早期口服补液对犬50％总体表面积烧伤休克期血流动力学和组织灌流的影响

Effects of early oral fluid resuscitation on hemodynamic and tissue perfusion during shock stage in dogs with a50% total body surface area full-thickness burn

目的研究早期口服补液对犬50％总体表面积（TBSA）烧伤休克期血流动力学和组织灌流的影响。方法成年雄性Beagle犬18只，先期无菌手术行颈总动脉、颈外静脉、胃、空肠及膀胱置管，24h后用凝固汽油燃烧法造成其颈、背和胸、腹部约50％TBSAm。烧伤。随机分为不补液（NR）、口服补液（OR）和静脉补液（IR）三组，每组6只。伤后第1个24hNR组无治疗，OR和IR组于伤后30min开始按Parkland公式分别从胃管和静脉输注葡萄糖一电解质溶液，伤后24h起各组犬均实施静脉补液。测定犬伤前（0h）和伤后2、4、8、24、48和72h非麻醉状态下的平均动脉压（MAP）、全身血管阻力（SVR）、心输出量（CO）、左室内压易大变化速率（dp／dtmax）、尿量以及胃黏膜CO2分压（PgCO2）和小肠黏膜血流量（IMBF），并记录伤后72h死亡率。结果与伤前相比，各组犬MAP、CO、dp／dtmax、IMBF和尿量在伤后2h均大幅降低（P〈0．01），而SVR和PgCO2显著升高。两补液组上述指标伤后8h开始恢复，72hIR组除IMBF外均恢复至伤前水平，但OR组CO、SVR及胃肠组织灌流指标仍差于伤前水平（P〈0．01）。NR组上述指标持续恶化，伤后24h内无尿并全部死亡。OR组血液动力学和内脏组织灌流指标显著优于NR组，但差于IR组。伤后72h死亡率NR组为6／6、OR组3／6，而IR组为0／6。结论50％TBSA烧伤后早期口服葡萄糖一电解质溶液复苏效果虽差于静脉补液，但相比不补液，能显著改善血流动力学指标和内脏组织灌流，减少早期死亡，有潜力成为战争或灾害时静脉液体复苏的替代方法。

Objective To investigate the effect of early oral fluid resuscitation on hemodynamic and tissue perfusion in dogs with severe burn shock. Methods Eighteen male Beagle dogs with intubation of carotid artery, jugular vein, stomach, jejunum and bladder for 24 h were subjected to a 50% TBSA fullthickness burn, then were equally divided into non fluid resuscitation （NR）, oral resuscitation （OR） and intravenous resuscitation（IR） groups, （each n = 6）. Dogs in IR and OR groups were given glucoseelectrolyte solution （GES） by gastric tube or intravenous infusion according to Parkland formula within 24 h after burn, while those in NR group were not given any treatment. Dogs in each group were given intravenous fluid resuscitation from 24 h after burn. The mean arterial pressure （ MAP）, cardiac output （CO） , systemic vascular resistance （ SVR ）, dp/dt max of left ventrieular contractility （ dp/dtmax） , gastric carbon dioxide pressure（ PgCO2 ）, intestinal mucosal blood flow（ IMBF）, and urinary output were determined before burn （0 h） and 2,4,8,24,48 and 72 h after burn at no anaesthesia state. Mortality rate of 72 h after burn was also recorded. Results MAP, CO, dp/dtmax, IMBF greatly decreased, and SVR and PgCO2 obviously increased from 2 h after burn in each group （P 〈 0.01 ）. The measurements except IMBF of IR group returned to preinjury levels at 72 h after burn, while CO, SVR, PgCO2 and IMBF of OR group still worse compared with 0 h（P 〈 0. 01 ）. All measurements of NR group kept on worsen, and died with anuria within 24 h after burn. Parameters of hemodynamic and tissue perfusion of OR group were significantly superior to those of NR group, but it inferior to those of IR group. At 72 h after burn, 6 （6/6） survived in IR group, 3 （3/6） in OR group and 0 （0/6） in NR group. Conclusions Although oral resuscitation with GES is not as efficient as intravenous resuscitation in a 50% TBSA burn injury, it still can promote hemodynamic, improve the tissue perfusion and reduce the mortality comparing to no resuscitation. Oral resuscitation might be an ideal alternative way of intravenous resuscitation, especially in wars or other site of mass casualties.