卡巴胆碱促进烧伤休克患者口腔复苏期间的胃肠功能。

Carbachol promotes gastrointestinal function during oral resuscitation of burn shock.

机构信息

Research Laboratory of Shock and Multiple Organ Dysfunction, Burns Institute, First Hospital Affiliated to the PLA General Hospital, Beijing 100048, China.

出版信息

World J Gastroenterol. 2011 Apr 7;17(13):1746-52. doi: 10.3748/wjg.v17.i13.1746.

DOI:10.3748/wjg.v17.i13.1746

PMID:21483636

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3072640/

Abstract

AIM

To investigate the effect of carbachol on gastrointestinal function in a dog model of oral resuscitation for burn shock.

METHODS

Twenty Beagle dogs with intubation of the carotid artery, jugular vein and jejunum for 24 h were subjected to 35% total body surface area full-thickness burns, and were divided into three groups: no fluid resuscitation (NR, n = 10), in which animals did not receive fluid by any means in the first 24 h post-burn; oral fluid resuscitation (OR, n = 8), in which dogs were gavaged with glucose-electrolyte solution (GES) with volume and rate consistent with the Parkland formula; and oral fluid with carbachol group (OR/CAR, n = 8), in which dogs were gavaged with GES containing carbachol (20 μg/kg), with the same volume and rate as the OR group. Twenty-four hours after burns, all animals were given intravenous fluid replacement, and 72 h after injury, they received nutritional support. Hemodynamic and gastrointestinal parameters were measured serially with animals in conscious and cooperative state.

RESULTS

The mean arterial pressure, cardiac output and plasma volume dropped markedly, and gastrointestinal tissue perfusion was reduced obviously after the burn injury in all the three groups. Hemodynamic parameters and gastrointestinal tissue perfusion in the OR and OR/CAR groups were promoted to pre-injury level at 48 and 72 h, respectively, while hemodynamic parameters in the NR group did not return to pre-injury level till 72 h, and gastrointestinal tissue perfusion remained lower than pre-injury level until 120 h post-burn. CO(2) of the gastric mucosa and intestinal mucosa blood flow of OR/CAR groups were 56.4 ± 4.7 mmHg and 157.7 ± 17.7 blood perfusion units (BPU) at 24 h post-burn, respectively, which were significantly superior to those in the OR group (65.8 ± 5.8 mmHg and 127.7 ± 11.9 BPU, respectively, all P < 0.05). Gastric emptying and intestinal absorption rates of GES were significantly reduced to the lowest level (52.8% and 23.7% of pre-injury levels) in the OR group at about 2 and 4 h post-burn, and did not return to 80% of pre-injury level until 24 h. In the first 24 h post-burn, the rate of gastric emptying and intestinal water absorption were elevated by a mean 15.7% and 11.5%, respectively, in the OR/CAR group compared with the OR group. At 5 days, the mortality in the NR group was 30% (3/10), 12.5% in the OR group (1/8), and none in the OR/CAR group.

CONCLUSION

Carbachol had a beneficial effect on oral resuscitation of burn shock by promoting gastric emptying and intestinal absorption in our canine model.

摘要

目的

研究在狗口腔复苏烧伤休克模型中，毒蕈碱对胃肠道功能的影响。

方法

将 20 只植入颈动脉、颈静脉和空肠导管的比格犬进行 35%的全身体表面积深度烧伤，分为三组：无液体复苏（NR，n=10），烧伤后 24 h 内动物不接受任何方式的液体；口服液体复苏（OR，n=8），给予与 Parkland 公式一致的葡萄糖电解质溶液（GES）灌胃；口服液体加毒蕈碱组（OR/CAR，n=8），给予含有毒蕈碱（20 μg/kg）的 GES，灌胃量和速度与 OR 组相同。烧伤后 24 h 所有动物给予静脉液体替代，伤后 72 h 给予营养支持。在意识和合作状态下连续测量血流动力学和胃肠道参数。

结果

三组动物烧伤后平均动脉压、心输出量和血浆容量明显下降，胃肠道组织灌注明显减少。OR 和 OR/CAR 组的血流动力学参数和胃肠道组织灌注分别在 48 和 72 h 时恢复到伤前水平，而 NR 组的血流动力学参数直到 72 h 才恢复到伤前水平，胃肠道组织灌注直到 120 h 仍低于伤前水平。OR/CAR 组胃黏膜和肠黏膜血流 CO2 分别为 24 h 时 56.4±4.7 mmHg 和 157.7±17.7 血灌注单位（BPU），明显优于 OR 组（分别为 65.8±5.8 mmHg 和 127.7±11.9 BPU，均 P<0.05）。OR 组在烧伤后约 2 和 4 h 时 GES 的胃排空和肠吸收速度降至最低水平（分别为伤前水平的 52.8%和 23.7%），直到 24 h 才恢复到伤前水平的 80%。在烧伤后 24 h 内，OR/CAR 组胃排空和肠水吸收速度分别平均提高 15.7%和 11.5%。第 5 天，NR 组死亡率为 30%（3/10），OR 组为 12.5%（1/8），OR/CAR 组无死亡。