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编号:10522973
两种复苏措施对犬海水浸泡弹烧复合伤血流动力学的影响
http://www.100md.com 2005年1月17日 中国危重病急救医学2005年1月第17卷第1期
     陈强 赖西南 葛衡江

    【摘要】 目的 比较标准Parkland公式复苏与改良液体复苏对弹烧复合伤后海水浸泡犬血流动力学的影响,为早期救治提供理论依据。方法海水浸泡弹烧复合伤模型犬20只随机分为海水浸泡弹烧复合伤组(浸泡组,n=8)、标准Parkland公式复苏组(标准组,n=6)与改良液体复苏组(改良组,n=6),动态监测伤前及伤后4、7、10、20和28 h共6个时间点的中心体温、尿量、心率(HR)、平均动脉压(MAP)、平均肺动脉压(MPAP)、中心静脉压(CVP)、肺毛细血管楔压(PCWP)、心脏指数(CI)的变化,计算每搏输出指数(SVI)、外周循环阻力指数(SVRI)、肺循环阻力指数(PVRI)、左室每搏功输出指数(LVSWI)和右室每搏功输出指数(RVSWI),并观察动物死亡率。结果采用标准Parkland公式复苏,血流动力学、中心体温、尿量均有明显改善,但复苏早期(伤后7 h)CVP偏高,达(14.7±3.1)cm H2O(1 cm H2O=0.098 kPa);实验后期血流动力学稳定性较差;尿量在伤后7 h偏多,达(2.38±0.18)ml·h-1·kg-1。改良组血流动力学指标改善明显优于标准组,不仅纠正了标准组复苏早期容量超载的风险,而且在实验后期,血流动力学较标准组更稳定。改良组动物在观察期内全部存活,而浸泡组死亡4只,标准组死亡1只。结论改良液体复苏较Parkland公式复苏更适合于弹烧复合伤后海水浸泡动物的早期液体复苏。

    【关键词】 复苏; 海水浸泡; 弹烧复合伤; 血流动力学

    Comparsion of resuscitation with Parkland formula and with improved protocol on hemodynamics in projectile-burn combined wound in dogs with seawater immersion

    CHEN Qiang, LAI Xi-nan, GE Heng-jiang.

    Department of Anesthesiology, Daping Hospital and Research Institute of Surgery, The Third MilitaryMedical University, Chongqing 400042, China

    【Abstract】 Objective To compare hemodynamic effects of resuscitation with Parkland formula or with the improved protocol on projectile-burn combined wound in dogs with seawater immersion. Methods A model of projectile-burn combined wound in dogs with seawater immersion was reproduced, and 20 dogs were randomized into three groups: projectile-burn combined wound with seawater immersion(immersion group, n=8), Parkland formula resuscitation (lactated Ringer's solution 4 ml/kg per 1% total body surface area for 24 hours, standard resuscitation group,n=6), and improved protocol groups (lactated Ringer's solution 2.5 ml/kg per 1% total body suface area colloid solution 6% hetastarch 0.5 ml/kg per 1% total body surface area for 24 hours, improved group, n=6). Changes of hemodynamics and central temperature (CT) before injury, and 4, 7, 10, 20 and 28 hours after injury were observed. The mortality was observed. Results After resuscitation with Parkland formula, CT as well as hemodynamic indexes and amount of urine were improved, but central venous pressure (CVP) and the amount of urine were higher in early period of resuscitation. CVP was (14.7±3.1)cm H2O and the amount of urine was(2.38±0.18)ml·h-1·kg-1 at 7 hours after injury. Hemodynamics was not stable during later period of experiment. After resuscitation with the improved protocol, the hemodynamics ameliorated better than resuscitation with Parkland formula. No animals died in improved group, but 4 and 1 died respectively in immersion group and standard resuscitation group. Conclusion Fluid resuscitation according to the improved protocol is more suitable for projectile-burn combined wound in dogs with seawater immersion than resuscitation with Parkland formula. ......

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