低渗丙酮酸钠口服补液盐对50%总体表面积烫伤大鼠血管通透性、胃肠及脏器功能的影响

目的探讨低渗丙酮酸钠口服补液盐对严重烧伤大鼠血管通透性、胃肠及脏器功能的影响。 方法选择雄性SD大鼠80只，建立50%总体表面积(TBSA)Ⅲ度烫伤模型，按随机数字表法将大鼠分为4组：烫伤不补液组(NR组)、低渗丙酮酸钠口服补液盐组(PR组)、低渗枸橼酸钠口服补液盐组(CR组)、假烫伤对照组(SR组)，每组20只。NR组、PR组及CR组采用96 ℃水浴浸泡大鼠背部15 s、双下肢15 s、腹部8 s，造成50%TBSAⅢ度烫伤模型(经病理切片证实，为严重烧伤)；SR组采用37 ℃水浴浸泡相同时间。PR组、CR组于伤后即刻开始采用灌胃输入的方法口服补液，补液量和速度均依据Parkland公式，即每1%TBSA补液4 mL/kg，伤后第1个8 h补补液量的一半，之后16 h补另一半，每0.5 h均严格按照计算所得补液量灌注。SR组自由饮水，NR组不予口服补液。观察烫伤后8、24 h各组大鼠各脏器组织含水率、脏器功能指标变化及胃肠功能变化。数据比较采用单因素方差分析、t检验及χ²检验。 结果(1)伤后8、24 h，4组大鼠的脏器组织(心脏、肝脏、肺、肾脏和肠)含水率比较，差异均有统计学意义(P值均小于0.05)；与NR比较，其余3组大鼠脏器组织含水率均降低，差异均有统计学意义(P值均小于0.05)。伤后8 h，PR组心脏、肝脏、肺、肾脏和肠的组织含水率分别为(75.66±1.21)%、(72.83±1.12)%、(75.91±1.24)%、(77.67±1.17)%、(79.16±1.01)%，均低于CR组(79.48±1.25) %、(74.16±1.12) %、(78.87±0.88) %、(79.39±1.19)%、(81.23±0.86)%，差异均有统计学意义(t＝3.698、4.368、5.112、5.287、4.257，P值均小于0.05)；伤后24 h，PR组心脏、肝脏、肺、肾脏和肠的组织含水率分别为(71.78±1.08)%、(66.89±1.11)%、(71.42±1.18)%、(71.64±1.17)%、(73.91±1.03)%，均低于CR组(77.12±1.22)%、(71.13±1.09)%、(75.81±1.14)%、(76.78±1.15)%、(78.42±0.94)%，差异均有统计学意义(t＝4.165、4.572、4.981、4.653、5.017，P值均小于0.05)。(2)伤后8、24 h 4组大鼠各脏器功能指标磷酸肌酸激酶同工酶(CK-MB)、血清谷丙转氨酶(ALT)、肌酐]比较，差异均有统计学意义(P值均小于0.05)；与NR组比较，PR组和CR组大鼠伤后8、24 h CK－MB、ALT、肌酐均明显下降，差异均有统计学意义(P值均小于0.05); 伤后8 h，PR组CK-MB、ALT和肌酐分别为(2575.6±165.1)U/L、(270.3±61.2)U/L、(46.1±6.4)μmol/L，均低于CR组(3949.4±165.5)U/L、(542.6±60.1)U/L、(66.7±6.8)μmol/L，差异均有统计学意义(t＝2.396、5.465、5.146，P值均小于0.05)；伤后24 h，PR组CK-MB、ALT和肌酐分别为(1652.8±167.8)U/L、(226.9±12.1)U/L、(38.2±4.8)μmol/L，均低于CR组(3247.2±121.2)U/L、(418.1±10.9)U/L、(51.1±5.4)μmol/L，差异均有统计学意义(t＝2.382、4.957、4.060，P值均小于0.05)。(3)伤后8、24 h，PR组胃排空率(85.1±1.4)%、(91.2±1.8)%，均高于CR组(45.7±1.8)%、(66.1±1.4)%，差异均有统计学意义(χ²＝37.327，38.421，P值均小于0.05)。(4)伤后8、24 h，PR组肠吸收总量(20.07±0.78) 、(44.07±2.54) mL，均高于CR组(14.81±0.69)、(31.53±1.62) mL，差异均有统计学意义(χ²＝4.716、5.217，P值均小于0.05)。 结论低渗丙酮酸钠口服补液盐能显著改善严重烫伤大鼠血管通透性、胃肠及脏器功能，可能对严重烫伤大鼠的复苏提供一定的治疗作用。

Effects of hypotonic sodium pyruvate oral rehydration salt on capillary permeability,gastrointestinal and organs function in rats with a 50% total body surface area scald injury

