[犬35%体表面积烧伤肠内复苏时葡萄糖电解质溶液肠吸收速率的研究]

[Study on intestinal absorption rate of glucose electrolyte solution during enteral resuscitation of 35% total body surface area burn injury in dog].

作者信息

Che Jin-wei, Hu Sen, Du Ying, Bao Cheng-mei, Tian Yi-jun, Wang Lei, Sheng Zhi-yong

机构信息

Laboratory of Shock and Organ Dysfunction, Burns Institute, First Affiliated Hospital of PLA General Hospital, Beijing 100037, China.

出版信息

Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2008 Mar;20(3):163-6.

PMID:18328130

Abstract

OBJECTIVE

To investigate the intestinal absorption rate of glucose-electrolyte solution (GES) during enteral resuscitation of burn injury in Beagle dogs, and compare the effect of enteral intake with that of intravenous infusion resuscitation.

METHODS

Twelve male Beagle dogs were subjected to a 35% total body surface area (TBSA) full-thickness flame III degree injury. Thirty minutes after burn, each dog was given either enteral resuscitation with a GES (EGES group) or intravenous resuscitation with lactated Ringer's solution (IVLR group), and the amount and speed of replenishment of fluid were in accordance with Parkland formula. In the first 8 hours post burn, intestinal absorption rates of water and Na+ were continuously assessed using phenol red as a nonabsorbable marker for water absorption rate. The plasma volume (PV) was measured by the dye (indocyanine green) dilution technique, and the plasma concentration of Na+, mean arterial pressure (MAP) cardiac output (CO), and urine volume were also determined in the first 8 hours. All above measurement were performed in animals without anesthesia. At the end of 8-hour-period of experiment, the remnant fluids in the intestine were collected to calculate the total volume of fluid absorbed in 8 hours.

RESULTS

The intestinal absorption rates of water and Na+ reduced markedly down to lowest level (21% and 37% of pre-injury level) at 3.5 hours post burn, and then increased slowly. But the mean absorption rate of water was similar to infusing rate according to Parkland formula [(99+/-47) mlxh(-1)xm(-1) vs. (81+/-11) mlxh(-1)xm(-1), P>0.05]. The total fluid absorbed by intestine was (94.8+/-3.7)% of the total fluid infused within 8 hours post burn. There were no significant differences in plasma concentration of Na+, MAP and CO between two groups at 8 hours post burn. The urine volume and PV at 4 hours in EGES group were lower than those in IVLR group (both P<0.05), but those indexes at 8 hours showed no significant difference between two groups (both P>0.05).

CONCLUSION

Intestinal absorption rate of fluid given according to Parkland formula after burn injury is sufficient to resuscitate shock in animals suffering from a 35%TBSA full-thickness burn. Enteral resuscitation with GES may attain a similar therapeutic effect in expanding PV and maintain hemodynamic parameters.

摘要

目的

探讨葡萄糖电解质溶液（GES）在比格犬烧伤肠内复苏期间的肠吸收速率，并比较肠内补液与静脉输液复苏的效果。

方法

12只雄性比格犬遭受35%总体表面积（TBSA）全层火焰Ⅲ度烧伤。烧伤后30分钟，每只犬分别接受GES肠内复苏（EGES组）或乳酸林格氏液静脉复苏（IVLR组），补液量和速度按照Parkland公式。在烧伤后的前8小时，以酚红作为水吸收速率的不可吸收标记物，连续评估水和Na⁺的肠吸收速率。采用染料（吲哚菁绿）稀释技术测量血浆容量（PV），并在最初8小时内测定血浆Na⁺浓度、平均动脉压（MAP）、心输出量（CO）和尿量。所有上述测量均在未麻醉的动物身上进行。在实验8小时结束时，收集肠内残余液体以计算8小时内吸收的液体总量。

结果

烧伤后3.5小时，水和Na⁺的肠吸收速率显著降低至最低水平（分别为伤前水平的21%和37%），然后缓慢上升。但水的平均吸收速率与根据Parkland公式的输注速率相似[（99±47）ml·h⁻¹·m⁻¹对（81±11）ml·h⁻¹·m⁻¹，P>0.05]。烧伤后8小时内肠吸收的总液体量为输注总液体量的（94.8±3.7）%。烧伤后8小时，两组间血浆Na⁺浓度、MAP和CO无显著差异。EGES组4小时时的尿量和PV低于IVLR组（均P<0.05），但两组8小时时的这些指标无显著差异（均P>0.05）。