肠内输入高渗电解质葡萄糖液对犬35％总体表面积烧伤复苏效果的研究

The curative effect of 1.8 % hypertonic electrolyte glucose solution in enteral resuscitation of burn shock

目的探讨肠内输入高渗电解质葡萄糖液（HEGS）对犬35％总体表面积（TBSA）烧伤复苏效果的影响。方法Beagle犬18只，随机分为对照组（N组）、高渗液组（H组）和等渗液组（I组），每组6只，采用凝固汽油燃烧法制作35％TBSAⅢ°烧伤模型。高渗液组于伤后0．5h通过肠道给予HEGS（1．8％NaCI的5％葡萄糖液），24h补液总量按2ml／（kg·1％TBSA）计算；等渗液组烧伤后0．5h通过肠道补充IEGS（即0．9％NaCl的5％葡萄糖液），24h补液总量按4ml／（kg·1％TBSA）计算；对照组烧伤后不予补液。测定各组犬烧伤前及烧伤后0．5、2．0、4．0、6．0、8．0、24．0h的心排血指数、全心舒张末期容积指数、血容量、血浆渗透浓度、肠黏膜血流量、肠道对复苏液中水分和钠离子的吸收速率，数据进行双因素方差分析。结果烧伤后各组心排血指数、全心舒张末期容积指数、血容量和肠黏膜血流量均明显下降，两补液组于伤后2h逐渐回升，明显高于对照组（P〈0．05），两补液组之间差异无统计学意义（P〉0．05）；高渗液组补液后血浆渗透浓度明显升高，显著高于其他两组（P〈0．05）；烧伤后两补液组肠道对复苏液中的水分和钠离子的吸收速率均逐渐增加，高渗液组肠道对水分吸收速率低于等渗液组（P〈0．05），钠离子吸收速率则高于等渗液组（P〈0．05）。结论35％TBSA烧伤后0．5h通过肠内补充HEGS可以被肠道有效吸收，并在减少1／2补液量的前提下，基本维持有效血容量，达到肠内补充等渗液体复苏相似的血流动力学效果。

Objective To study the resuscitative effect of hypertonic electrolyte glucose solution （HEGS） in enteral resuscitation of burn shock. Methods Eighteen Beagle dogs with 35% TBSA fullthickness flame injury were used in this study. They were randomized to a control group （no-fluid resuscitation, N group）, a HEGS resuscitation group （H group） or an isotonic electrolyte glucose solution （IEGS） resuscitation group （Ⅰ group）. The solution enterally was given for resuscitation from half an hour after burn. The volumes and rates of fluid infusion in the H group were basically in accordance with 2 ml/ （kg·1% TBSA）, those in the Ⅰ group were basically in accordance with parkland formula [ 4 mE/ （kg · 1% TBSA） ]. The haemodynamic parameters, global end-diastolic volume index, plasma volume, osmotic pressure of plasma, intestinal absorptive rates of water and Na ＋ , and intestine mucosa blood flow were continuously assessed. Results The cardiac output index, global end-diastolic volume index, plasma volume and intestine blood mucosa flow reduced markedly after burn in the three groups, and then gradually returned from 2 h after burn in two resuscitation groups, which were higher than that in the N group （P 〈 0. 05 ）. The activities of diamine oxidase in plasma in the two resuscitation groups were higher than that in N group （ P 〈 0. 05 ）. The intestinal absorption rates of water and Na＋ reduced markedly after burn in two resuscitation groups with the lowest levels, and then returned from 6 h after burn. The rates of water in H group were lower than that in Ⅰ group （P 〈 0. 05 ） ; the rates of Na ＋ in H group were higher than in Ⅰ group （P 〈 0. 05 ）. Conclusion The results indicated that 35% TBSA Ⅲ° burn-injury dogs be resuscitated effectively with 1.8% hypertonic electrolyte-glucose solution by enteral, which 1/2 volume of an isotonic electrolyte glucose solution.