Sharar S R, Heimbach D M, Green M, Winn R K, Hildebrandt J
University of Washington School of Medicine, Seattle.
J Burn Care Rehabil. 1988 Jan-Feb;9(1):26-30. doi: 10.1097/00004630-198801000-00008.
The etiology of postburn circulatory impairment ("burn shock") is multifactorial and incompletely understood. However, systemic vasoconstriction is a consistent observation during this period and occurs in spite of aggressive fluid resuscitation therapy. We studied the degree and time course of systemic vasoconstriction in goats for 24 hours following burns of two sizes (20% and 35% TBSA), in which fluid resuscitation was performed according to a common clinical crystalloid regimen. Cardiac index and urine output (reflecting renal perfusion) fell dramatically at two hours after burn, but returned slowly to preburn levels by 24 hours. The degree of fall and rate of recovery were dependent on burn size. Dermal perfusion was assessed by laser Doppler flowmetry in both burned and unburned skin. Dermal perfusion was negligible in burned skin. Unburned skin blood flow fell with increasing burn size, progressively recovered to preburn levels after the small burn, but at 24 hours remained significantly depressed after the larger burn. The stimulus for this persistent skin vasoconstriction is unclear.
烧伤后循环功能障碍（“烧伤休克”）的病因是多因素的，尚未完全明确。然而，在此期间系统性血管收缩是持续存在的现象，即便进行积极的液体复苏治疗也依然会发生。我们研究了按照常见临床晶体液方案进行液体复苏的山羊在两种烧伤面积（20%和35%体表面积）后24小时内系统性血管收缩的程度和时间进程。烧伤后两小时心脏指数和尿量（反映肾灌注）急剧下降，但到24小时时缓慢恢复至烧伤前水平。下降程度和恢复速度取决于烧伤面积。通过激光多普勒血流仪评估烧伤皮肤和未烧伤皮肤的真皮灌注情况。烧伤皮肤的真皮灌注可忽略不计。未烧伤皮肤的血流随着烧伤面积的增加而下降，小面积烧伤后逐渐恢复至烧伤前水平，但大面积烧伤后24小时仍显著低于正常水平。这种持续性皮肤血管收缩的刺激因素尚不清楚。
