Dyess D L, Ardell J L, Townsley M I, Taylor A E, Ferrara J J
Department of Surgery, University of South Alabama, Mobile 36688.
Am J Physiol. 1992 Jun;262(6 Pt 2):H1832-7. doi: 10.1152/ajpheart.1992.262.6.H1832.
Administration of hyperosmolar fluids to burn patients has been proposed as a means of decreasing resuscitative fluid volume and, subsequently, wound edema accumulation. To test this hypothesis, canine hindpaw lymph flow (QL) and lymph (CL) and plasma (CP) total protein concentrations were measured, and capillary filtration coefficient (Kf) was calculated before and for 6 h after a 5-s 100 degrees C footpaw scald. Scald was followed 30 min later by bolus infusion (4 ml/kg) of 7% saline or 6% Dextran 70 or the two in combination. Before scald, venous pressure was elevated until a minimal CL/CP was reached. The reflection coefficient (sigma d) was calculated by the formula: 1-minimal CL/CP. Scald increased QL, CL/CP, and Kf, but sigma d was decreased (P less than 0.05). Compared with burn alone, 7% saline exacerbated burn-induced increases in QL and Kf. In contrast, infusion of Dextran 70 did not exacerbate these changes in QL or Kf. Perhaps more importantly, Dextran 70 may have attenuated the increase in CL/CP and reduced edema formation in the burned hindpaw. However, the addition of 7% saline to the dextran eliminated these beneficial effects.
有人提出给烧伤患者输注高渗液，作为减少复苏液量并进而减少伤口水肿积聚的一种方法。为验证这一假设，在犬后爪进行5秒100℃足底烫伤前及烫伤后6小时，测量犬后爪淋巴流量（QL）、淋巴（CL）和血浆（CP）总蛋白浓度，并计算毛细血管滤过系数（Kf）。烫伤30分钟后，推注输注（4毫升/千克）7%盐水、6%右旋糖酐70或二者的组合。在烫伤前，升高静脉压直至达到最小CL/CP。反射系数（σd）通过以下公式计算：1 - 最小CL/CP。烫伤增加了QL、CL/CP和Kf，但σd降低（P < 0.05）。与单纯烧伤相比，7%盐水加剧了烧伤诱导的QL和Kf增加。相比之下，输注右旋糖酐70并未加剧QL或Kf的这些变化。也许更重要的是，右旋糖酐70可能减弱了CL/CP的增加，并减少了烧伤后爪的水肿形成。然而，在右旋糖酐中加入7%盐水消除了这些有益效果。
