目的 研究烧伤犬静脉补液时丙酮酸钠林格液对循环血容量和血乳酸水平的影响。方法 采用雄性Beagle犬，预先施行颈总动脉和颈外静脉置管，24 h后用凝固汽油燃烧法制成犬50%总体表面积(TBSA)Ⅲ度烧伤模型。将犬随机分为3组:不补液组(NR组，n=8)、乳酸钠林格液静脉补液组(VL组，n=10)和丙酮酸钠林格液静脉补液组(VP组，n=10)。两静脉补液组于伤后30 min依据Parkland公式经颈静脉分别输注丙酮酸钠林格液或乳酸钠林格液。动物在清醒状态下测定平均动脉压、循环血浆容量、动脉血气和血乳酸水平。结果 伤后2 h，NR组、VL组和VP组动物平均动脉压分别为(45.3±7.8)、(91.3±10.2)和(98.7±9.5)mmHg，较伤前值(141.7±6.0)、(142.3±6.1)和(142.8±5.5)mmHg明显降低(P均＜0.05);循环血浆容量、动脉pH值和PaO2变化趋势与平均动脉压相似，但血乳酸浓度较伤前明显降低(P<0.05)。伤后4 h起NR组各项指标均持续恶化，直至死亡;而静脉补液组各指标逐渐恢复。两静脉补液组比较，VP组优于VL组，在烧伤补液后6 h差别尤为明显(P均＜0.05)。结论 50%TBSA Ⅲ度烧伤犬静脉补液时，丙酮酸钠林格液改善循环血容量和乳酸性酸中毒的效果优于常用的乳酸林格液。
Abstract
Objective To study the effects of sodium pyruvate Ringer’s solution on lactic acidosis and plasma volume during intravenous resuscitation in dogs with 50% TBSA degree Ⅲ full thickness burn injury. Methods Beagle dogs with intubation of the carotid artery and jugular vein for 24 h were subjected to a 50% TBSA degree Ⅲ burns, and were divided into three groups: burn injury without fluid resuscitation (NR, n=8), burn injury with fluid Lac-Ringer (VL, n=10), and with fluid Pry-Ringer (VP,n=10). The two intravenous fluid resuscitation began at 30 minutes after burn with volume and rate consistent with the Parkland Formula. The arterial and venous blood were sampled at different time points after injury,and then mean arterial pressure, circulating plasma volume, artery blood gas analysis and lactic acid were measured at conscious state. Results Two hours after burn, the mean arterial pressures in NR,VL and VP groups were(45.3±7.8)mmHg,(91.3±10.2)mmHg and(98.7±9.5)mmHg, respectively, which were significantly reduced(all P<0.05)compared with those before injury(41.7±6.0) mmHg,(142.3±6.1) mmHg and (142.8±5.5)mmHg,the change in plasma volume,pH value,PaO2 had the same trend as the mean arterial pressure, blood lactate level significantly reduced(P<0.05). All measurements in NR group kept worsening, and all died within 24 h after burn; while those of two intravenous resuscitation groups improved gradually,VP group was significantly superior to VL group at 6 hour after rususcitation(all P<0.05). Conclusions The Pyr-Ringer may be superior to the standard Lac-Ringer in the improvement of lactic acidosis and plasma volume during intravenous resuscitation in dogs with 50%TBSA full thickness burn injury.
关键词
烧伤 /
休克 /
静脉补液 /
丙酮酸盐 /
循环血容量 /
乳酸性酸中毒
Key words
burns /
shock /
intravenous solution /
pyruvate /
plasma volume /
lactic acidosis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Kraut J A, Kurtz I. Use of base in the treatment of severe acidemic states [J]. Am J Kidney Dis, 2001, 3(8): 703-727.
[2] 郇京宁. 烧伤休克液体复苏研究进展[J]. 中华烧伤杂志, 2013, 29(3): 285-288.
[3] 胡 森, 夏 斌, 黎君友, 等. 犬肠缺血-再灌流时小肠对早期胃内营养耐受能力的实验研究[J]. 中国危重病急救医学,2006, 18(10): 605-608.
