摘要
目的观察卡巴胆碱(CAR)对50%TBSA烧伤休克期犬口服补液时组织灌流和脏器功能的改善作用。方法成年雄性Beagle犬12只,先期无菌手术行颈动、静脉置管和肠造口术,24h后用凝固汽油燃烧法分别造成50%TBSA三度烧伤,然后随机均分为口服补液组和CAR组,伤后第1个24h从胃内分别输注葡萄糖-电解质溶液(GES)和含CAR(20μg/kg)的GES液;伤后24h起实施静脉延迟补液,补液量和速率均根据Parkland公式确定。测定动物非麻醉状态下的平均动脉压(MAP)、血浆容量(PV)、尿量、胃黏膜二氧化碳分压(PgCO2)、小肠黏膜血流量(I MBF)以及血浆丙氨酸转氨酶(ALT)、肌酐(Cr)、磷酸肌酸激酶同工酶(CK-MB)、二胺氧化酶(DAO)水平,并统计72h死亡率。结果口服补液组MAP和PV分别于伤后1h和4h降至最低,仅为伤前的29.8%和67.7%,伤后72h恢复至伤前水平;伤后1h和2h CAR组MAP显著高于口服补液组(P<0.05,P<0.01),但PV在两组之间无显著差异。两组伤后尿量均明显减少,且CAR组伤后24h尿量显著高于口服补液组(P<0.05)。两组伤后PgCO2均显著升高,I MBF显著减少;CAR组PgCO2低于口服补液组,I MBF高于口服补液组,且伤后72h均未恢复至伤前水平。两组伤后血浆ALT、Cr、CK-MB、DAO水平均明显高于伤前(P<0.01),且CAR组均明显低于口服补液组(P<0.01),但伤后72h仍显著高于伤前。口服补液组和CAR组72h死亡率分别为50%(3/6)和33%(2/6)。结论50%TBSA烧伤口服补液伍用CAR能显著改善组织灌流和脏器功能,提高口服液体复苏的疗效。
Objective To explore the effect of earbachol （CAR） on splanchnic perfusion and organ function during oral fluid resuscitation in 50% TBSA bum in shock stage in dogs. Methods Twelve adult male Beagle dogs were surgically prepared for jejunostomy and cannulation of carotid artery and jugular vein. Twenty-four hours after the surgical manipulations, the animals were subjected to a 50% TBSA full-thickness flame injury, and then they were randomly divided into oral resuscitation group （OR group） and oral resuscitation＋ CAR group （CAR group）. In the first 24 hours after burn, glucose-electrolyte solution （GES） and GES containing CAR （20μg/kg） were intragastrieally given to animals of OR and CAR group respectively. Fluid resuscitation was delayed for 24h. The delivery rate and volume of GES was in accordance with Parkland formula. Mean arterial pressure （MAP）, plasma volume （PV）, urinary output, gastric mucosa PCOe（PgCO2）, intestinal mucosa blood flow （IMBF） and plasma levels of alanine aminotransferase （ALT）, creatinine （Cr）, MB isoenzyme of creatine kinase （CK-MB） and diamine oxidase （DAO） were determined, and the 72-hour mortality was recorded. Results The values of MAP and PV reached the lowest level at 1 and 4 hours, respectively, after burn in OR group （only 29. 8% and 67. 7% of that before bum）, and they recovered to the pre-burn level at 72h; the values of MAP at 1 and 2 hours after bum in CAR group were higher than those in OR group （P〈0. 05, P〈0. 01）, while no significant difference of PV was found between the two groups. Urinary output was significantly decreased in the two groups after burn, but was higher in CAR group than in OR groups at 24h post bum （P〈 0. 05）. The PgCO2. elevated and IMBF reduced significantly in both groups after burn, while the PgCO2 was lower and IMBF was higher in CAR group than in OR group, and they did not recovered to pre-hum levels at 72h post burn. The plasma levels of ALT, Cr, CK-MB and DAO increased significantly in both groups after burn （P〈0. 01）, but they were lower in CAR group than in OR group, yet still higher than the pre-bum levels at 72h. The 72-hour mortality of OR and CAR group was 50% （3/6） and 33 （2/6）, respectively. Conclusion Carbacbol can improve the splanchnic perfusion and organ function, and promote the efficiency of oral resuscitation in 50% TBSA burn.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2009年第9期1058-1061,共4页
Medical Journal of Chinese People's Liberation Army
基金
军队"十一五"科研计划专项课题(06Z055)
关键词
卡巴胆碱
烧伤
休克
肠内复苏
carbachol
burns
shock
enteral resuscitation
