口服补液对烧伤休克犬肺组织含水量和血管通透性的影响

Effect of oral fluid resuscitation on pulmonary vascular permeability and lung water content in burn dogs in shock stage

目的了解口服补液对烧伤休克犬肺组织含水量和血管通透性的影响。方法雄性Beagle犬18只，行颈动、静脉置管后24h造成50％TBSAⅢ度烧伤。伤后随机分为不补液组、口服补液组和静脉补液组，每组6只。伤后第1个24h不补液组不作任何治疗，口服补液组和静脉补液组分别经胃管或静脉输注葡萄糖-电解质溶液；伤后24h起3组犬均给予静脉补液。统计各组犬伤后72h内的死亡率。测定3组犬伤前、伤后30min和4、8、24、48、72h非麻醉状态下的平均动脉压（MAP）、呼吸频率（RR）、PaO2、血管外肺水指数（ELWI）和肺血管通透性指数（PVPI），于伤后72h或犬濒死前测定肺组织含水率。结果不补液组6只犬均在伤后9～22h死亡，口服补液组中3只犬伤后25～47h死亡，静脉补液组犬无一死亡。不补液组伤后8hRR为（44．0±5．0）次／min、ELWI（10．3±0．6）mL／kg、PVPI6．6±0．6，比伤前大幅增加；PaO2和MAP均明显低于伤前（P〈0．05）。口服补液组伤后8hRR为（33．0±4．0）次／min、ELWI（8．9±0．3）mL／kg、PVPI5．7±0．4，显著低于不补液组（P〈0．05），但高于静脉补液组[（26．0±3．0）次／min、（8．2±0．3）mL／kg、4．2±0．4，P〈0．05]；口服补液组PaO2和MAP均高于不补液组（P〈0．05）。两补液组肺组织含水率相近（P〉0．05），均低于不补液组（P〈0．05）。结论早期口服补液对烧伤犬肺的保护作用虽不如静脉补液，但与不补液相比能显著改善休克期肺血管通透性，减轻肺水肿，减少肺脏并发症。

Objective To investigate the effect of oral fluid resuscitation on pulmonary vascular permeability and lung water content in burn dogs during shock stage. Methods Eighteen male Beagle dogs with catheterization of carotid artery and jugular vein for 24 hours were subjected to 50% TBSA full-thickness burn, then they were divided into non-fluid resuscitation（NR）, oral fluid resuscitation （OR）, intravenous fluid resuscitation （IR） groups, with 6 dogs in each group. Dogs in OR and IR groups were given glucose- electrolyte solution （GES） by gastric tube or intravenous infusion according to Parkland formula within 24 hours after burn, while those in NR group were not given any treatment. Dogs in each group were then given intravenous fluid for further resuscitation after 24 post burn hours （PBH）. Deaths were recorded within 72 hours after burn. Mean arterial pressure（MAP） , respiratory rate （RR） , PaO2, extravascular lung water index （ELWI） and pulmonary vascular permeability index （PVPI） were determined before burn and at 30 rains and 4, 8, 24, 48, 72 PBH with the aid of PICCO. Dogs were sacrificed to collect lung tissue for determination of water content at 72 PBH or just before death. Results All dogs died during 9 - 22 PBH in NR group, 3 dogs died during 25 -47 PBH in OR group, and all dogs survived within 72 PBH in IR groups. Compared with those before burn, RR （44.0 ± 5.0） times/rain, ELWI （10.3 ± 0.6） mL/kg and PVPI （6.6 ±0. 6） were markedly increased in NR group at 8 PBH, but PaO2 and MAP were obviously decreased （ P 〈0.05）. In OR group, RR （33.0 ±4.0） times/rain, ELWI （8.9 ±0.3） mL/kgandPVPI （5.7±0.4） were significantly lower than those of NR group （ P 〈 0.05 ） , but higher than those of IR group [ RR （26.0 ±3.0） times/min, ELWI （8.2±0.3） mL/kg, PVPI （4.2±0.4）, P 〈0.05] at 8 PBH. PaO2 and MAP in OR group were higher than that in NR group （ P 〈0.05）. Lung water content showed no statistically significant difference between OR ang IR groups （ P 〉 0.05） , which were lower than that in NR group （ P 〈 0.05）. Conclusions Although the protective effect of oral fluid resuscitation with GES on the lung of burn dog at shock stage was inferior to intravenous fluid, it still can decrease pulmonary vascular permeability, alleviate pulmonary edema, and reduce pulmonary complication compared with no resuscitation with fluids.