Demling R, LaLonde C, Knox J, Youn Y K, Zhu D, Daryani R
Longwood Area Trauma Center, Brigham and Women's Beth Israel Hospital, Boston, MA 02115.
J Trauma. 1991 Apr;31(4):538-43; discussion 543-4. doi: 10.1097/00005373-199104000-00014.
We studied the effect of deferoxamine (DFO) infused after burns on hemodynamic stability as well as local and systemic inflammation and oxidant-induced lipid peroxidation. Eighteen anesthetized sheep were given a 40% of total body surface burn and fluid resuscitated to restore oxygen delivery (DO2) and filling pressures to baseline values. Animals were resuscitated with lactated Ringer's (LR) alone or LR plus 1,500 ml of a 5% hetastarch complexed with DFO (8 mg/ml). Animals were killed 6 hours postburn. The sheep resuscitated with LR and LR plus hetastarch demonstrated significant lung inflammation and significant increases in lung and liver malondialdehyde (MDA) from controls of 47 +/- 6 and 110 +/- 7 nMol/gm to 63 +/- 13 and 202 +/- 59 for LR and 67 +/- 4 and 211 +/- 9 for LR + hetastarch, respectively. The group resuscitated with hetastarch alone required 15% less fluid. VO2 returned to baseline values in both groups by 2 hours. Resuscitation with the 5% hetastarch-DFO decreased total fluids by 30% over LR and prevented the increase in lung and liver MDA. In addition, postburn VO2 increased by 25% above baseline values. Burn tissue edema, measured as protein-rich lymph flow, was significantly increased with the administration of DFO compared with the other groups. We conclude that DFO used for burn resuscitation prevents systemic lipid peroxidation and decreases the vascular leak in nonburn tissues while also increasing O2 utilization. Resuscitation with hetastarch-DFO may accentuate burn tissue edema, possibly by increased perfusion of burn tissue.
我们研究了烧伤后输注去铁胺（DFO）对血流动力学稳定性以及局部和全身炎症反应、氧化应激诱导的脂质过氧化的影响。18只麻醉的绵羊全身40%体表烧伤，给予液体复苏以将氧输送（DO2）和充盈压恢复至基线值。动物分别单独用乳酸林格氏液（LR）或LR加1500ml与DFO（8mg/ml）络合的5%羟乙基淀粉进行复苏。烧伤后6小时处死动物。用LR和LR加羟乙基淀粉复苏的绵羊出现显著的肺部炎症，肺和肝脏丙二醛（MDA）较对照组显著增加，LR组从47±6和110±7nMol/g分别增至63±13和202±59，LR加羟乙基淀粉组分别为67±4和211±9。单独用羟乙基淀粉复苏的组所需液体量少15%。两组VO2在2小时时均恢复至基线值。用5%羟乙基淀粉-DFO复苏比用LR总液体量减少30%，并防止肺和肝脏MDA增加。此外，烧伤后VO2比基线值增加25%。与其他组相比，给予DFO后以富含蛋白质的淋巴液流量衡量的烧伤组织水肿显著增加。我们得出结论，用于烧伤复苏的DFO可防止全身脂质过氧化，减少非烧伤组织的血管渗漏，同时增加氧利用。用羟乙基淀粉-DFO复苏可能会加重烧伤组织水肿，可能是由于烧伤组织灌注增加所致。
