两种复苏措施对犬海水浸泡弹烧复合伤血流动力学的影响

发布时间：2018-06-26 05:22

本文选题：复苏 + 海水浸泡　；参考：《中国危重病急救医学》2005年01期

【摘要】：目的比较标准Parkland公式复苏与改良液体复苏对弹烧复合伤后海水浸泡犬血流动力学的影响,为早期救治提供理论依据。方法海水浸泡弹烧复合伤模型犬20只随机分为海水浸泡弹烧复合伤组 (浸泡组,n=8)、标准Parkland公式复苏组(标准组,n=6)与改良液体复苏组(改良组,n=6),动态监测伤前及伤后4、7、10、20和28 h共6个时间点的中心体温、尿量、心率(HR)、平均动脉压(MAP)、平均肺动脉压 (MPAP)、中心静脉压(CVP)、肺毛细血管楔压(PCWP)、心脏指数(CI)的变化,计算每搏输出指数(SVI)、外周循环阻力指数(SVRI)、肺循环阻力指数(PVRI)、左室每搏功输出指数(LVSWI)和右室每搏功输出指数 (RVSWI),并观察动物死亡率。结果采用标准Parkland公式复苏,血流动力学、中心体温、尿量均有明显改善,但复苏早期(伤后7 h)CVP偏高,达(14.7±3.1)cm H2O(1 cm H2O=0.098 kPa);实验后期血流动力学稳定性较差;尿量在伤后7 h偏多,达(2.38±0.18)ml·h-1·kg-1。改良组血流动力学指标改善明显优于标准组,不仅纠正了标准组复苏早期容量超载的风险,而且在实验后期。血流动力学较标准组更稳定。改良组动物在观察期内全部存活.而浸泡组死亡4只,标准组死亡1只。结论改良液体复苏较Parkland公式复苏更适合于弹烧复合伤后海水浸泡
[Abstract]:Objective to compare the effects of standard Parkland formula resuscitation and modified fluid resuscitation on hemodynamics of marinated dogs after combined bullet burn injury and provide theoretical basis for early treatment. Methods Twenty dogs were randomly divided into seawater immersion bomb burn combined injury group (immersion group), standard Parkland formula resuscitation group (standard group) and modified liquid resuscitation group (modified group). And the central body temperature of 6 time points at 20 and 28 hours after injury, Changes of urine volume, heart rate (HR), mean arterial pressure (map), mean pulmonary artery pressure (MPAP), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), The stroke output index (SVI), peripheral vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), left ventricular stroke work output index (LVSWI) and right ventricular stroke work output index (RVSWI) were calculated. Results the standard Parkland formula was used for resuscitation, hemodynamics, central body temperature and urine volume were improved obviously, but the CVP was higher in the early stage of resuscitation (7 h after injury), reaching (14.7 卤3.1) cm H2O (1 cm H 2O 0.098 KPA), and the stability of hemodynamics was poor in the later stage of experiment. Urine volume was (2.38 卤0.18) ml h-1 kg-1 at 7 h after injury. The improvement of hemodynamic indexes in the modified group was significantly better than that in the standard group, which not only corrected the risk of early volume overload in the resuscitation of the standard group, but also in the late stage of the experiment. Hemodynamics was more stable than the standard group. All the animals in the modified group survived during the observation period. 4 rats died in immersion group and 1 died in standard group. Conclusion the modified fluid resuscitation is more suitable than Parkland's formula for immersion in sea water after projectile burn combined injury.
【作者单位】：第三军医大学大坪医院野战外科研究所麻醉科国家创伤、烧伤、复合伤重点实验室战伤救治基础研究室第六室第三军医大学大坪医院野战外科研究所麻醉科
【基金】：全军"十五"重点课题(01-L011)
【分类号】：R826

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