AIM: To investigate the effect of carbachol on gastrointestinal function in a dog model of oral resuscitation for burn shock. METHODS: Twenty Beagle dogs with intubation of the carotid artery, jugular vein and jejunum...AIM: To investigate the effect of carbachol on gastrointestinal function in a dog model of oral resuscitation for burn shock. METHODS: Twenty Beagle dogs with intubation of the carotid artery, jugular vein and jejunum for 24 h were subjected to 35% total body surface area fullthickness burns, and were divided into three groups: no fluid resuscitation (NR, n = 10), in which animals did not receive fluid by any means in the first 24 h postburn; oral fluid resuscitation (OR, n = 8), in which dogs were gavaged with glucose-electrolyte solution (GES) with volume and rate consistent with the Parkland formula; and oral fluid with carbachol group (OR/CAR, n = 8), in which dogs were gavaged with GES containing carbachol (20 μg/kg), with the same volume and rate as the OR group. Twenty-four hours after burns, all animals were given intravenous fluid replacement, and 72 h after injury, they received nutritional support. Hemodynamicand gastrointestinal parameters were measured serially with animals in conscious and cooperative state. RESULTS: The mean arterial pressure, cardiac output and plasma volume dropped markedly, and gastrointestinal tissue perfusion was reduced obviously after the burn injury in all the three groups. Hemodynamic parameters and gastrointestinal tissue perfusion in the OR and OR/CAR groups were promoted to pre-injury level at 48 and 72 h, respectively, while hemodynamic parameters in the NR group did not return to pre-injury level till 72 h, and gastrointestinal tissue perfusion remained lower than pre-injury level until 120 h post-burn. CO 2 of the gastric mucosa and intestinal mucosa blood flow of OR/CAR groups were 56.4 ± 4.7 mmHg and 157.7 ± 17.7 blood perfusion units (BPU) at 24 h postburn, respectively, which were significantly superior to those in the OR group (65.8 ± 5.8 mmHg and 127.7 ± 11.9 BPU, respectively, all P < 0.05). Gastric emptying and intestinal absorption rates of GES were significantly reduced to the lowest level (52.8% and 23.7% of pre-injury levels) in the OR group at about 2 and 4 h post-burn, and did not return to 80% of pre-injury level until 24 h. In the first 24 h postburn, the rate of gastric emptying and intestinal water absorption were elevated by a mean 15.7% and 11.5%, respectively, in the OR/CAR group compared with the OR group. At 5 days, the mortality in the NR group was 30% (3/10), 12.5% in the OR group (1/8), and none in the OR/CAR group. CONCLUSION: Carbachol had a beneficial effect on oral resuscitation of burn shock by promoting gastric emptying and intestinal absorption in our canine model.展开更多
AIM To investigate the changes of gastric acidproduction and its mechanism in shock period ofsevere burn in rats.METHODS A rat model with 30% TBSA full-thickness burn injury was employed and thegastric acid production...AIM To investigate the changes of gastric acidproduction and its mechanism in shock period ofsevere burn in rats.METHODS A rat model with 30% TBSA full-thickness burn injury was employed and thegastric acid production,together with gastricmucosal blood flow(GMBF)and energy charge(EC)were measured serially within 48hpostburn.RESULTS The gastric acid production in theacute shock period was markedly inhibited aftersevere burn injury.At the 3rd h postburn,thegastric juice volume,total acidity and acidoutput were already significantly decreased(P【0.01),and reached the lowest point,0.63mL/L±0.20mL/L,10.81mmol/L±2.58mmol/L and 2.23mmol/h±0.73mmol/hrespectively,at the 12th h postburn.Althoughrestored to some degree 24 h after thermalinjury,the variables above were stillstatistically lower,compared with those ofcontrol animals at the 48th h postburn.TheGMBF and EC were also significantly reducedafter severe burns,consistent with the trend ofgastric acid production changes.CONCLUSION Gastric acid production,as wellas GMBF and EC was predominantly decreased in the early postburn stage,suggesting that gastricmucosal ischemia and hypoxia with resultantdisturbance in energy metabolism,but notgastric acid proper,might be the decisive factorin the pathogenesis of AGML after thermalinjury,and that the preventive use of anti-aciddrugs during burn shock period wasunreasonable in some respects.Therefore,taking effective measures to improve gastricmucosal blood perfusion as early as possiblepostburn might be more preferable for the AGMLprevention and treatment.展开更多
