不同液体复苏方案对猪烧伤休克期缺血再灌注损伤的影响

Effects on ischemia-reperfusion injury with different fluid resuscitation regimens during burn shock stage in swines

目的：探讨不同液体复苏方案对猪烧伤休克期缺血再灌注损伤的影响。方法24只广西巴马小型猪按随机数字表法分为琥珀酰明胶组、羟乙基淀粉（130/0.4）组、Parkland组（乳酸钠林格液）、异体血浆组各6只，建立烧伤休克模型，按照烧伤休克复苏方案的原则复苏。在烧伤前及烧伤后4、8、24、48 h时相点检测血清中丙二醛、超氧化物歧化酶（ SOD）、黄嘌呤氧化酶（ XOD）、总抗氧化能力（ T-AOC）水平，并进行统计学分析。结果每组6只猪顺利度过休克期，剔除异常值后各有5个样本纳入分析。伤后8 h 异体血浆组丙二醛水平显著低于琥珀酰明胶组而高于 Parkland 组[（3.46±0.40）比（4.55±0.82）及（2.59±0.35）μmol/L，均 P ＜0.05]。伤后48 h 羟乙基淀粉（130/0.4）组SOD水平显著高于异体血浆组[（72.55±5.70）比（65.42±5.07） U/ml，P＜0.05]。伤后4、8 h琥珀酰明胶组XOD水平均显著高于伤前[（12.00±0.57）、（11.28±0.71）比（9.12±0.51） U/L，均P＜0.01]，且均分别显著高于异体血浆组对应时相点水平[（10.39±1.24）、（9.59±1.17） U/L]（均P＜0.01）。伤后8 h羟乙基淀粉（130/0.4）组T-AOC水平显著高于伤前[（2.06±0.43）比（1.30±0.35） U/ml，P＜0.05]，伤后4、8 h异体血浆组也显著高于伤前[（1.55±0.37）、（2.59±0.60）比（1.06±0.13） U/ml，P＜0.05]；伤后8、48 h琥珀酰明胶组显著低于异体血浆组[（1.14±0.26）、（0.89±0.20）比（2.59±0.60）、（1.16±0.20） U/ml，均P＜0.05]；伤后24、48 h羟乙基淀粉（130/0.4）组显著高于异体血浆组[（1.84±0.41）、（1.53±0.21）比（1.13±0.35）、（1.16±0.20） U/ml，均P＜0.01]；伤后8 h 时 Parkland 组显著低于异体血浆组[（1.31±0.19）比（2.59±0.60） U/ml，P＜0.01]。结论羟乙基淀粉（130/0.4）与异体血浆对猪烧伤休克期缺血再灌注损伤的影响作用相当，损害程度均较小。

Objective To explore the effects on ischemia-reperfusion injury with different regimens of fluid resuscitation during severe burn shock stage in swines.Methods A total of 24 Guangxi BA-MA mini-swine were numbered from 1 to 24 and randomly divided by EXcell2007 into 4 groups of succinylated gelatin, hydroxyethyl starch （HES 130/0.4）, Parkland and allogeneic plasma （n=6 each）.Then the burn shock model was established.And fluid resuscitation therapy was applied according to the established regimens of burn shock fluid resuscitation.Blood samples were collected from the animals prior to burn injury and again at intervals of 4, 8, 24 and 48 hours post-injury.The levels of malondialdehyde , superoxide dismutase （SOD）, xanthine oxidase （XOD） and total antioxidant capacity （T-AOC） were measured.And the results were analyzed statistically.Results Six swines within each group survived the shock stage and the outliers in detection index were eliminated.Then there were 5 swines in each group.The MDA of allogeneic plasma group at intervals of 8 hours was significantly lower than that of succinylated gelatin group , but higher than that of Parkland group [（3.46 ±0.40） vs （4.55 ±0.82）, （2.59 ±0.35） μmol/L, both P〈0.05].The level of SOD had statistical difference at 48 hours between the HES 130/0.4 and allogeneic＆amp;nbsp;plasma groups （ （ 72.55 ±5.70 ） vs （ 65.42 ±5.07 ） U/ml, P 〈0.05 ）.The level of XOD of the succinylated gelatin group at 4,8 hour and they increased when compared to pre-burn （（12.00 ±0.57）, （11.28 ±0.71） vs （9.12 ±0.51） U/L, both P〈0.01）.Statistical significance was observed at 4, 8 hours between succinylated gelatin and allogeneic plasma groups （ （ 10.39 ±1.24 ） , （ 9.59 ±1.17 ） U/L, both P〈0.01）.The T-AOC of HES 130/0.4 group at 8 hours exceed the pre-burn （（2.06 ±0.43） vs （1.30 ± 0.35） U/ml, P〈0.05）.The allogeneic plasma group at 4, 8 hours showed increase when compared to pre-burn （（1.55 ±0.37）, （2.59 ±0.60） vs （1.06 ±0.13） U/ml, both P〈0.05）.The succinylated gelatin group at 8, 48 hours decreased during the corresponding phase of allogeneic plasma group （（1.14 ±0.26）, （0.89 ±0.20） vs （2.59 ±0.60）, （1.16 ±0.20） U/ml, both P〈0.05）.The comparison at 24, 48 hours between HES 130/0.4 and allogeneic plasma groups （（1.84 ±0.41）, （1.53 ±0.21） vs （1.13 ±0.35）, （1.16 ±0.20） U/ml） had statistical difference （both P〈0.01）.The Parkland group at intervals of 8 hours was lower than that of allogeneic plasma group （（1.31 ±0.19） vs （2.59 ±0.60） U/ml, P〈0.01）.Conclusion HES130/0.4 and allogeneic plasma have comparable the parallel minimum damage effect on ischemia-reperfusion injury during burn shock stage are .