延迟复苏对烧伤休克犬氧代谢的影响

Influence of delayed rapid fluid resuscitation on oxygen metabolism in dogs with burn shock

目的探讨在烧伤休克延迟复苏情况下,快速补液对烧伤犬氧代谢的影响。方法建立40%TBSAⅢ度烫伤犬模型,将24只伤犬随机分为对照组、延迟均匀复苏组和延迟快速复苏组,每组8只。观察犬伤前及伤后2、6、8、12、24、36、48h氧供(DO2)、氧耗(VO2)、氧摄取率(O2ext)及血液中碱缺失(BD)和乳酸(LA)含量的变化。结果烧伤后各组犬DO2均显著下降,明显低于伤前值(P<0.01),而O2ext均大幅增加,明显高于伤前值(P<0.01)。伤后8h延迟快速复苏组DO2为(7.35±0.21)L·min-1·m-2,明显高于延迟均匀复苏组(5.32±0.96)L·min-1·m-2(P<0.01);其VO2(2.02±0.58)L·min-1·m-2也明显高于延迟均匀复苏组(1.71±0.38)L·min-1·m-2(P<0.01);但O2ext有所下降,延迟快速复苏组为(27.7±5.9)%,明显低于延迟均匀复苏组(32.2±3.9)%(P<0.01)。烧伤后各组犬BD均大幅降低并明显低于伤前(P<0.01),但复苏后逐渐升高,伤后8h延迟快速复苏组为(-6.5±0.7)mmol/L,显著高于延迟均匀复苏组(-9.3±1.4)mmol/L(P<0.01)。伤后各组犬LA均大幅升高,明显高于伤前(P<0.01),复苏后逐渐降低,伤后8h延迟快速复苏组LA为(2.30±0.20)mmol/L,显著低于延迟均匀复苏组(2.67±0.30)mmol/L(P<0.01)。结论快速补液可以显著改善烧伤犬组织的氧代谢状况,有益于烧伤休克的延迟复苏。

Objective To investigate the influence of delayed rapid fluid resuscitation on oxygen metabolism in dogs with burn shock. Methods Twenty - four mongrel dogs inflicted with 40% TBSA full thickness scald were enrolled in the study and randomly divided into burn control （C） , delayed even fluid replacement （E） , and delayed rapid fluid replacement （R） groups, with 8 dogs in each group. The changes in oxygen delivery （ DO2）, oxygen consumption （ VO2） , oxygen extraction （O2ext） and blood base deficit （BD） , and lactate （LA） were determined before scalding and at 2, 6, 8, 12, 24, 36 and 48 post scalding hours （PSHs）. Results The DO2 in each group was decreased obviously after scalding and was evidently lower than that before injury（ P 〈0. O1 ） , while the O：ext value markedly increased compared with that before scalding （ P 〈0.01 ）. After fluid resuscitation, DO2 and VO2 in E arid R groups increased, but O：ext decreased. The values of DO2, VO2 and O2ext showed significant differences between R and E groups at 8 PSH （R group vs E group , DO2：7.35±0.21 L , min^-1· m^2 vs5.32±0.96 L· min^-1· m^2, P 〈0.01;VO2：2.02±0.58 L· min^-1· m^2 vs 1.71±0.38 L· min^-1· m^2, P 〈0.01） ;The blood BD levels in each group were remarkably lower after scald than that before scald （ P 〈 0. 01 ） ,and they gradually increased after fluid replacement. The blood BD level in R group at 8 PSH （ -6.5 ±0. 7 mmol/L） was obviously higher than that in E group （ -9.3± 1.4 mmol/L, P 〈0. 01 ）. The blood LA level in each group were evidently higher than that before scald （ P 〈 0. 01 ） ,and they decreased after fluid replacement. The blood LA level in R group at 8 PSH （2.30 ±0. 20 mmol/L） was obviously lower than that in E group（2.67±0. 30 mmol/L,P 〈 0. 01 ） Conclusion Rapid fluid replacement could improve tissue oxygen metabolism, which was beneficial to the correction of tissue oxygen supply when fluid resuscitation was delayed.