摘要
目的从血流动力学、心肌力学及代谢等方面探讨高张氯化钠右旋糖酐液(7.5%氯化钠+6%右旋糖酐70,HSD)在烧伤休克延迟复苏中的作用。方法采用犬35%TBSAⅢ度烧伤模型,伤后6 h 分别用乳酸林格液及 HSD 进行复苏,并以每 h 尿量为1.0ml/kg 及心输出量为伤前值的70%～80%来调整输液速度及输液量,观察 HSD 在复苏中容量负荷、左心室等容收缩期最大压力变化速率及左心室舒张期压力下降最大变化速率(±dp/dt_(max))、心脏指数(CI)、氧供给(DO_2)及氧消耗(VO_2)等的变化。结果 HSD 在烧伤休克延迟复苏伤后第一个24 h 输液量比乳酸林格液复苏少30.56%,其中复苏后4 h 的输液量比乳酸林格液少59.50%,在复苏后0.5～2 h,+dp/dt_(max)、CI、DO_2及 VO_2的增加幅度明显高于乳酸林格液复苏。结论 HSD 在烧伤休克延迟复苏中具有容量负荷小、改善心肌功能及促进组织代谢等作用。
Objective To investigate the effect of hypertonic saline/dextran 70 on delayed resusci- tation of burn shock.Methods Eighteen mongrel dogs with 35% TBSA,third-degree burn were used in this study.Lactated Ringer's(LR)or 7.5 % NaCl+6% dextran 70(HSD)was given for resuscitation 6h postburn.The volumes and rates of fluid infusion were controlled basically on the urinary output of 1.0ml·kg ^(-1)·h^(-1)and cardiac output(CO)of 70%～80% of preburn values.The volume load,+dp/ dt_(max),-dp/dt_(max),CI,DO_2 and VO_2 were obtained to evaluate the effect of HSD resuscitation.Results The resuscitated volume of HSD was 30.56% less during first 24h postburn and 59.50% less at 4h after resuscitation than LR's.The+dp/dt_(max),CI,DO_2 and VO_2 were increased significantly with HSD infusion at 2h,1 h and 0.5 h after resuscitation compared with LR's.Conclusion HSD could expand plasma vol- ume significantly with small quantity.The cardiac contractility was enhanced and the oxygen delivery, oxygen consumption were increased in delayed resuscitation of burn shock.
