Parkland公式对海水浸泡弹烧复合伤犬血流动力学的影响

目的:探讨Parkland公式用于海水浸泡弹烧复合伤复苏时的价值.方法:建立海水浸泡弹烧复合伤模型后,依模型将14只成年杂种犬随机分为海水浸泡弹烧复合伤组(浸泡组,n=8)和Parkland公,n=6).动态监测两组动物伤前及伤后4、7、10、20和28 h共6个时间点的中心体温(CT)、心率(HR)、平均动脉压(MAP)、平均肺动脉压(MPAP)、中心静脉压(CVP)、肺毛细血管楔压(PCWP)、心脏指数(CI),并计算每搏输出指数(SVI)、外周循环阻力指数(SVRI)、肺循环阻力指数(PVRI).结果:复苏治疗后,复合伤动物血流动力学多项指标明显改善,但在复苏早期有尿量偏多、CVP一过性增高的现象,存在一定容量超载的风险;同时,在实验的后期,虽然仍在进行复苏治疗,但血流动力学指标再次下降,反映了血流动力学稳定性欠佳.结论:Parkland公式对海水浸泡弹烧复合伤动物救治有效,但仍存在一定不足,需进一步改进.

Effects of resuscitation with Parkland formula on hemodynamics in projectile-burn combined wound in dogs with seawater immersion

Objective: To explore the value of resuscitation with Parkland formula on hemodynamic in dogs with projectileburn combined wound and seawater immersion. Methods: After creating model of projectileburn combined wound in dogs with seawater immersion, 14 dogs were randomized into two groups : projectileburn combined wound with seawater immersion group(immersion group, n =8), Parkland formula resuscitation group(resuscitation group, n =6). Before injury and 4, 7, 10, 20, 28 hours after injury, the changes of central temperature(CT) and hemodynamics, including heart rate, mean arterial pressure(MAP), mean pulmonary arterial pessure(MPAP), central venous pressure(CVP), pulmonary capillary wedge pressure (PCWP), cardiac index(CI), were recorded, and stroke volume index(SVI), systemic vascular resistance index(SVRI) , pulmonary vascular resistance index(PVRI) were calculated. Results: After resuscitation , CT was increased significantly, MAP, PCWP, CI, SVI were improved significantly. CVP and the amount of urine were increased compared to normal in early period of resuscitation, indicating that circulating volume was overloaded . Hemodynamics aggravate again during later period of experiment when resuscitation was performed , indicating that hemodynamics was not stable. Conclusion: Fluid resuscitation according to Parkland formula is available. Therefore, The Parkland formula has deficiency, and need improve .