延迟快速复苏对犬40%体表烫伤后早期肺功能的影响

Effects of delayed rapid resuscitation pulmonary function in severely scalded dogs

目的探讨烧伤后延迟复苏情况下，快速补液对伤后早期肺功能的影响。方法利用犬４０％ＴＢＳＡⅢ度烫伤模型，２４只大被随机分为烧伤对照组（Ｃ组）、延迟均匀补液组（Ｅ组）和延迟快速补液组（Ｒ组）进行补液。观察伤前、伤后２、６、８、１２、２４、３６和４８ｈ动脉血氧分压（ＰａＯ２）、二氧化碳分压（ＰａＣＯ２）、肺泡动脉血氧分压差（Ｐ（Ａ－ａ）Ｏ２）、肺动脉血压（ＰＡＰ）和肺动脉楔状压（ＰＡＷＰ）等指标的变化。结果体表烫伤后早期各组ＰａＯ２改变不明显，伤后４８ｈ均匀补液组显著低于快速补液组；Ｐａ－ＣＯ２则均有所下降，但补液两组间比较并无显著差异。伤后各组Ｐ（Ａ－ａ）Ｏ２均显著上升，Ｒ组快速补液时明显回落。伤后各组ＰＡＰ和ＰＡＷＰ均显著下降，Ｒ组快速补液时迅速回升，但补液两组间ＰＡＷＰ并无显著差异。结论在大４０％体表烫伤后延迟复苏情况下，如此快速补液肺循环可以承受，且对肺功能有一定改善作用。

Objective To explore the effects of delayed rapid resuscitation on pulmonary function in severely scalded dogs.Methods Twenty-four mongrel dogs were inflicted with 40%TBSA full thickness scalding and randomly divided into three groups, i. e. coned geroup (C), delayed even resuscitation group (E) and delayed rapid resuscitation group (R). Partial pressure of oxygen and carbon dioxide in arterial blood (PaO2, PaCO2), alveolar-arterial oxygen tension dif- fermce (P(A-a) O2),pulmonary arterial pressure(PAP)and pulmonary arterial wedge pressure (PAWP)were determined before scalding and in 2,6, 8, 12,24, 36 and 48 hours after scalding. Results At the early post scalding stage PaO2 remained at near normal level in evedry group,but decreased to significant lower lever at 48 post scalding hours in E group than that in R group.PaCO2 decreased post scalding in every pop and exhibited no obvious difference between R and E groups. Post scalding P(A-a)O2 increased remarkably at early post scalding stage in every group and dounced back by rapid resuscitation. Post scalding PAP and PAWP de- creased at early post scalding stage in every group and inceased rapidly upon rapid resuscitation. But PAWP remained no evident difference between R and E groups.Conclusion Suffering 40% TBSA full thickness scalding,the injured canine lungs can sustain rapid resuscitation and pulmonary function may even im- prove thereafter.