Hu Quan, Chai Jiake, Hu Sen, Zhou Guoyong, Sheng Zhiyong
Burns Institute, First Hospital Affiliated to General Hospital of PLA, Beijing, People's Republic of China.
J Burn Care Res. 2012 Mar-Apr;33(2):e63-9. doi: 10.1097/BCR.0b013e31823dc6f4.
The objective of this study is to investigate the effect of oral feeding of an electrolyte glucose mosapride solution for resuscitation in dogs with shock after a 35% TBSA full-thickness burn and the effect of mosapride on gastric emptying time. Eighteen male Beagle dogs were randomly divided into intravenous isotonic solution group, intragastric hypertonic solution group, and mosapride group after they were subjected to a 35% TBSA full-thickness flame injury. In intravenous isotonic solution group (I group), isotonic electrolyte glucose solution was given through vein with adoption of the Parkland formula. The resuscitation fluid in intragastric hypertonic solution group (H group) and mosapride group (M group) consisted of 1.8% NaCl and 5% glucose, the total fluid volume was one half of that for I group, and it was given in divided amount every 2 hours. Mosapride was added to the resuscitation fluid in mosapride group. Fluid replacement was begun 30 minutes after the injury in all the groups. Mean arterial pressure (MAP), cardiac output index (CI), intrathoracic blood volume index (ITBI), blood volume (BV), serum sodium concentration, intestinal mucosal blood flow (IMBF), gastric emptying, and serum motilin levels were determined at different time points. The urinary output of all animals was measured immediately after burn upto 360 minutes postburn. CI, ITBI, BV, and IMBF were all decreased obviously after burn. In I group and M group, CI, ITBI, BV, and IMBF were increased gradually after resuscitation, and they were significantly higher than that of H group (P < .05). MAP in all three groups was lowered significantly and then gradually recovered, showing no significant difference among groups. The urinary output in M group was similar to that in I group (P > .05), and it was higher than that in H group (P < .05). Serum sodium level in H group and M group increased in varying degrees and were markedly higher compared with the I group (P < .05). Postburn gastric emptying in H group was much more delayed (P < .05), but in M group it was much faster. Motilin level in the latter group also increased gradually postburn and was markedly higher than that of the other two groups (P < .05). At the early stage of 35% TBSA third-degree burns, gavage of 1.8% hypertonic electrolytes glucose ends in slow gastric emptying, resulting in delayed recovery from shock. When a prokinetic drug mosapride was added to the solution, gastric emptying could be accelerated and a resuscitation effect similar to that of intravenous isotonic fluid resuscitation can be achieved, while total fluid volume can be decreased by half.
本研究的目的是探讨口服电解质葡萄糖莫沙必利溶液对35%体表面积全层烧伤后休克犬复苏的效果以及莫沙必利对胃排空时间的影响。18只雄性比格犬在遭受35%体表面积全层火焰烧伤后,随机分为静脉输注等渗溶液组、胃内输注高渗溶液组和莫沙必利组。静脉输注等渗溶液组(I组)采用Parkland公式经静脉给予等渗电解质葡萄糖溶液。胃内输注高渗溶液组(H组)和莫沙必利组(M组)的复苏液由1.8%氯化钠和5%葡萄糖组成,总液量为I组的一半,每2小时分剂量给予。莫沙必利组在复苏液中加入莫沙必利。所有组在伤后30分钟开始补液。在不同时间点测定平均动脉压(MAP)、心输出指数(CI)、胸腔内血容量指数(ITBI)、血容量(BV)、血清钠浓度、肠黏膜血流量(IMBF)、胃排空及血清胃动素水平。测量所有动物伤后直至伤后360分钟的尿量。烧伤后CI、ITBI、BV和IMBF均明显降低。在I组和M组,复苏后CI、ITBI、BV和IMBF逐渐升高,且显著高于H组(P < 0.05)。三组的MAP均显著降低,然后逐渐恢复,组间无显著差异。M组的尿量与I组相似(P > 0.05),且高于H组(P < 0.05)。H组和M组的血清钠水平不同程度升高,且显著高于I组(P < 0.05)。H组烧伤后胃排空明显延迟(P < 0.05),但M组则快得多。后一组的胃动素水平在烧伤后也逐渐升高,且显著高于其他两组(P < 0.05)。在35%体表面积三度烧伤的早期,胃内给予1.8%高渗电解质葡萄糖会导致胃排空缓慢,从而导致休克恢复延迟。当在溶液中加入促动力药物莫沙必利时,可加速胃排空,并可获得与静脉输注等渗液体复苏相似的复苏效果,同时总液量可减少一半。