[4] Flaherty D C, Hoxha B, Sun J, et al. Pyruvate-fortified fluid resuscitation improves hemodynamic stability while suppressing systemic inflammation and myocardial oxidative stress after hemorrhagic shock[J]. Mil Med, 2010, 175(3): 166-172.
[5] Zager R A, Johnson A C, Becker K. Renal cortical pyruvate depletion during AKI [J]. J Am Soc Nephrol, 2014, 25(5): 998-1012.
[6] Mallet R T, Sun J, Knott E M, et al. Metabolic cardio protection by pyruvate: recent progress[J]. Exp Biol Med (Mayweed), 2005, 23(7): 435-443.
[7] 车晋伟,胡 森, 吴 静, 等. 烧伤休克犬肠粘膜血流量动态监测方法的研究[J]. 感染、炎症、修复, 2008, 9(1): 15-17.
[8] 孙业祥,汪昌荣,陈侠英. 严重烧伤病人休克期酸碱失衡类型及其机理的探讨[J].中国烧伤创疡杂志, 2003, 15 (4): 282-285.
[9] Cotton B A,Guy J S,Morris J A Jr, et al. The cellular,metabolic,and systemic consequences of aggressive fluid resuscitation strategies[J].Shock,2006,26(2):115-121.
[10] Santry H P,Alam H B.Fluid resuscitation:past,present,and the future[J]. Shock,2010,33(3):229-241.
[11] Su Fuhong, Wang Zhen, CaiYing, et al. Beneficial effects of ethyl pyruvate in septic shock from peritonitis[J]. Arch Surg, 2007, 142: 166-171.
[12] Schillinger W, Hunlich M, Sossalla S, et al. Intracoronary pyruvate in cardiogenic shock as an adjunctive therapy to catecholamines and intra-aortic balloon pump shows beneficial effects on hemodynamics [J]. Clin Res Cardiol, 2011,100(5):433-438.
[13] Ojha S, Goyal S, Kumari S, et al. Pyruvate attenuates cardiac dysfunction and oxidative stress in isoproterenol-induced cardiotoxicity[J]. Exp Toxicol Pathol, 2012, 64(4): 393-399.
[14] Olivencia-Yurvati A H, Blair J L, Baig M, et al. Pyruvate-enhanced cardio protection during surgery with cardiopulmonary bypass [J]. Cardiothoracic Vasc Anesth, 2003,17(6): 715-720.
[15] Yi J S, Kim T Y, Kim D K, et al. Systemic pyruvate administration markedly reduces infarcts and motor deficits in rat models of transient and permanent focal cerebral ischemia[J]. Neurobiol Dis, 2007, 26(1): 94-104.
[16] Capacchione J, Fontana J L, West S, et al. Pyruvate improves cerebral metabolism during hemorrhagic shock[J]. Am J Physiol, 2001, 281: H854-H864.
[17] Mongan P D, Capacchione J, West S, et al. Pyruvate improves redox status and decreases indicators of hepatic apoptosis during hemorrhagic shock in swine[J]. Am J Physiol, 2002, 283: H1634-H1644.
[18] Ochiai K, Zhang J, Gong G, et al. Effects of augmented delivery of pyruvate on my ocardial high-energy phosphate metabolism at high work state[J]. Am J Physiol Heart Circ Physiol, 2004, 286 (10) : 2237.
[19] Cai B L, Deitch E A, Grande D, et al. Anti-inflammatory resuscitation improves survival in hemorrhage with trauma[J]. J Trauma, 2009, 66(6): 1632-1640.
[20] Gou D M, Tan H J, Cai H J, et al. Pyruvate effects on red blood cells during in vitro cardiopulmonary bypass with dogs’ blood [J]. Artif Organs, 2012, 36(11) : 988-991.
[21] Sharma A B, Knott E M, Jian B, et al. Pyruvate improves cardiac electromechanical and metabolic recovery from cardiopulmonary arrest and resuscitation [J]. Resuscitation, 2005, 66: 71-81.
[22] Hu S, Bai X D, Liu X Q, et al. Pyruvate Ringer’s solution corrects lactic acidosis and prolongs survival during hemorrhagic shock in rats[J]. J Emerg Med, 2013, 45(6): 885-893.
基金
军队十一五科研专项课题(06Z055);发改委卫星示范项目(2014号)
PDF(713 KB)
