Horton J W, White D J, Baxter C R
Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9031.
Ann Surg. 1990 Mar;211(3):301-11.
Burn treatment requires large volumes of crystalloid, which may exacerbate burn-induced cardiopulmonary dysfunction. Small-volume hypertonic saline dextran (HSD) resuscitation has been used for effective treatment of several types of shock. In this study isolated coronary perfused guinea pig hearts were used to determine if HSD improved left ventricular contractile response to burn injuries. Parameters measured included left ventricular pressure (LVP) and maximal rate of LVP rise (+dP/dt max) and fall (-dP/dt max) at a constant preload. Third-degree scald burns comprising 45% of total body surface area (burn groups, N = 75), or 0% for controls (group 1, N = 25) were produced using a template device. In group 2, 25 burned guinea pigs were not fluid resuscitated and served as untreated burns; 20 burns were resuscitated with 4 mL lactated Ringer's (LR) solution/kg/% burn for 24 hours (group 3); additional burn groups were treated with an initial bolus of HSD (4 mL/kg, 2400 mOsm, sodium chloride, 6% dextran 70) followed by either 1, 2, or 4 mL LR/kg/% burn over 24 hours (groups 4, 5, and 6, respectively). Untreated burn injury significantly impaired cardiac function, as indicated by a fall in LVP (from 88 +/- 3 to 68 +/- 4 mmHg; p = 0.01) and +/- dP/dt max (from 1352 +/- 50 to 1261 +/- 90 and from 1150 +/- 35 to 993 +/- 59; p = 0.01, respectively) and a downward shift of LV function curves from those obtained from control hearts. Compared to untreated burns, hearts from burned animals treated with LR alone showed no significant improvement in cardiac function. However hearts from burned animals treated with HSD + 1 mL LR/kg/% burn had significantly higher LVP (79 +/- 4 vs. 68 +/- 4 mmHg, p = 0.01) and +/- dP/dt max (+dP/dt: 1387 +/- 60 vs. 1261 +/- 90 mmHg/sc, p = 0.01; -dP/dt: 1079 +/- 50 vs. 993 +/- 59 mmHg/sc, p = 0.01) than hearts from untreated burned animals and generated left ventricular function curves comparable to those calculated for hearts from control animals. Mortality 24 hours after burn was 29% for untreated burns was 0% for control animals, as well as for groups treated with the Parkland formula or HSD plus 1 or 2 mL/kg/% burn lactated Ringer's. The only deaths after treatment occurred in those animals given HSD plus 4 mL/kg/% burn, Parkland formula (17% mortality).(ABSTRACT TRUNCATED AT 400 WORDS)
烧伤治疗需要大量晶体液，这可能会加重烧伤引起的心肺功能障碍。小容量高渗盐水右旋糖酐（HSD）复苏已被用于有效治疗多种类型的休克。在本研究中，使用离体冠状动脉灌注豚鼠心脏来确定HSD是否能改善左心室对烧伤损伤的收缩反应。测量的参数包括左心室压力（LVP）以及在恒定前负荷下LVP上升（+dP/dt max）和下降（-dP/dt max）的最大速率。使用模板装置造成占全身表面积45%的三度烫伤（烧伤组，N = 75），对照组为0%（第1组，N = 25）。在第2组中，25只烧伤豚鼠未进行液体复苏，作为未治疗的烧伤组；20只烧伤动物用4 mL乳酸林格氏液（LR）/kg/%烧伤量进行24小时复苏（第3组）；其他烧伤组先用HSD初始推注（4 mL/kg，2400 mOsm，氯化钠，6%右旋糖酐70），然后在24小时内分别用1、2或4 mL LR/kg/%烧伤量进行后续治疗（分别为第4、5和第6组）。未治疗的烧伤损伤显著损害心脏功能，表现为LVP下降（从88±3降至68±4 mmHg；p = 0.01）以及±dP/dt max下降（从1352±50降至1261±90以及从1150±35降至993±59；p分别为0.01），并且左心室功能曲线相对于对照心脏所获得的曲线向下移位。与未治疗的烧伤相比，仅用LR治疗的烧伤动物心脏的心脏功能没有显著改善。然而，用HSD + 1 mL LR/kg/%烧伤量治疗的烧伤动物心脏的LVP（79±4对68±4 mmHg，p = 0.01）和±dP/dt max（+dP/dt：1387±60对1261±90 mmHg/sc，p = 0.01；-dP/dt：1079±50对993±59 mmHg/sc，p = 0.01）显著高于未治疗的烧伤动物心脏，并且产生的左心室功能曲线与对照动物心脏计算得出的曲线相当。烧伤后24小时，未治疗的烧伤死亡率为29%，对照动物以及用帕克兰公式或HSD加1或2 mL/kg/%烧伤量乳酸林格氏液治疗的组死亡率为0%。治疗后唯一的死亡发生在给予HSD加4 mL/kg/%烧伤量、帕克兰公式治疗的动物中（死亡率17%）。（摘要截断于400字）
