严重烧伤休克期大面积切痂对休克复苏的影响

The effects of massive escharectomy on the resuscitation of burn shock in the early stage after burn

目的 评价休克期大面积切痂对休克复苏的影响。 方法 采用 40 %TBSAⅢ度烫伤犬模型 ,随机分为切痂组 (E组 )和非切痂组 (C组 )。两组动物于伤后 1h按parkland公式补充复方乳酸钠溶液复苏 ,E组在伤后 3h切除全部焦痂 ,立即植以新鲜异体皮。动态观察血流动力学、血液流变学、氧供、氧耗和血乳酸的变化。 结果 两组犬烫伤后 30min均立即发生严重休克 ,心排出量 (CO)、心脏指数 (CI)、左心作功指数 (LVWI)显著降低 ,全血粘度、血浆粘度、红细胞聚集指数、血浆乳酸含量明显增加。E组动物伤后 3h切痂 ,CO、CI、血液流变学和乳酸含量较术前及C组均有明显改善。 结论 烧伤后单纯补液不能较快纠正休克 ,休克期大面积切痂是安全可行的 。

Objective To evaluate the effects of massive escharectomy on the resuscitation of burn shock in the early stage after severe burn. Methods Mongrel dog inflicted with 40% TBSA Ⅲ degree scalding were employed as the model. The dogs were randomly divided into two groups---escharectomy (E) and non-escharectomy (C) groups. All the dogs received balanced salt solution according to Parkland formula from 1 postburn hour (PBH). The dogs in E group underwent escharectomy en masse at 3 PBH with immediate grafting of fresh alloskin. The dynamic indices of hemodynamics, blood rheology, oxygen supply, oxygen consumption and blood lactic acid content were monitored. Results Severe shock occurred in all the dogs 30min after burn. The were evident decreased cardiac output (CO),cardiac index (CI) and left ventricular work index (LVWI) in all the dogs. But the viscosity of whole blood and plasma, the erythrocytic agglutination index and plasma lactic acid content increased significantly. The dogs in E group were operated with massive escharectomy at 3 PBH. In this group, CO, CI, the blood rheologic indices and plasma the lactic acid content were obviously improved when compared with those in the preoperational period and to those in the C group. Conclusion Simple fluid resuscitation couldn' t correct burn shock quickly. Massive escharectomy during shock stage was safe, feasible and effective in the correction of burn shock.