[卡巴胆碱对犬烧伤休克葡萄糖电解质溶液口服复苏时胃排空及胃黏膜二氧化碳分压的影响]
[Effect of carbachol on gastric emptying and gastric mucosa partial pressure of carbon dioxide in oral resuscitation of burn shock with a glucose-electrolyte solution in dogs].
作者信息
Tian Yi-jun, Hu Sen, Du Ying, Che Jin-wei, Geng Shi-jia, Wu Jing, 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):172-5.
OBJECTIVE
To investigate the effect of carbachol (CAR) on gastric emptying and gastric mucosa partial pressure of carbon dioxide (PgCO2) in the resuscitation of burn shock with oral administration of glucose-electrolyte solution (GES) in dogs.
METHODS
Twenty-four adult male Beagle dogs were randomly divided into 4 groups: 35% total body surface area (TBSA) III degree burn resuscitated with oral GES (35% TBSA GES, n=6), 35% TBSA III degree burn with oral GES containing 20 microg/kg of CAR (35% TBSA GES/CAR, n=6), 50% TBSA III degree burn with oral GES (50% TBSA GES, n=6) and 50% TBSA III degree burn with oral GES containing 20 microg/kg of CAR (50% TBSA GES/CAR, n=6). Dogs were subjected to 35% TBSA or 50% TBSA full-thickness flame injury respectively. Thirty minutes after burn, dogs were given GES or GES containing CAR according to Parkland formula (1/2 of 4 mlxkg(-1)x1% TBSA(-1) within 8 hours post burn, and the remaining 1/2 within next 16 hours post burn) by gavage. The gastric emptying rate, PgCO2 and intolerance symptoms were determined at 2, 4, 8 and 24 hours post burn.
RESULTS
The gastric emptying rate was significantly decreased in all groups after the burn (P<0.05), and it was 51.5% at 2 hours after burn in 35% TBSA GES group and 39.2% at 4 hours after burn in 50% TBSA GES group. It was gradually ameliorated, but still much lower than pre-injury levels (both P<0.05). The gastric emptying rate in GES/CAR group were significantly higher at all time points after injury than those in 35% GES group (P<0.05), and it was higher than that in 50% GES group at 8 hours and 24 hours (both P<0.05). The gastric emptying rate restored to pre-injury levels (P>0.05) in 35% GES/CAR group, and it was still lower than pre-injury level in 50% GES/CAR group (P<0.05). The PgCO2 were significantly elevated in all groups post burn (all P<0.05), and could not return to pre-injury levels. The PgCO2 in GES/CAR group were significantly higher at all time points after injury than those in 35% GES group (P<0.05), and it was higher than that in 50% GES group at 4 hours and 24 hours (P<0.05). The degree of gastric intolerance symptoms could be ranked as follows: 50%TBSA GES group (83.3%, 5/6)>50% TBSA GES/CAR group (50.0%, 3/6)>35%TBSA GES group (16.7%, 1/6)>35%TBSA GES/CAR group (0, 0/6).
CONCLUSION
The results indicate that CAR has a significant effect in improving gastric emptying and gastric ischemia during oral resuscitation of burn shock with a glucose electrolyte solution.
目的
探讨卡巴胆碱（CAR）对犬烧伤休克口服葡萄糖电解质溶液（GES）复苏时胃排空及胃黏膜二氧化碳分压（PgCO2）的影响。
方法
将24只成年雄性比格犬随机分为4组：35%总体表面积（TBSA）Ⅲ度烧伤口服GES复苏组（35%TBSA GES，n = 6）、35%TBSAⅢ度烧伤口服含20μg/kg CAR的GES组（35%TBSA GES/CAR，n = 6）、50%TBSAⅢ度烧伤口服GES组（50%TBSA GES，n = 6）和50%TBSAⅢ度烧伤口服含20μg/kg CAR的GES组（50%TBSA GES/CAR，n = 6）。犬分别接受35%TBSA或50%TBSA全层火焰烧伤。烧伤后30分钟，根据Parkland公式（烧伤后8小时内给予4ml·kg⁻¹·1%TBSA⁻¹的1/2，其余1/2在烧伤后接下来的16小时内给予）经口灌胃给予GES或含CAR的GES。于烧伤后2、4、8和24小时测定胃排空率、PgCO2及不耐受症状。
结果
烧伤后所有组胃排空率均显著降低（P<0.05），35%TBSA GES组烧伤后2小时胃排空率为51.5%，50%TBSA GES组烧伤后4小时胃排空率为39.2%。胃排空率逐渐改善，但仍远低于伤前水平（均P<0.05）。GES/CAR组伤后各时间点胃排空率均显著高于35%GES组（P<0.05），8小时和24小时高于50%GES组（均P<0.05）。35%GES/CAR组胃排空率恢复至伤前水平（P>0.05），50%GES/CAR组仍低于伤前水平（P<0.05）。烧伤后所有组PgCO2均显著升高（均P<0.05），且未恢复至伤前水平。GES/CAR组伤后各时间点PgCO2均显著高于35%GES组（P<0.05），4小时和24小时高于50%GES组（P<0.05）。胃不耐受症状程度排序如下：50%TBSA GES组（83.3%，5/6）>50%TBSA GES/CAR组（50.0%，3/6）>35%TBSA GES组（16.7%，1/6）>35%TBSA GES/CAR组（0，0/6）。
结论
结果表明，CAR对葡萄糖电解质溶液口服复苏烧伤休克时改善胃排空及胃缺血有显著作用。
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