犬烧伤休克延迟复苏的实验研究

目的探讨应用林格液进行烧伤休克延迟复苏的效果.方法12只犬随机分为对照组(S组,6只)和治疗组(LR组,6只).LR组采用35%TBSAⅢ度烧伤模型,伤后6h以乳酸林格液进行复苏,并以尿量为1.0ml@kg-1@h-1及心输出量为伤前值的70%～80%来调整输液速度及输入量,观察其在伤后第一个24h复苏中的容量负荷、平均动脉压(MAP)、左心室收缩压(LVSP)、左室内压最大上升/下降速率(±dp/dtmax)、心脏排血指数(CI)、氧供给(DO2)及氧消耗(VO2)等的变化.结果乳酸林格液在烧伤休克延迟复苏后第一个24h的复苏中,每1%烧伤面积的输液量为(887±1.02)ml/kg,比采用Parkland公式复苏多1.2倍,其中在复苏后4h内的输液量为(3.63±0.99)ml/kg,为总入量的41%;MAP、LVSP、±dp/dtmax、CI、DO2及VO2等指标在复苏后2h即达到或接近对照组水平.结论乳酸林格液在烧伤休克延迟复苏中,比早期复苏需要更多的液体量才能满足需求,而血流动力学、心肌功能及氧动力学等在复苏后2h即有明显改善.

An experimental study on the delayed resuscitation of dogs with burn shock

OBJECTIVE: To explore the effects of delayed resuscitation on burn shock with ringer's solution. METHODS: Twelve mongrel dogs were randomly divided into control (S, n = 6) and treatment (LR, n = 6) groups. The dogs in LR group were inflicted by 35% TBSA III degree burn and were resuscitated with Lactate Ringer's solution. Urine output in amount of 1 ml.kg-1.h-1, and cardiac output at level of 70% approximately 80% of pre-burn level were referred for the modulation of the speed and amount of fluid infusion. The postburn changes of volumetric load, mean arterial pressure (MAP), LVSP +/- dp/dtmax, CI, DO2 and VO2 during the first 24 hours of resuscitation were observed. RESULTS: The infusion amount of LR solution was 8.87 +/- 1.02 ml/kg per 1% TBSA during the first 24 hours of resuscitation, which was 1.2 times more than that with Parkland formula. Furthermore, the infusion fluid amount within the first 4 hours of resuscitation was (3.63 +/- 0.99) ml.kg(-1).1% TBSA-1, which was 41% of total amount within the first 24 hours. MAP, LVSP, +/- dp/dtmax, CI, DO2 and VO2 reached or approached the levels in S group within 2 hours of resuscitation. CONCLUSION: The infusion amount of Lactate Ringer's solution needed in delayed resuscitation was larger than that in early resuscitation. And the indices of hemodynamics and myocardial mechanics were improved obviously within 2 hours of resuscitation.