Lalonde C, Knox J, Youn Y K, Demling R
Longwood Area Trauma Center, Brigham and Women's Hospital, Boston, Mass.
Surgery. 1992 Nov;112(5):908-17.
We determined the lung and systemic response of a moderate smoke inhalation injury combined with a 15% total body surface third-degree burn compared with a burn alone and inhalation alone. Adult sheep were prepared with chronic lung and bilateral prefemoral soft tissue lymph fistula. The burn was confined to one side. Physiologic parameters, lymph flow (QL), and lymph/plasma protein ratio were monitored. Oxidant changes were measured as lipid peroxidation by circulating and lymph-conjugated dienes and lung tissue malondialdehyde. Animals were resuscitated with lactated Ringer's solution during the 24-hour study period to restore and maintain vascular filling pressures and cardiac index. We found net 24-hour fluid balance for burn-inhalation injuries to be 4.1 +/- 1.2 L compared with burn alone of 2.9 +/- 0.9 L and inhalation alone of 2.4 +/- 0.5 L, a significant difference. Protein-rich burn tissue QL increased by fivefold to sixfold with burn alone compared with more than tenfold with burn-inhalation injury. A twofold increase in both lung and nonburn soft tissue QL was also seen in the combined injury not seen with burn alone. Arterial blood gases decreased only at 12 hours. Plasma conjugated dienes were increased in all groups, whereas burn lymph values were increased only in combined insult. In addition, lung malondialdehyde content at 24 hours was 155 +/- 11 nmol/gm with burn-inhalation injury compared with 62 +/- 8 nmol/L for burn alone, 55 +/- 9 nmol/L in inhalation alone, and 45 +/- 4 nmol/L for controls. However, no alveolar flooding was noted in any group. We conclude that a modest smoke inhalation (carboxyhemoglobin of 25%) added to a 15% total body surface burn markedly increases the degree of burn edema, as well as nonburn soft tissue and lung QL, compared with burn alone, indicating increased plasma to interstitial fluid transport in these tissues as well. Increased burn tissue lipid peroxidation products corresponded with the increased burn fluid losses. The increased lung lipid peroxidation also indicates further lung oxidant activity as well.
我们测定了中度烟雾吸入性损伤合并15%体表面积三度烧伤时的肺部和全身反应，并与单纯烧伤和单纯吸入损伤进行了比较。成年绵羊制备了慢性肺部和双侧股前软组织淋巴瘘。烧伤局限于一侧。监测生理参数、淋巴流量（QL）和淋巴/血浆蛋白比值。通过循环和淋巴共轭二烯以及肺组织丙二醛测定脂质过氧化来衡量氧化变化。在24小时的研究期间，用乳酸林格氏液对动物进行复苏，以恢复和维持血管充盈压和心脏指数。我们发现，烧伤合并吸入损伤组24小时的净液体平衡为4.1±1.2L，单纯烧伤组为2.9±0.9L，单纯吸入损伤组为2.4±0.5L，差异显著。单纯烧伤时，富含蛋白质的烧伤组织QL增加了五到六倍，而烧伤合并吸入损伤时则增加了十倍以上。合并损伤时，肺部和非烧伤软组织的QL也增加了两倍，单纯烧伤时未见此现象。动脉血气仅在12小时时下降。所有组的血浆共轭二烯均升高，而仅在合并损伤时烧伤淋巴值升高。此外，烧伤合并吸入损伤组24小时时肺丙二醛含量为155±11nmol/g，单纯烧伤组为62±8nmol/L，单纯吸入损伤组为55±9nmol/L，对照组为45±4nmol/L。然而，任何组均未发现肺泡积水。我们得出结论，与单纯烧伤相比，15%体表面积烧伤合并中度烟雾吸入（碳氧血红蛋白为25%）显著增加了烧伤水肿程度以及非烧伤软组织和肺部的QL，表明这些组织中血浆向间质液的转运也增加。烧伤组织脂质过氧化产物增加与烧伤液体丢失增加相对应。肺脂质过氧化增加也表明肺部氧化活性进一步增强。
