口服补液复苏对严重烧伤家兔心肌力学指标的改善作用

目的 了解口服补液复苏对严重烧伤家兔心脏功能的保护作用. 方法 150只家兔随机分为正常对照组(6只)、烧伤组(42只)、立即补液组(42只)、延迟补液组(30只)和延迟快速补液组(30只).正常对照组不致伤不补液.其余4组家兔均造成40%TBSAⅢ度烧伤,烧伤组不补液,余下3组伤后用灌胃的方式进行口服补液复苏.经家兔颈动脉左心室内置管,测量正常对照组及4组致伤家兔伤后2、6、8、12、24、36、48 h的平均动脉压(MAP)、左心室收缩压(LVSP)、左心室舒张末期压(LVEDP)以及左心室压力最大上升/下降速率(LV±dp/dt max),另检测休克期尿量. 结果烧伤组家兔LVSP、LV±dp/dt max较正常对照组显著下降.立即补液组和延迟快速补液组上述指标在伤后24 h内高于烧伤组,其中立即补液组LV+dp/dt max在伤后8 h达峰值[(892±116)kPa/s,1 kPa=7.5 mm Hg],LV-dp/dt max在伤后6 h达峰值[(724±149)kPa/s];伤后8 h,延迟快速补液组LV±dp/dt max均达峰值.延迟补液组伤后各时相点LVSP、LV±dp/dt max与烧伤组接近.各组家兔MAP、伤后第1个24 h尿量的比较情况大致与以上指标相似.烧伤组与其余4组比较,各时相点LVEDP差异无统计学意义(P>0.05). 结论严重烧伤家兔伤后24 h内给予有效的口服补液,可改善心肌力学指标;延迟复苏的家兔按照延迟复苏补液公式预估补液量,才能进行有效复苏.

Improving myocardial mechanics parameters of severe burn rabbits with oral fluid resuscitation

Objective To investigate the protective effect of oral fluid resuscitation on cardiac func- tion in severe burn rabbits. Methods One hundred and fifty rabbits were randomly divided into normal control group (NC group,n =6,without treatment) ,burn group (B group,n =42,without fluid therapy),im- mediate oral fluid resuscitation group (C group , n = 42 ) , delayed oral fluid resuscitation group( D group, n = 30) and delayed and rapid oral fluid resuscitation group ( E group,n =30). The rabbits in B,C, D,E groups were subjected to 40% TBSA full-thickness burn,then were treated with fluid therapy immediately after burn (C group) ,at 6 hour after burn (D, E groups). The myocardial mechanics parameters including mean arteri- al pressure (MAP), left ventricular systolic pressure (LVSP),left ventricular end diastolic pressure (LV- EDP) ,LV ± dp/dt max were observed at 2,6,8,12,24,36 and 48 post burn hour( PBH ). Urine output was also examined. Results The level of LVSP,LV ± dp/dt max in B roup were significantly lower than those in NC group. The level of LVSP,LV ± dp/dt max in the C and E group were singnificantly increased during 24 hour after burn. The level of LV + dp/dt max and LV-dp/dt max in C group peaked at 8 PBH(892 ± 116 kPa/s)and at 6PBH(724 ± 149 kPa/s) respectively. The levels of LV ± dp/dt max, LVSP in D group at each time point were similar to B group( P >0.05 ). Both the levels of LV ± dp/dt max in E group peaked at 8 PBH. The level of LVEDP was no obvious difference between B and other groups at each time point( P > 0.05). The changes of MAP and urine output on 24 PBH in each group were similar to above indices. Conclusion Effective oral fluid therapy in severe burn rabbits during 24 hours after burn can ameliorate my- ocardial mechanies parameters. The amount of fluid resuscitation can be estimated according to relevant for- mute for delayed fluid resuscitation in burn rabbits.