烫伤犬延迟快速复苏对心肌损伤的影响

Effects of rapid fluid replacement in delayed resuscitation on myocardial damages during thermal injury in dogs

目的 :探讨烫伤后延迟复苏情况下 ,快速补液对伤后早期心肌损害的影响。方法 :利用犬40 %TBSAⅢ度烫伤模型 ,24只狗被随机分为烫伤对照组、延迟快速补液组和延迟均匀补液组进行补液 ,观察伤前、伤后2、6、8、12、24、36和48h血浆肌球蛋白轻链1(MLC1)、乳酸脱氢酶(LDH)、肌酸激酶(CK)和肿瘤坏死因子(TNF)等指标的变化。结果 :烫伤后各组血浆MLC1、LDH、CK和TNF都逐渐升高 ,2～6h即显著高于伤前 ,但补液两组MLC1、LDH、CK和TNF上升幅度明显低于烫伤对照组 ,而快速补液组烫伤8～12h后(快速补液后)上述指标均显著低于均匀补液组。结论 :在烫伤后延迟复苏情况下 ,快速补液可以减轻烫伤后早期心肌损害。

Objective: To study the effects of rapid fluid replacement in delayed resuscitation on myocardial damages during severe scalding in dogs. Methods: 24 dogs were inflicted with 40% TBSA full thickness scalding and randomized equally into the control group (C), delayed rapid fluid replacement group (R) and delayed even fluid replacement group (E). Serum myosin light chain 1 (MLC1) and myocardial lactate dehydrogenase (LDH), creatine kinase(CK) and tumor necrosis factor (TNF) were determined before scalding and in the 2nd, 6th, 8th, 12th, 24th, 36th and 48th hour postscalding. Results: After scalding, MLC1, LDH, CK and TNF were gradually increased and their leavel were significantly higher than the prescalding level in the 2nd to 6th hour postscalding. Nevertheless, all the 4 parameters were lower in R and E groups than those in C group. In the 8th to 12th hour and thereafter (after rapid or even fluid replacement), the 4 parameters were lower in the R group than those in the E group. Conclusion: In delayed resuscitation after severe scalding, rapid fluid replacement will result in less severe myocardial damages than even fluid replacement.