Kawakami M, Endoh Y, Orringer E P, Meyer A A
North Carolina Jaycee Burn Center, Chapel Hill.
J Burn Care Rehabil. 1992 May-Jun;13(3):316-22. doi: 10.1097/00004630-199205000-00003.
Severe burn injury impairs tissue perfusion both by adversely altering the rheologic properties of blood and by decreasing circulating blood volume. Although resuscitation is known to improve perfusion by increasing whole blood volume, it is possible that it may also improve blood flow. To assess these latter effects of resuscitation after burn injury, we studied several determinants of blood flow. Burned animals were resuscitated with 20 ml of lactated Ringer's solution given intraperitoneally. This fluid resuscitation significantly improved the hemoconcentration that was produced by burn injury (p less than 0.05). Burn injury caused an increase in free plasma hemoglobin (p less than 0.05). Fluid resuscitation after injury reduced free plasma hemoglobin compared with that of the burned animals (p less than 0.05), although it still remained higher than free plasma hemoglobin in unburned controls (p less than 0.05). Increased whole blood viscosity and increased osmotic fragility, which were caused by burn injury, were also corrected by fluid resuscitation. Finally, the decrease in red blood cell membrane deformability that is associated with burn injury was improved by resuscitation, although it never completely returned to normal. These results demonstrate beneficial effects of fluid resuscitation on rheologic properties of blood after burn injury. Restoration of blood flow to tissue by resuscitation after burn injury may be due to improved blood rheology as well as to intravascular volume loading.
严重烧伤会通过不利地改变血液的流变学特性以及减少循环血容量来损害组织灌注。尽管已知复苏通过增加全血容量来改善灌注,但它也可能改善血流。为了评估烧伤后复苏的这些后期影响,我们研究了血流的几个决定因素。给烧伤的动物腹腔内注射20毫升乳酸林格氏液进行复苏。这种液体复苏显著改善了烧伤所致的血液浓缩(p<0.05)。烧伤导致游离血浆血红蛋白增加(p<0.05)。与烧伤动物相比,损伤后的液体复苏降低了游离血浆血红蛋白(p<0.05),尽管其仍高于未烧伤对照的游离血浆血红蛋白(p<0.05)。烧伤所致的全血粘度增加和渗透脆性增加也通过液体复苏得到纠正。最后,与烧伤相关的红细胞膜变形性降低通过复苏得到改善,尽管其从未完全恢复正常。这些结果证明了液体复苏对烧伤后血液流变学特性的有益影响。烧伤后复苏使组织血流恢复可能是由于血液流变学改善以及血管内容量负荷增加。