烧伤休克期液体复苏方案对相关炎症介质影响的实验观察

Effects of fluid resuscitation programs on the levels of inflammatory mediators during burn shock stage

目的探讨烧伤休克期不同的液体复苏方案对相关炎症介质的影响。方法将24只小型猪用随机数字表法随机平分为琥珀酰明胶组、羟乙基淀粉组、Parkland组、异体血浆组4组建立重度烧伤休克模型，伤后2h开始分别以琥珀酰明胶、羟乙基淀粉（130／0．4）、乳酸林格氏液、猪异体血浆进行复苏。观察伤前及伤后心率、血压、尿量及中心静脉压变化；分别在伤前和伤后4、8、24、48h检测猪血清中肿瘤坏死因子α（TNF—α）和白细胞介素（IL）-1β、1L-8水平，并进行对比分析。结果各组均平稳渡过休克期。血清TNF—α：琥珀酰明胶组伤后48h显著高于异体血浆组[（351±74）比（215±44）ng／L]，羟乙基淀粉组伤后8h显著高于异体血浆组[（327±38）比（249±29）ng/L]，且均显著高于同组伤前水平（均P〈0．05）。血清IL-1β：琥珀酰明胶组伤后4、8、48h均显著高于伤前[（563±76）、（589±76）、（736±42）比（508±64）ng/L]（均P〈0．05）；羟乙基淀粉组伤后48h显著高于伤前[（574±72）比（492±41）ng／L]（P〈0．05）；Parkland组伤后24、48h均显著高于伤前[（575±31）、（584±65）比（498±33）ng/L]（均P〈0．05）；琥珀酰明胶组伤后48h显著高于异体血浆组的（561±48）n∥L（P〈0．01）。血清IL-8：琥珀酰明胶组伤后8、24h均显著高于伤前[（1012±100）、（993±87）比（865±82）ng/L]，且伤后24h时显著高于异体血浆组[（866±99）ng/L]（均P〈0．05）；羟乙基淀粉组伤后4h、Parkland组伤后8、48h均显著高于伤前（均P〈0．05），但与异体血浆组各时相点比较差异均无统计学意义（均P〉0．05）。结论烧伤休克期采用羟乙基淀粉、Parkland复苏方案对相关炎症介质具有较好的抑制作用，与天然胶体组作用相近。

Objective To explore the effects of different methods of fluid resuscitation on the levels of inflammatory mediators during burn shock stage. Methods Twenty-four miniature swines were numbered from 1 to 24 and randomly divided by EXCEL 2007 into 4 groups of succinylated gelatin, hydroxyethyl starch, Parkland and allogeneic plasma （n = 6 each）. Severe burn shock model was established. Sueeinylatedgelatin, hydroxyethyl starch （130/0.4） , Ringer＇s lactate and swine al]ogenic plasma were used as resuscitation fluid （alternative colloid） according to the burn shock recovery principles （beginning at 2 h post-injury）. The parameters of heart rate （HR）, blood pressure （BP） , urine volume and central venous pressure （CVP） before and within 48 h post-burn were recorded. And the levels of tumor necrosis factor alpha （ TNF-α）, interleukin （IL） -1β and IL-8 were measured at the time of pre-injury as well as 4 h, 8 h, 24 h and 48 h post-injury. Statistical analyses were performed. Results All swines survived the shock stage. TNF-a in succinylated gelatin group was significantly higher at 48 h post-injury than that in allogeneic plasma group （（ 351 ± 74） vs （215 ± 44） ng/L, P 〈 0. 05 ）. TNF-α in hydroxyethyl starch group was significantly higher at 8 h post-injury than that in allogeneic plasma group （（327± 38） vs （249± 29） ng/L, P 〈 0. 05 ）. And they were both higher than the pre-burn levels （ both P 〈 0. 05）. Compared with pre-injury（ （ 508 ± 64） ng/L）, the level of IL-1β in succinylated gelatin group increased substantially at 4 h （ （563 ± 76） ng/L）, 8 h （（589 ±76） ng/L） and 48 h （（736 ±42） ng/L） post-injury （all P 〈0.05）. The hydroxyethyl starch group was higher at 48 h post-injury than that at pre-injury （ （574 ±72） vs （492 ±41 ） ng/L, P 〈 0. 05 ）. Also in Parkland group, the levels were higher at 24 h and 48 h hours post-injury than that at pre-injury （ （ 575 ± 31 ）, （584 ± 65 ） vs （498 ± 33 ） ng/L, both P 〈 0.05 ）. Only succinylated gelatin group was significantly higher （P 〈 0.01 ） at 48 h post-injury than allogeneic plasma group （ （561 ± 48） ng/L）. Campared with pre-injury （（561 ±48） ng/L）, the level of IL-8 in suceinylated gelatin group increased significantly at 8 h （ （ 1012 ± 100） ng/L）, 24 h post-burn （ （993 ± 87） ng/L）, significantly higher than allogeneic plasma group （ （ 866 ± 99 ） ng/L） at 24 h （ all P 〈 0.05 ）. Although hydroxyethyl starch and Parkland groups increased significantly at 4 h post-injury and 8 h, 48 h post-injury versus those at pre-injury （ all P 〈 0. 05 ）. There was no significant difference at each timepoint compared with pre-burn （ P 〉 0. 05 ）. Conclusions The recovery regimens of hydroxyethyl starch and Parkland groups may restrain the levels of inflammatory mediators. And the effects are similar to those of allogeneic plasma group.