Sakurai Hiroyuki, Nozaki Motohiro, Traber Kazutaka Soejima Lillian D, Traber Daniel L
Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666 Japan.
Burns. 2005 Sep;31(6):737-43. doi: 10.1016/j.burns.2005.03.002.
Markedly elevated levels of plasma atrial natriuretic peptide (ANP), which exhibit potent diuretic and vasoactive properties, has been well documented in patients with acute lung injury. We examined the physiological effects of additional smoke inhalation on plasma ANP concentrations in an ovine burn model. Seventeen sheep were instrumented to receive fluid and have physiological measurements taken. The burn group (n=8) received 40% body surface area third degree burn and the burn+smoke group (n=9) received the same burn plus 48 breaths of cotton smoke insufflation. The animals were resuscitated according to the Parkland formula with Ringer's lactate in the following 72 h period. Hemodynamic, oxygenation, fluid balance, and plasma ANP levels were serially determined. The effects of smoke inhalation manifested as deteriorated oxygenation, and increased fluid accumulation after a sustained initial shock period of more than 12 h. Plasma ANP levels in the burn+smoke group showed a biphasic elevation, whereas the burn group showed no appreciable changes throughout the whole experimental period. The initial increase in plasma ANP concentrations occurred immediately after injury (from 96+/-10 at baseline to 136+/-17 pg/mL at 3h after injury); thereafter, it decreased towards baseline value, followed by a second increase in the post resuscitation period (183+/-43 pg/mL at 72 h after injury). Decreased urine output and accentuated pulmonary vascular resistance in the combined injury group was observed between the two ANP level peaks, indicating that ANP release modified physiological responses to the burn+smoke injury.
血浆心钠素（ANP）水平显著升高，它具有强大的利尿和血管活性特性，这在急性肺损伤患者中已有充分记录。我们在绵羊烧伤模型中研究了额外吸入烟雾对血浆ANP浓度的生理影响。17只绵羊安装了接受液体和进行生理测量的装置。烧伤组（n = 8）接受40%体表面积的三度烧伤，烧伤+烟雾组（n = 9）接受相同的烧伤并加48次棉烟吹入。在接下来的72小时内，按照帕克兰公式用乳酸林格氏液对动物进行复苏。连续测定血流动力学、氧合、液体平衡和血浆ANP水平。吸入烟雾的影响表现为氧合恶化，以及在持续超过12小时的初始休克期后液体蓄积增加。烧伤+烟雾组的血浆ANP水平呈双相升高，而烧伤组在整个实验期间没有明显变化。血浆ANP浓度在受伤后立即出现初始升高（从基线时的96±10升高到受伤后3小时的136±17 pg/mL）；此后，它降至基线值，随后在复苏期出现第二次升高（受伤后72小时为183±43 pg/mL）。在两个ANP水平峰值之间观察到联合损伤组的尿量减少和肺血管阻力增加，表明ANP释放改变了对烧伤+烟雾损伤的生理反应。
