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高原肺水肿患者吸入低浓度一氧化氮治疗前后体内自由基变化的观察
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不同胶体复苏对重度烧伤猪休克期肺水肿的影响
目的 观察比较应用人工胶体与天然胶体对重度烧伤猪休克期肺水肿的影响. 方法 将12只广西巴马小型猪造成背部约40％ TBSAⅢ度烧伤,按随机数字表法分为天然胶体组和人工胶体组,每组6只,于伤后2h开始补液.电解质液以乳酸林格液为主,胶体分别为猪血浆和羟乙基淀粉130/0.4.记录2组猪伤前及伤后48 h内每小时心率、血压、尿量、中心静脉压(CVP)和肺动脉楔压(PAWP),计算伤后第1、2个24 h的平均心率、血压、每小时每千克尿量、CVP、PAWP、复苏液体量和液体入出量比.于伤后48 h,行肺组织病理学观察并计算肺脏含水率.对数据行单因素方差分析、重复测量方差分析、LSD检验和独立样本t检验. 结果 (1)2组伤前及伤后第1、2个24 h的心率、血压、尿量比较,差异均无统计学意义(P值均大于0.05)；伤后第1个24 h,人工胶体组CVP、PAWP均明显高于天然胶体组(P值均小于0.05).与伤前比较,2组伤后第1、2个24 h的心率均明显加快、CVP及PAWP显著升高(P＜0.05或P＜0.01)；天然胶体组伤后第1个24 h的尿量减少(P＜0.05),人工胶体组无明显变化(P＞0.05),2组伤后第2个24 h尿量虽均呈增加趋势,但差异均无统计学意义(P值均大于0.05)；2组伤后第1、2个24 h的血压与伤前比较差异均无统计学意义(P值均大于0.05).(2)天然胶体组与人工胶体组伤后第1、2个24 h复苏液体量及液体入出量比比较,差异均无统计学意义(P值均大于0.05).(3)2组肺组织切片均可见肺泡间隔不同程度增宽,肺间质内大量水肿液积聚及炎性细胞浸润.(4)天然胶体组猪肺脏含水率为(71±10)％,与人工胶体组的(79±4)％比较,差异无统计学意义(t=-1.753,P＞0.05). 结论 在重度烧伤猪休克期选用天然胶体或人工胶体(羟乙基淀粉130/0.4)行液体复苏,对肺组织水肿的影响程度基本相同.
Abstract：
Objective To observe and compare the effects of natural colloid and artificial colloid on pulmonary edema of swine during shock stage of severe burn injury.Methods Twelve Guangxi Bama miniature swine were inflicted with 40％ TBSA full-thickness burn on the back,and then they were divided into natural colloid group (N) and artificial colloid group (A) according to the random number table,with six swine in each group.At post injury hour (PIH) 2,fluid resuscitation was begun.The main part of electrolyte was lactic acid Ringer's solution.The colloids included swine plasma and hydroxyethyl starch 130/0.4.Before injury and at every hour within PIH 48,heart rate,blood pressure,urine volume,central venous pressure (CVP),and pulmonary arterial wedge pressure (PAWP) were recorded.The mean heart rate,blood pressure,urine volume per hour per kg of body weight,CVP,PAWP,resuscitation liquid volume,and the ratio of fluid intake to output during the first and second PIH 24 were calculated.At PIH 48,lung tissue was harvested for histopathological observation and calculation of lung water ratio.Data were processed with one-way analysis of variance,analysis of variance of repeated measurement,LSD test and independent sample t test.Results (1) There were no statistically significant differences between two groups in heart rate,blood pressure,and urine volume before injury and during the first and second PIH 24 (P values all above 0.05) ; during the first PIH 24,the CVP and PAWP of group A were significantly higher than those of group N (P values all below 0.05).Compared with those before injury,the heart rate,CVP and PAWP of two groups during the first and second PIH 24 were significantly higher (P ＜ 0.05 or P ＜ 0.01) ;the urine volume of group N was decreased during the first PIH 24 (P ＜ 0.05),while there was no significant change in group A (P ＞ 0.05) ; the urine volumes of two groups during the second PIH 24 were increased,while no statistically significant differences were observed (P values all above 0.05).There were no statistically significant differences in blood pressure of two groups between the first,second PIH 24 and before injury (P values all above 0.05).(2) There were no statistically significant differences in the resuscitation liquid volume and fluid intake to output ratio between two groups during the first and second PIH 24(P values all above 0.05).(3) The alveolar septum was found widened in varying degrees,and there were edema fluid accumulating and inflammatory cell infiltrating within the pulmonary interstitial of lung tissue sections in both two groups.(4) The lung water ratio of group N [(71 ± 10) ％] was not statistically significant different from that of group A [(79±4)％,t =-1.753,P ＞0.05].Conclusions The natural colloid or artificial colloid (hydroxyethyl starch 130/0.4) applied during shock stage had similar effects on pulmonary edema in swine with severe burn.
YOU Xiao-en
CHEN Jiong
ZHOU Jian-jun
SHI Jian-wu
SU Guo-liang
作者单位：
温州医学院附属第六医院整形烧伤科,323000
温州医学院附属第三医院瑞安市烧伤研究所,浙江省瑞安市,325200
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浙江省科技计划
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