Gregoretti S, Gelman S, Dimick A R
Department of Anesthesiology, University of Alabama, Birmingham 35294.
J Burn Care Rehabil. 1988 Mar-Apr;9(2):180-3. doi: 10.1097/00004630-198803000-00012.
The high cardiac output (CO) observed during the chronic phase in burned patients has been ascribed, among other factors, to the elevated blood flow in the burn wound. The hemodynamic effects of wound excision to fascia have been studied in eight patients with second- and third-degree burns ranging from 42% to 70% total body surface area (TBSA) undergoing debridement and skin-grafting procedures. The study was performed on the 4th to the 51st postburn day when all patients were in a hyperdynamic state. Serial hemodynamic measurements, including arterial and mixed-venous blood O2 saturation and content, were made before induction of anesthesia, during surgery both before and after wound excision, and in the recovery room a few hours after surgery. During anesthesia, the elevated CO decreased probably as a consequence of decreased metabolic requirements, but no further hemodynamic change was observed following wound excision. The size of burn wound excised to fascia averaged 24% TBSA and ranged from one-third to more than one-half of the initial burn. With discontinuation of anesthesia, CO rose rapidly above preoperative values, apparently to meet a similar increase in oxygen consumption. The excision of large areas of burned tissue did not attenuate the hyperdynamic circulation in burned patients, at least during and immediately after surgery. The data suggest that the elevated blood flow in the burn wound does not play a significant role in the pathogenesis of the hyperdynamic state.
烧伤患者慢性期出现的心输出量（CO）升高，除其他因素外，还归因于烧伤创面血流量增加。对8例全身表面积（TBSA）为42%至70%的二度和三度烧伤患者进行了清创和植皮手术，研究了切除至筋膜的创面切除的血流动力学效应。该研究在烧伤后第4天至第51天进行，此时所有患者均处于高动力状态。在麻醉诱导前、手术期间创面切除前后以及术后数小时的恢复室中进行了一系列血流动力学测量，包括动脉血和混合静脉血的氧饱和度及含量。麻醉期间，升高的CO可能由于代谢需求降低而下降，但创面切除后未观察到进一步的血流动力学变化。切除至筋膜的烧伤创面平均面积为24%TBSA，范围为初始烧伤面积的三分之一至一半以上。随着麻醉的停止，CO迅速升至术前值以上，显然是为了满足氧耗的类似增加。大面积烧伤组织的切除至少在手术期间和术后即刻并未减弱烧伤患者的高动力循环。数据表明，烧伤创面血流量增加在高动力状态的发病机制中不起重要作用。