Objectives: Evaluation of the effects of withholding plasma during the initial part of the burn shock period (the shock period in the study is estimated as the first 36 hours following the burns) when it will be lost ...Objectives: Evaluation of the effects of withholding plasma during the initial part of the burn shock period (the shock period in the study is estimated as the first 36 hours following the burns) when it will be lost into the interstitial tissues through the permeable capillaries. During that time crystalloids are administered. Another objective is to evaluate the effect of administering normal saline as the crystalloid resuscitation fluid during the initial part of the shock period. Design: A Retrospective 4 years study compares the use of normal saline as the resuscitative intravenous fluid during the first 12 hours post burns followed by intravenous 5% Purified Plasma Protein Fraction (PPPF) during the rest of the shock period i.e. the remaining 24 hours, with the use of the PPPF throughout the burns shock period according to Muir and Barclay formula. Setting: The Plastic Surgery Department and the Department of Laboratory, Directorate General of Khoula Tertiary Hospital, Muscat, Sultanate of Oman. Patients and Methods: The study included 2 groups of patients;Group A: Patients who received 5% Plasma (Human PPPF) throughout the shock period and Group B: Patients who received crystalloids in the form of normal saline during the first 12 hours post burn followed by plasma for the next 24 hours. Monitoring of the patients in both groups was done by using clinical signs of pulse, blood pressure, temperature and urine output and by using laboratory investigations in the form of the haematocrit value, sodium, potassium, chloride, total proteins and albumin levels in the blood at the time of admission and at the end of the shock period. Results: 140 patients were included in the study;64 in Group A and 76 in Group B. There was no mortality and the vital signs were maintained during the shock period in both groups. The mean values of urine output were nearer to the normal level in Group B compared to Group A. The same was observed regarding the Haematocrit value. In both groups the mean values showed no hypoproteinaemia or hypoalbuminaemia at the end of the shock period. There was no hypernatraemia in spite of giving 150 mmol/L of Na during the initial 12 hours post burns in Group B. The mean values of potassium and chloride levels were normal in both groups at the end of the shock period. Conclusion: Giving plasma during the first 12 hours of the burn shock period when the capillary leakage is maximum has no significant benefit. The plasma usage can be reduced by 50% compared to the use of the Muir and Barclay Formula from the beginning of the shock period with reduction of the costs and the possibility of transmission of undetected pathogens by nearly the same value if crystalloids are given during the first 12 hours of burns shock period. The use of isotonic normal saline during the first 12 hours appears more appropriate as it maintains adequate sodium balance to correct the hyponatraemia and at the same time prevents elevation of the serum potassium during the period when potassium is released from the cells. In addition, it does not have a significant reduction on the level of the serum proteins.展开更多
A model of burn shock was reproduced in rats and the changes of water content andmalondialdehyde(MDA)concentration in tissues were measured.The results showed that there wasa significant increase of MDA concentration ...A model of burn shock was reproduced in rats and the changes of water content andmalondialdehyde(MDA)concentration in tissues were measured.The results showed that there wasa significant increase of MDA concentration and water content in lung and bumed skin post burnand a positive correlation was found between MDA level and water content.Pretreatment withsuperoxide dismutase(SOD)prevented effectively lung and skin from edema.The role of oxygen freeradicals in vascular permeability disturbance and development of edema in burns was discussed.展开更多
To investigate the effect of hypertonic saline / dextran 70 (HSD) on cardiac function in delayed resuscitation of burn shock. Methods: HSD was used for resuscitation 6 h postburn in dogs and its effect on cardiac func...To investigate the effect of hypertonic saline / dextran 70 (HSD) on cardiac function in delayed resuscitation of burn shock. Methods: HSD was used for resuscitation 6 h postburn in dogs and its effect on cardiac function was evaluated byvolume load,MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax, CO and SVR. Results: The volume of HSD was 30.50% less duringfirst 24 h postburn and 59.50% less during 4 h after resuscitation than that of lactated Ringer’s solution (LR’s). MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax and CO increased and SVR reduced in HSD resuscitation. Conclnsion: Smaller volume of HSD canexpand plasma volume significantly and improve cardiac function in delayed resuscitation of burn shock.展开更多
