对于二度烧伤且延迟开始抗坏血酸治疗的患者，减少复苏液量。

Reduced resuscitation fluid volume for second-degree burns with delayed initiation of ascorbic acid therapy.

作者信息

Tanaka H, Matsuda H, Shimazaki S, Hanumadass M, Matsuda T

机构信息

Department of Traumatology and Critical Care Medicine, Kyorin University, Tokyo, Japan.

出版信息

Arch Surg. 1997 Feb;132(2):158-61. doi: 10.1001/archsurg.1997.01430260056011.

DOI:10.1001/archsurg.1997.01430260056011

PMID:9041919

Abstract

BACKGROUND

Oxygen radicals may play an important role in injury due to thermal burns. High-dose antioxidant ascorbic acid (vitamin C, Cenolete, Abbott Laboratory, Abbott Park, Ill) therapy reduces edema of burned and unburned tissue, lipid peroxidation, and subsequent resuscitation fluid volume requirement in experimental burn models.

OBJECTIVE

To determine the hemodynamic effects of delayed initiation (2 hours after injury) of antioxidant therapy in patients with second-degree burns.

DESIGN

Experimental study. MATERIALS AND INTERVENTION: Burns over 70% of body surface area were produced by subxiphoid immersion of 12 guinea pigs in 100 degrees C water for 3 seconds. The animals were resuscitated with Ringer's lactated solution according to the Parkland formula (4 mL/kg for 1% of burned body surface area during the first 24 hours) from 0.5 to 2 hours following injury, after which the resuscitation fluid volume was reduced to 25% of the Parkland formula. Animals received Ringer's lactated solution to which ascorbic acid (340 mg/kg during the first 24 hours) was added (vitamin C group [n = 6]) or Ringer's lactated solution only (control group [n = 6]).

MEASUREMENTS

Heart rates, mean arterial blood pressure, cardiac output, hematocrit level, and water content in burned and unburned tissue were measured before injury and at intervals thereafter.

RESULTS

There were no significant differences in heart rates (P = .29) and blood pressures (P = .53) between the 2 groups throughout the 24-hour study period. No animal died. The vitamin C group showed significantly lower hematocrit levels (P < .05) and significantly higher cardiac output values (P < .05) at 7 hours following burn injury and at intervals thereafter (P < .001).

CONCLUSION

With delayed initiation of high-dose ascorbic acid therapy, the 24-hour fluid resuscitation volume was reduced to 32.5% of the Parkland formula, while maintaining adequate cardiac output values.

摘要

背景

氧自由基可能在热烧伤所致损伤中起重要作用。在实验性烧伤模型中，大剂量抗氧化剂抗坏血酸（维生素C，Cenolete，雅培实验室，伊利诺伊州雅培公园）治疗可减轻烧伤及未烧伤组织的水肿、脂质过氧化反应，并降低后续复苏液体量需求。

目的

确定二度烧伤患者延迟启动（伤后2小时）抗氧化治疗的血流动力学效应。

设计

实验研究。材料与干预：将12只豚鼠剑突下浸入100℃水中3秒，造成体表面积70%以上的烧伤。伤后0.5至2小时，根据帕克兰公式（伤后首个24小时内，每1%烧伤体表面积给予4 mL/kg乳酸林格液）对动物进行复苏，之后复苏液体量减至帕克兰公式的25%。动物接受添加了抗坏血酸（首个24小时内340 mg/kg）的乳酸林格液（维生素C组[n = 6]）或仅接受乳酸林格液（对照组[n = 6]）。