Cioffi W G, Vaughan G M, Heironimus J D, Jordan B S, Mason A D, Pruitt B A
U.S. Army Institute of Surgical Research, Fort Sam Houston, TX 78234-5012.
Ann Surg. 1991 Sep;214(3):213-8; discussion 218-20. doi: 10.1097/00000658-199109000-00004.
The relationship between effective blood volume and related hormones in burn patients following resuscitation is not well understood. Previous reports have suggested that hormone secretion is altered by a resetting of neural control mechanisms. Serum and urine sodium, plasma renin activity, serum ADH, cardiac index, effective renal plasma flow, and total blood volume were measured in seven burn patients (mean age, total burn size, and postburn day: 32 years, 56%, and 9 days, respectively). The same values (with the exception of cardiac index and blood volume) were measured in 10 control patients (mean age, 24 years). The blood volume of patients was measured by 51chromium red blood cell (RBC) labeling and compared to normal predicted values based on body surface area and sex. Mean serum sodium and osmolality were 138 mmol/L (millimolar) and 286 mosm/kg, respectively, in both patients and control subjects. Mean +/- standard error of the mean total blood volume in the patients was low, 81% +/- 4% of predicted values. Cardiac index and renal plasma flow were significantly elevated. Plasma renin activity and antidiuretic hormone (ADH) levels were elevated and altered in the direction expected from blood volume measurements despite the findings of increased blood flow. Dissociation of organ flow and hormonal response suggests that simultaneous direct blood volume measurements are necessary to elucidate factors other than altered neural control settings to explain hormonal changes in the flow phase of injury. Depressed total blood volume appears to promote elevated ADH levels in burn patients following resuscitation. Whether there is an additional role of altered neural control settings remains to be established.
烧伤患者复苏后有效血容量与相关激素之间的关系尚未完全明确。以往报告表明，神经控制机制的重置会改变激素分泌。对7例烧伤患者（平均年龄、烧伤总面积和烧伤后天数分别为32岁、56%和9天）测定了血清和尿钠、血浆肾素活性、血清抗利尿激素（ADH）、心脏指数、有效肾血浆流量和总血容量。对10例对照患者（平均年龄24岁）测定了相同的值（心脏指数和血容量除外）。通过51铬标记红细胞（RBC）测量患者的血容量，并与基于体表面积和性别的正常预测值进行比较。患者和对照受试者的平均血清钠和渗透压分别为138 mmol/L（毫摩尔）和286 mosm/kg。患者的平均总血容量±平均标准误差较低，为预测值的81%±4%。心脏指数和肾血浆流量显著升高。尽管有血流增加的发现，但血浆肾素活性和抗利尿激素（ADH）水平升高，并朝着与血容量测量预期一致的方向改变。器官血流与激素反应的分离表明，为了解释损伤血流期的激素变化，除了改变神经控制设置外，还需要同时进行直接血容量测量，以阐明其他因素。复苏后烧伤患者总血容量降低似乎会促进抗利尿激素水平升高。神经控制设置改变是否还有其他作用尚待确定。
