral resuscitation may be an ideal alternative way of Ⅳ resuscitation, especially in wars or other site of mass casualties.