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[不同液体复苏方法对烧伤休克期猪血液流变学的影响]

[Effects of different fluid resuscitation methods on hemorheology in pigs during burn shock stage].

作者信息

Chen J, Xing N, Zhou J J, Huang W X, Xue D J

机构信息

Ruian Burns Research Institute, the Third Affiliated Hospital of Wenzhou Medical University, Ruian 325200, China.

Burn Department of Weihai Municipal Hospital, Weihai 250021, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2019 May 14;99(18):1421-1426. doi: 10.3760/cma.j.issn.0376-2491.2019.18.013.

Abstract

To investigate the impact of different methods of fluid resuscitation on hemorheology during burn shock stage. Twenty four miniature swines were randomly divided into four groups with 6 in each group (succinylated gelatin group, hydroxyethyl starch group, Parkland group and allogeneic plasma group). Severe burn shock model was established by burning miniature swine with napalm. Two hours after injury, succinylated gelatin, hydroxyethyl starch (130/0.4) and swine allogenic plasma were used as colloid (alternative colloid) in fluid resuscitation according to the burn shock fluid resuscitation formula which is commonly accepted in the field of Burns Surgery. In Parkland group, miniature swines received liquid recovery according to Parkland Formula. The vital signs before and within 48 h after burn were observed by Solar 8000i electrocardiomonitor during the process of transfusion. The infusion speed was adjusted based on the heart rate, blood pressure, urine volume and central venous pressure. The level of hematocrit (HCT), viscosity of plasma (ηp), index of rigidity (IR), red cell assembling index (RCA) and erythrocyte electrophoresis time (EFT) were measured at the time of pre-injury as well as 4, 8, 24 and 48 h post-injury and statistical analysis was performed. HCT in hydroxyethyl starch group and Parkland group at 8 h post-injury were significantly higher than pre-injury [(0.395±0.047) vs (0.333±0.042), (0.379±0.026) vs (0.352±0.019)] (both 0.05). And compared with pre-injury, HCT in hydroxyethyl starch (130/0.4) group at 48 h decreased significantly (0.232±0.021) vs (0.333±0.042) (0.05). HCT in Parkland group at 24, 48 h post-injury were lower than pre-injury [(0.277±0.021), (0.241±0.029) vs (0.352±0.019)] (both 0.05). Compared with pre-injury, the levels of ηp in Parkland group decreased substantially at 4, 8 and 24 h post-injury [(1.61±0.07), (1.55±0.07) and (1.63±0.07) vs (1.73±0.04) mPa·s] (all 0.05). Compared with allogeneic plasma group, IR decreased in succinylated gelatin group at 24, 48 h post-injury [(1.10±0.05 vs 1.26±0.07), (1.11±0.05 vs 1.32±0.05)](both 0.05). RCA in succinylated gelatin group was significantly higher (both 0.05) at 4 h (6.80±0.87) than pre-injury (5.92±0.43). RCA in hydroxyethyl starch group at 8 h post-injury (6.73±0.56) was significantly higher (both 0.05) than pre-injury (6.03±0.53). Compared with pre-injury (17.3±1.3 s, 16.4±1.5 s), the levels of EFT in hydroxyethyl starch group (15.5±1.4 s) and Parkland group (13.4±1.2 s) decreased substantially at 48 h post-injury (both 0.05). Compared with allogeneic plasma group, the level of EFT in succinylated gelatin group at 4 h post-injury (19.5±2.3 s) increased and decreased at 24 h post-injury (12.0±5.7 s) (both 0.05). During swine burn shock stage, the hemorheological parameters of shock resuscitation with artificial colloid are more stable than those with Parkland formula resuscitation.

摘要

探讨不同液体复苏方法对烧伤休克期血液流变学的影响。将24只小型猪随机分为4组,每组6只(琥珀酰明胶组、羟乙基淀粉组、Parkland组和异体血浆组)。采用凝固汽油烧伤小型猪建立重度烧伤休克模型。伤后2小时,根据烧伤外科领域普遍接受的烧伤休克液体复苏公式,将琥珀酰明胶、羟乙基淀粉(130/0.4)和猪异体血浆用作液体复苏中的胶体(替代胶体)。在Parkland组,小型猪根据Parkland公式进行液体复苏。在输血过程中,使用Solar 8000i心电图监测仪观察烧伤前及伤后48小时内的生命体征。根据心率、血压、尿量和中心静脉压调整输液速度。在伤前以及伤后4、8、24和48小时测量血细胞比容(HCT)水平、血浆黏度(ηp)、刚性指数(IR)、红细胞聚集指数(RCA)和红细胞电泳时间(EFT),并进行统计分析。羟乙基淀粉组和Parkland组伤后8小时的HCT显著高于伤前[(0.395±0.047)对(0.333±0.042),(0.379±0.026)对(0.352±0.019)](均P<0.05)。与伤前相比,羟乙基淀粉(130/0.4)组伤后48小时的HCT显著降低(0.232±0.021)对(0.333±0.042)(P<0.05)。Parkland组伤后24、48小时的HCT低于伤前[(0.277±0.021),(0.241±0.029)对(0.352±0.019)](均P<0.05)。与伤前相比,Parkland组伤后4、8和24小时的ηp水平显著降低[(1.61±0.07),(1.55±0.07)和(1.63±0.07)对(1.73±0.04)mPa·s](均P<0.05)。与异体血浆组相比,琥珀酰明胶组伤后24、48小时的IR降低[(1.10±0.05对1.26±0.07),(1.11±0.05对1.32±0.05)](均P<0.05)。琥珀酰明胶组伤后4小时的RCA(6.80±0.87)显著高于伤前(5.92±0.43)(均P<0.05)。羟乙基淀粉组伤后8小时的RCA(6.73±0.56)显著高于伤前(6.03±0.53)(均P<0.05)。与伤前(17.3±1.3秒,16.4±1.5秒)相比,羟乙基淀粉组(15.5±1.4秒)和Parkland组(13.4±1.2秒)伤后48小时的EFT水平显著降低(均P<0.05)。与异体血浆组相比,琥珀酰明胶组伤后4小时的EFT水平(19.5±2.3秒)升高,伤后24小时降低(12.0±5.7秒)(均P<0.05)。在猪烧伤休克期,人工胶体休克复苏的血液流变学参数比Parkland公式复苏更稳定。

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