ObjectiveTo investigate the effects of hypotonic sodium pyruvate oral rehydration salts on vascular permeability, gastrointestinal and organ function in severely burned rats. MethodsEighty male Sprague-Dawley(SD) rats were selected and 50% total body surface area (TBSA) full thickness scald model was established. Rats were divided into 4 groups according to the random number table: scalded non-rehydration group (NR group), hypotonic sodium pyruvate-oral rehydration solution group ( PR group), hypotonic sodium citrate-oral rehydration solution group (CR group) and false scald control group (SR group), 20 rats in each group. NR group, PR group and CR group using 96 ℃ water bath soaked rat back for 15 s, double lower limb for 15 s, abdomen for 8 s, resulting in 50% TBSA Ⅲ degree scald model (severe burns confirmed by pathological section); The SR group was immersed in a 37 ℃ water bath for the same time. The PR group and the CR group started oral rehydration by intragastric administration immediately after the injury. The volume and speed of rehydration were based on the Parkland formula, that is, 4 mL/kg per 1% TBSA rehydration, one half of volume was infused during the first 8 hours, the rest during the following 16 hours after burns, all rats received the oral rehydration solution treatment through the gavage in every 0.5 h strictly according to the coculation. The SR group was treated with free drinking water and the NR group was not given oral rehydration. The changes of organ water content, organ function index and gastrointestinal function of rats in each group were observed at 8 h and 24 h after scald. Data were processed with one way analysis of variance, t test and chi-square test. Results(1) At 8 and 24 h after injury, the water content of organ tissues (heart, liver, lung, kidney and intestine) of the 4 groups were statistically significant (with P values below 0.05); compared with NR group, the water content of organ tissues in the other three groups decreased, and the difference was statistically significant (with P values below 0.05). At 8 h after injury, the tissue water contents of the heart, liver, lung, kidney and intestine of the PR group were (75.66±1.21)%, (72.83±1.12)%, (75.91±1.24)%, (77.67±1.17)% and (79.16±1.01)%, respectively, all lower than those of the CR group (79.48±1.25)%, (74.16±1.12)%, (78.87±0.88)%, (79.39±1.19)%, (81.23±0.86)%], the differences were statistically significance (t=3.698, 4.368, 5.112, 5.287, 4.257; with P values below 0.05). At 24 h after injury, the tissue water contents of the heart, liver, lung, kidney and intestine of the PR group were (71.78±1.08)%, (66.89±1.11)%, (71.42±1.18)%, (71.64±1.17)%, (73.91±1.03)%, all lower than those of the CR group (77.12±1.22)%, (71.13±1.09)%, (75.81±1.14)%, (76.78±1.15)%, (78.42±0.94)%], the differences were statistical significance (t=4.165, 4.572, 4.981, 4.653, 5.017; with P values below 0.05). (2) At 8 and 24 h after injury, the organ function indexes creatine phosphokinase isoenzyme (CK-MB), alamine aminotransferase (ALT), creatinine] were significantly different in the 4 groups (with P values below 0.05); compared with the NR group, CK-MB, ALT and creatinine were significantly observed in the PR group and the CR group at 8 and 24 h after injury, the differences were statistically significant (with P values below 0.05); 8 h after injury, CK-MB, ALT and creatinine in the PR group were (2 575.6±165.1) U/L, (270.3±61.2) U/L, (46.1±6.4) μmol/L, all lower than those in the CR group (3 949.4±165.5) U/L, (542.6±60.1) U/L, (66.7±6.8) μmol/L], the differences were statistically significant (t=2.396, 5.465, 5.146; with P values below 0.05); 24 h after injury, CK-MB, ALT and creatinine in the PR group were (1 652.8±167.8) U/L, (226.9±12.1) U/L, (38.2± 4.8) μmol/L, all lower than those in the CR group (3247.2±121.2) U/L, (418.1±10.9) U/L, (51.1±5.4) μmol/L], the differences were statistically significant (t=2.382, 4.957, 4.060; with P values below 0.05). (3) At 8 and 24 h after injury, the gastric emptying rate of the PR group was (85.1±1.4)%, (91.2±1.8)%, which were higher than those of the CR group (45.7±1.8)%, (66.1±1.4)%], the differences were statistically significant (χ²=37.327, 38.421; with P values below 0.05). (4) At 8 and 24 h after injury, the total intestinal absorption in the PR group (20.07±0.78) , (44.07±2.54) mL] were higher than those in the CR group (14.81±0.69), (31.53±1.62) mL], the differences were statistical significance (χ²=4.716, 5.217; with P values below 0.05). ConclusionHypotonic sodium pyruvate oral rehydration salts can significantly improve vascular permeability, gastrointestinal and organ function in severely scalded rats, and may provide a certain therapeutic effect on the recovery of severely scalded rats.