早期口服补液对35% TBSA烧伤犬血流动力学和后期脏器功能的影响

Effects of early oral rehydration on hemodynamics and organ functions of dogs with 35% TBSA burn shock

目的研究35% TBSA烧伤休克早期口服补液对血流动力学、脏器功能和伤后5d预后的影响。方法成年雄性Beagle犬18只,体重11.0±0.5kg,先期无菌手术行动静脉置管术监测血流动力学和肠黏膜血流量(IMBF),24h后用速效药丙泊酚作10min短时麻醉,凝固汽油燃烧造成35%TBSAⅢ度烧伤,随机分为不补液组、口服补液组和静脉补液组,每组6只。伤后第1个24h不补液组无治疗,口服补液组和静脉补液组于伤后30min分别胃内输注葡萄糖-电解质溶液和静脉滴注乳酸林格液,补液量为4ml/(kg.1% TBSA),前8h补一半,后16h补另一半。伤后24h起各组动物均实施静脉补液,伤后第4天起实施静脉营养支持。分别于伤前和伤后第2、4、8、24、48、72、120h测定动物清醒状态下的平均动脉压(MAP)、心输出量(CO)、IMBF以及血中丙氨酸转氨酶(ALT)、肌酐(Cr)和磷酸肌酸激酶同工酶(CK-MB)水平,并统计三组动物的5d死亡率。结果各组动物伤后MAP、CO和IMBF均下降,但MAP在伤后4h已恢复至伤前水平,之后各组间MAP均无统计学差异(P>0.05);伤后24h内口服补液组CO和IMBF均高于不补液组(P<0.05),但低于静脉补液组(P<0.05),24h后各组间血流动力学无统计学差异(P>0.05),各组IMBF恢复均较CO滞后。伤后各组血浆ALT、Cr和CK-MB水平均不同程度升高,伤后72h内口服补液组ALT和CK-MB低于不补液组(P<0.05),但高于静脉补液组(P<0.05);口服补液组Cr在4、8、24h时点低于不补液组但高于静脉补液组(P<0.05)。不补液组伤后5d内死亡率为33.3%(2/6),口服补液组和静脉补液组死亡率均为0。结论35%TBSA烧伤后早期口服葡萄糖-电解质溶液复苏效果虽略差于静脉补液,但相比不治疗组仍能显著改善血流动力学和保护脏器功能,减少早期死亡率,有望成为战争或灾害时早期静脉复苏的替代方法。

Objective To investigate the effects of early oral rehydration on hemodynamics, organ functions and 5-day prognosis in 35% TBSA bum shock. Methods Eighteen male Beagle dogs （11±0. 5kg） were surgically prepared for measurement of hemodynamics parameters, and 24 hours later they were subjected to a 35 % TBSA full-thickness flame injury under a 10-minute anesthesia by intravenous injection of propofol. The dogs were randomly divided into three groups （6 each） in the first 24 hours after burn. Six dogs were given oral rehydration （OR group） with a glucose-electrolyte solution, six dogs were given intravenously rehydration （IR group） with lactated Ringer＇s solution, and another six dogs were given no rehydration as control （NR group）. The fluid delivery rates in OR and IR groups were in accordance with that of Parkland formula. In the second 24 hours all animals received intravenous rehydration, and intravenous nutritional support after 72h post burn. The mean arterial pressure （MAP）, cardiac output （CO）, intestinal mucosal blood flow （IMBF） and plasma levels of alanine aminotransfemse （ALT）, creatinine （Cr） and MB isoenzyme of creatine kinase （CK-MB） were determined at 0, 2, 4, 8, 24, 48, 72 and 120 hours after injury. At the end of 5-day experiment, the mortality in each group was recorded. Results 35% TBSA bum injury resulted in significant reduction of MAP, CO and IMBF in each group, but MAP recovered quickly to pre-injury level at 4h after burn. Within the first 24h, CO and IMBF in OR group were significantly higher than those in NR group （P〈0. 05）, but lower than those in IR group （P〈0. 05）. 48h after bum, the hemodynamics in all the three groups returned to pre-injury levels and had no significant difference （P〉0. 05）. The plasma levels of ALT, Cr and CK-MB in each group were all markedly increased after bum compared with preinjury levels. Within 72h after bum, ALT and CK-MB in OR group were significantly lower than those in NR group （ P〈0. 05）, but higher than those in IR group （P〈0. 05）. Plasma level of Cr in OR group was lower than that in NR group, and higher than that in IR group （P〈0. 05） at 4, 8 and 24h post burn. Two of six （33. 3%） dogs in NR group died before 5 days postbum after bum, and there was no death in IR and OR groups. Conclusions Although oral rehydmtion with glucose-electrolyte solution does not as efficient as intravenous rehydration in a 35% TBSA bum injury, it still can promote hemodynamics, protect the organ functions and reduce the mortality comparing with no rehydration. It might be an ideal ahemative way of intravenous rehydration, especially in wars or other site of mass casualties.