摘要
目的研究丙酮酸钠羟乙基淀粉(HES)胶体液对50%总体表面积(TBSA)Ⅲ度烧伤大鼠肾血流量和肾功能指标的影响。方法选取SD大鼠180只,100℃水浴烫伤制成50%TBSAⅢ度烧伤模型,37℃水浴制备假伤模型。随机数字表法分为5组:单纯烧伤组(n=20)、假伤组(n=40)、丙酮酸钠HES组(n=40)、醋酸钠HES组(n=40)和氯化钠HES组(n=40),其中前2组大鼠不补液,后3组(统称复苏组)伤后通过颈静脉导管补液,用微量输液泵控制输液速度。静脉补液总量为0.75 m L/kg×1%TBSA,胶晶比例1∶1,伤后12 h内输完,前4 h各复苏组输入总量的1/2均为醋酸钠林格氏液,后8 h输入总量的余1/2为相应不同胶体。单纯烧伤组于伤后4、8 h分别选取鼠10只,余4组于伤后4、8、12、24 h各时刻点选取鼠10只,激光多普勒血流仪测定肾血流量(RBF),全自动生化分析仪测定血浆中肌酐和尿素氮含量。采用SPSS17.0统计软件包分析,组间两两比较采用单因素方差分析。结果伤后4、8 h,单纯烧伤组大鼠RBF(32.10±6.40、11.80±5.43)BPU较假伤组(146.50±23.73、144.80±24.27)BPU降低,差异有统计学意义(P<0.05);伤后4、8、12、24 h,丙酮酸钠HES组、醋酸钠HES组、氯化钠HES组大鼠RBF分别为(46.40±8.14、104.80±22.75、89.40±12.07、77.10±10.78)、(45.50±8.21、77.20±13.19、70.60±10.55、56.90±8.49)、(45.30±8.76、58.10±11.32、51.70±9.65、40.20±8.25)BPU,均较假伤组(146.50±23.73、144.80±24.27、147.60±26.55、143.20±23.94)BPU明显降低,差异均有统计学意义(P均小于0.05);伤后8、12、24 h,丙酮酸钠HES组RBF均高于醋酸钠HES组和氯化钠HES组,醋酸钠HES组又高于氯化钠HES组,差异均有统计学意义(P均小于0.05)。伤后24 h,丙酮酸钠HES组血浆肌酐(66.70±6.67)μmol/L显著低于醋酸钠HES组(80.20±9.97)μmol/L和氯化钠HES组(91.30±9.50)μmol/L,差异均有统计学意义(P均小于0.05),丙酮酸钠HES组尿素氮(29.00±2.48)mmol/L显著低于醋酸钠HES组(34.60±3.11)mmol/L和氯化钠HES组(44.40±4.89)mmol/L,差异均有统计学意义(P均小于0.05)。结论严重烧伤大鼠静脉复苏时,HES 130/0.4的载体溶液对肾功能有明显的影响,丙酮酸钠HES能显著改善50%TBSA烧伤大鼠RBF和肾功能指标,优于常用的氯化钠HES和醋酸钠HES。
Objective To study the effects of pyruvate-containing hydroxyethyl starch （HES 130/ 0.4） on renal blood flow and kidney function in rats subjected with 50% total body surface area Ⅲ degree burns. Methods One hundred and eighty SD rats, of which 160 rats were subjected to a 50% total body surface area burn, were divided into five groups： burns without fluid resuscitation （n = 20） , shame control group（n = 40）, burns with pyruvate-containing hydroxyethyl starch group （n = 40）, burns with acetatecontaining hydroxyethyl starch group （ n = 40） , and burns with normal saline- containing hydroxyethyl starch group （ n = 40 ）, the front two groups were no resuscition, otherwise fluid infusion was taken via the jugular vein catheter to the after groups, using a trace infusion pump controlled theinfusion speed. The total amount of fluids infused was 0.75 ml/kg × 1% total body surface area （1/2 colloidal rehydration formula） of various hydroxyethyl starch and the equal volume of acetated Ringer＇s solution with the colloid to crystalloid ratio of 1：1 within 12 h post-resuscittion bums. Burn in 4 h with acetated Ringer＇s solution, then in after 8 h with different colloid. Each group was further divided into four subgroups： 4 h, 8 h, 12 h, and 24 h after scald （n = 10 ）. Laser doppler blood flow meter determination of renal blood flow, automatic biochemical analyzer of creatinine and urea nitrogen content in the blood plasma were measured. SPSS 17.0 statistical software package be used to analyze the data, with two comparison using single factor analysis of variance between groups. Results At 4 h and 8 h after burns, the renal blood flow level in burns without fluid resuscitation （32.10 ± 6.40, 11.80 ± 5.43） BPU of rats were lower than those in shame control group （ 146.50 ± 23.73, 144.80 ± 24.27 ） BUP, the difference was statistically significant （ P 〈 0.05 ） ; At 4 h, 8 h, 12 h and 24 h after burns, the renal blood flow of burns with pymvate-containing hydroxyethyl starch group, burns with acetate-containing hydroxyethyl starch group, and bums with normal saline-containing hydroxyethyl starch group were （46.40 ± 8. 14, 104.80 ± 22.75, 89.40 ± 12.07, 77. 10 ± 10.78 ） , （45.50 ±8.21, 77.20 ±13. 19, 70.60±10.55, 56.90±8.49）, （45.30±8.76, 58. 10±11.32, 51.70 ± 9.65, 40.20 ± 8.25 ） BPU, which were all significantly lower than those in shame control group （146.50±23.73, 144. 80 ±24. 27, 147. 60 ±26. 55, 143. 20 ±23.94） BPU, the difference was statistically significant （P 〈0.05） ; At 8 h, 12 h and 24 h after burns, the renal blood flow of burns with pyruvate-containing hydroxyethyl starch group was higher than burns with acetate-containing hydroxyethyl starch group and burns with normal saline-containing hydroxyethyl starch group, and burns with acetatecontaining hydroxyethyl starch group was higher than bums with normal saline-containing hydroxycthyl starch group, the difference was statistically significant（P 〈 0.05 ）. At 24 h after burns, the Cr level of burns with pyruvatecontaining hydroxyethyl starch group was （ 66.70 ± 6.67 ） p.mol/L, which was significantly lower than burns with acetate-containing hydroxyethyl starch group （80.20 ± 9.97 ） μmol/L and normal salinecontaining hydroxyethyl starch group （91.30 ± 9.50） μmol/L（ P 〈 0.05 ）, the difference was statistically significant（ P 〈 0. 05 ）; and BUN of pyruvate-containing hydroxyethyl starch group was （29.00± 2.48） mmol/L, which was also significantly lower than, the difference was statistically significant （P 〈 0.05）. Conclusions The carrier of HES 130/0.4 played a critical role in renal blood flow and kidney function in resuscitation of rats subjected with 50% total body surface area Ⅲ burns. The sodium pyruvatecontaining hydroxyethyl starch might be superior to sodium acetate and normal saline-containing hydroxyethyl starch in preservation of kidney functionduring fluid resuscitation in rats with severe burn injury.
出处
《中华损伤与修复杂志（电子版）》
CAS
2015年第5期13-19,共7页
Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)
基金
军队十一五医学科研专项课题基金资助项目(06Z055)