基金Supported by The Special Foundation of the 11th five-yearPlan for Military Medical Projects, No. 06Z055
文摘AIM: To investigate the effect of carbachol on gastrointestinal function in a dog model of oral resuscitation for burn shock. METHODS: Twenty Beagle dogs with intubation of the carotid artery, jugular vein and jejunum for 24 h were subjected to 35% total body surface area fullthickness burns, and were divided into three groups: no fluid resuscitation (NR, n = 10), in which animals did not receive fluid by any means in the first 24 h postburn; oral fluid resuscitation (OR, n = 8), in which dogs were gavaged with glucose-electrolyte solution (GES) with volume and rate consistent with the Parkland formula; and oral fluid with carbachol group (OR/CAR, n = 8), in which dogs were gavaged with GES containing carbachol (20 μg/kg), with the same volume and rate as the OR group. Twenty-four hours after burns, all animals were given intravenous fluid replacement, and 72 h after injury, they received nutritional support. Hemodynamicand gastrointestinal parameters were measured serially with animals in conscious and cooperative state. RESULTS: The mean arterial pressure, cardiac output and plasma volume dropped markedly, and gastrointestinal tissue perfusion was reduced obviously after the burn injury in all the three groups. Hemodynamic parameters and gastrointestinal tissue perfusion in the OR and OR/CAR groups were promoted to pre-injury level at 48 and 72 h, respectively, while hemodynamic parameters in the NR group did not return to pre-injury level till 72 h, and gastrointestinal tissue perfusion remained lower than pre-injury level until 120 h post-burn. CO 2 of the gastric mucosa and intestinal mucosa blood flow of OR/CAR groups were 56.4 ± 4.7 mmHg and 157.7 ± 17.7 blood perfusion units (BPU) at 24 h postburn, respectively, which were significantly superior to those in the OR group (65.8 ± 5.8 mmHg and 127.7 ± 11.9 BPU, respectively, all P < 0.05). Gastric emptying and intestinal absorption rates of GES were significantly reduced to the lowest level (52.8% and 23.7% of pre-injury levels) in the OR group at about 2 and 4 h post-burn, and did not return to 80% of pre-injury level until 24 h. In the first 24 h postburn, the rate of gastric emptying and intestinal water absorption were elevated by a mean 15.7% and 11.5%, respectively, in the OR/CAR group compared with the OR group. At 5 days, the mortality in the NR group was 30% (3/10), 12.5% in the OR group (1/8), and none in the OR/CAR group. CONCLUSION: Carbachol had a beneficial effect on oral resuscitation of burn shock by promoting gastric emptying and intestinal absorption in our canine model.
基金the National Natural Science Foundation of China,No.39290700.
文摘AIM To investigate the changes of gastric acidproduction and its mechanism in shock period ofsevere burn in rats.METHODS A rat model with 30% TBSA full-thickness burn injury was employed and thegastric acid production,together with gastricmucosal blood flow(GMBF)and energy charge(EC)were measured serially within 48hpostburn.RESULTS The gastric acid production in theacute shock period was markedly inhibited aftersevere burn injury.At the 3rd h postburn,thegastric juice volume,total acidity and acidoutput were already significantly decreased(P【0.01),and reached the lowest point,0.63mL/L±0.20mL/L,10.81mmol/L±2.58mmol/L and 2.23mmol/h±0.73mmol/hrespectively,at the 12th h postburn.Althoughrestored to some degree 24 h after thermalinjury,the variables above were stillstatistically lower,compared with those ofcontrol animals at the 48th h postburn.TheGMBF and EC were also significantly reducedafter severe burns,consistent with the trend ofgastric acid production changes.CONCLUSION Gastric acid production,as wellas GMBF and EC was predominantly decreased in the early postburn stage,suggesting that gastricmucosal ischemia and hypoxia with resultantdisturbance in energy metabolism,but notgastric acid proper,might be the decisive factorin the pathogenesis of AGML after thermalinjury,and that the preventive use of anti-aciddrugs during burn shock period wasunreasonable in some respects.Therefore,taking effective measures to improve gastricmucosal blood perfusion as early as possiblepostburn might be more preferable for the AGMLprevention and treatment.
