Hu Sen, Che Jin-wei, Du Ying, Bao Cheng-mei, Tian Yi-jun, Wang Lei, Geng Shi-jia, Wu Jing, Sheng Zhi-yong
Laboratory of Shock and Organ Dysfunction, Burns Institute, First Affiliated Hospital of PLA General Hospital, Beijing 100037, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2008 Mar;20(3):167-71.
To investigate the effect of carbachol (CAR) on blood flow of intestinal mucosa and absorption rate of glucose-electrolyte solution (GES) during enteral resuscitation of burn shock in dog.
Eighteen male Beagle dogs were subjected to a (51.2+/-2.6)% total body surface area (TBSA) full-thickness flame injury, and fluid resuscitation was given according to Parkland formula 0.5 hour after burn. Animals were randomly divided into intravenous infusion of GES group (VGES group, n=6), enteral infusion of GES group (EGES group, n=6) and EGES containing 0.25 microg/kg of CAR group (EGES/CAR group n=6). In the first 8 hours post burn, intestinal absorption rate of water and Na+, intestinal mucosa blood flow (IBF), the plasma volume (PV) and plasma concentration of Na+ were continuously determined without anesthesia. At the end of 8 hours animals were sacrificed, and specimens of gut tissue were taken to determine the activity of Na+-K+-ATPase.
The intestinal absorption rate of water and Na+ was reduced markedly after burn in two enteral resuscitation groups and much lower than pre-injury levels and the expected infusing rate according to Parkland formula. It was found that the absorption rate of water and Na+ from 1.5 hours and 2.5 hours in EGES/CAR group were significantly higher compared with those in EGES group (all P<0.05). During 8 hours after burn, only 47.1% and 63.8% of fluids enterally infused in EGES and EGES/CAR groups were absorbed by the gut. The volume of fluid absorbed and the fluid absorption rate were significantly higher in EGES/CAR group than those in EGES group (P<0.05). Incidence of gut intolerance (diarrhea) was 83% in EGES group, which was higher than that of in EGES/CAR group (50%). IBF was significantly decreased compared with pre-injury levels in all groups. Enteral infusion of CAR led to a significant elevation of IBF in EGES/CAR compared with GES group from 4 hours after burn, but it was still lower than pre-injury levels and those in VGES group. The Na+-K+-ATPase activity between three groups ranked as follows: VGES group>EGES/CAR group>EGES group (P<0.05). Within 8 hours post injury, PV and plasma concentration of Na+ in two enteral resuscitation groups were much lower than those in VGES group, but from 4 hours after burn the values in EGES/CAR group were higher than those in EGES group (all P<0.05).
50%TBSA full-thickness flame injury led to a markedly decrease in intestinal absorption rate of water and Na+. The total volume of fluid absorbed by intestine in 8 hours was significantly lower in enteral resuscitation groups compared to the regime of the Parkland formula. CAR promoted intestinal absorption rate and PV by increasing the intestinal blood flow and Na+-K+-ATPase activity, and it seems to exert a helpful effect on the resuscitation of burn shock with electrolyte solution per oral route.
探讨卡巴胆碱（CAR）对犬烧伤休克肠内复苏期间肠黏膜血流量及葡萄糖-电解质溶液（GES）吸收率的影响。
18只雄性比格犬经51.2±2.6%总体表面积（TBSA）全层火焰烧伤，伤后0.5小时按Parkland公式进行液体复苏。动物随机分为静脉输注GES组（VGES组，n = 6）、肠内输注GES组（EGES组，n = 6）和含0.25μg/kg CAR的EGES组（EGES/CAR组，n = 6）。烧伤后前8小时，在未麻醉状态下连续测定肠内水和Na⁺吸收率、肠黏膜血流量（IBF）、血浆容量（PV）及血浆Na⁺浓度。8小时末处死动物，取肠组织标本测定Na⁺-K⁺-ATP酶活性。
两个肠内复苏组烧伤后肠内水和Na⁺吸收率明显降低，远低于伤前水平及按Parkland公式预期的输注速率。发现EGES/CAR组1.5小时和2.5小时水和Na⁺吸收率显著高于EGES组（均P<0.05）。烧伤后8小时内，EGES组和EGES/CAR组肠内输注的液体分别仅有47.1%和63.8%被肠道吸收。EGES/CAR组液体吸收量及液体吸收率显著高于EGES组（P<0.05）。EGES组肠道不耐受（腹泻）发生率为83%，高于EGES/CAR组（50%）。所有组IBF均较伤前水平显著降低。肠内输注CAR使EGES/CAR组烧伤后4小时起IBF较GES组显著升高，但仍低于伤前水平及VGES组。三组间Na⁺-K⁺-ATP酶活性排序为：VGES组>EGES/CAR组>EGES组（P<0.05）。伤后8小时内，两个肠内复苏组的PV及血浆Na⁺浓度均远低于VGES组，但烧伤后4小时起EGES/CAR组的值高于EGES组（均P<0.05）。
50%TBSA全层火焰烧伤导致肠内水和Na⁺吸收率显著降低。与Parkland公式方案相比，肠内复苏组8小时内肠道吸收的液体总量明显减少。CAR通过增加肠血流量及Na⁺-K⁺-ATP酶活性促进肠吸收率及PV，似乎对口服电解质溶液复苏烧伤休克有有益作用。