文摘Objectives: Evaluation of the effects of withholding plasma during the initial part of the burn shock period (the shock period in the study is estimated as the first 36 hours following the burns) when it will be lost into the interstitial tissues through the permeable capillaries. During that time crystalloids are administered. Another objective is to evaluate the effect of administering normal saline as the crystalloid resuscitation fluid during the initial part of the shock period. Design: A Retrospective 4 years study compares the use of normal saline as the resuscitative intravenous fluid during the first 12 hours post burns followed by intravenous 5% Purified Plasma Protein Fraction (PPPF) during the rest of the shock period i.e. the remaining 24 hours, with the use of the PPPF throughout the burns shock period according to Muir and Barclay formula. Setting: The Plastic Surgery Department and the Department of Laboratory, Directorate General of Khoula Tertiary Hospital, Muscat, Sultanate of Oman. Patients and Methods: The study included 2 groups of patients;Group A: Patients who received 5% Plasma (Human PPPF) throughout the shock period and Group B: Patients who received crystalloids in the form of normal saline during the first 12 hours post burn followed by plasma for the next 24 hours. Monitoring of the patients in both groups was done by using clinical signs of pulse, blood pressure, temperature and urine output and by using laboratory investigations in the form of the haematocrit value, sodium, potassium, chloride, total proteins and albumin levels in the blood at the time of admission and at the end of the shock period. Results: 140 patients were included in the study;64 in Group A and 76 in Group B. There was no mortality and the vital signs were maintained during the shock period in both groups. The mean values of urine output were nearer to the normal level in Group B compared to Group A. The same was observed regarding the Haematocrit value. In both groups the mean values showed no hypoproteinaemia or hypoalbuminaemia at the end of the shock period. There was no hypernatraemia in spite of giving 150 mmol/L of Na during the initial 12 hours post burns in Group B. The mean values of potassium and chloride levels were normal in both groups at the end of the shock period. Conclusion: Giving plasma during the first 12 hours of the burn shock period when the capillary leakage is maximum has no significant benefit. The plasma usage can be reduced by 50% compared to the use of the Muir and Barclay Formula from the beginning of the shock period with reduction of the costs and the possibility of transmission of undetected pathogens by nearly the same value if crystalloids are given during the first 12 hours of burns shock period. The use of isotonic normal saline during the first 12 hours appears more appropriate as it maintains adequate sodium balance to correct the hyponatraemia and at the same time prevents elevation of the serum potassium during the period when potassium is released from the cells. In addition, it does not have a significant reduction on the level of the serum proteins.
文摘A model of burn shock was reproduced in rats and the changes of water content andmalondialdehyde(MDA)concentration in tissues were measured.The results showed that there wasa significant increase of MDA concentration and water content in lung and bumed skin post burnand a positive correlation was found between MDA level and water content.Pretreatment withsuperoxide dismutase(SOD)prevented effectively lung and skin from edema.The role of oxygen freeradicals in vascular permeability disturbance and development of edema in burns was discussed.
文摘To investigate the effect of hypertonic saline / dextran 70 (HSD) on cardiac function in delayed resuscitation of burn shock. Methods: HSD was used for resuscitation 6 h postburn in dogs and its effect on cardiac function was evaluated byvolume load,MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax, CO and SVR. Results: The volume of HSD was 30.50% less duringfirst 24 h postburn and 59.50% less during 4 h after resuscitation than that of lactated Ringer’s solution (LR’s). MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax and CO increased and SVR reduced in HSD resuscitation. Conclnsion: Smaller volume of HSD canexpand plasma volume significantly and improve cardiac function in delayed resuscitation of burn shock.
