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2016年第12期
不同液体复苏对大鼠热伤休克心肌功能的影响
Effect of different resuscitation fluid to the early stage of myocardial injury of the thermal injury shock rat
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DOI:
作者:
洪彬源
hong bin yuan
作者单位:
广东省佛山市第一人民医院麻醉科
Department of Anesthesiology. The First People’ Hospital of Foshan City,Guangdong Province
关键词:
醋酸钠林格注射液;乳酸钠林格注射液;心肌功能
Acetate Ringer's Injection; Lactate Ringer's Injection; cardiac function
摘要:
【摘要】目的 研究不同复苏液对热伤休克的大鼠早期心肌损伤的影响。方法 雄性大鼠80只,体重250~300 g,采用随机数字表法,将其随机分为4组(n=20):正常对照组(C组)、0.9 %生理盐水组(B组)、乳酸钠林格液组(LR组)和复方电解质液组(CE组)。B组、LR组和CE组制备25%~30%体表面积Ⅲ度烫伤模型,模型制备成功后进行容量治疗,在每小时和每一个烫伤面积百分比下,先以0.33 mL/kg速率静脉输注4 h,随后以0.13 mL/kg速率静脉输注44 h。容量治疗24 h时,4组各取10只动物,制备离体心脏模型,分别于左心房灌注压为7.5、10、12.5、15、20 cm H2O时记录心输出量(CO)、左心室内压力上升最大速率(+dp/dt)、左心室压力下降最大速率(-dp/dt)、每搏功和主动脉峰值收缩压,及测量机体中乳酸根离子浓度,然后取心肌组织,测定腺嘌呤核苷三磷酸(ATP)和磷酸肌酸(CP)含量。记录另外10只动物容量治疗48 h期间生存情况。结果 与C组比较,B组和LR组CO、+dp/dt和-dp/dt降低,乳酸根离子浓度明显升高,心肌ATP含量降低(P<0.05或0.01),B组的每搏功和主动脉峰值收缩压明显降低;与B组比较,CE组CO、+dp/dt和-dp/dt升高,LR组和CE组的每搏功和主动脉峰值收缩压明显升高(P<0.05或0.01);与C组生存率比较,B组24、48 h降低,LR组48 h降低(P <0.05);与B组生存率比较,LR组24 h升高,CE组24、48 h升高(P <0.05)。结论 与生理盐水和乳酸钠林格液比较,复方电解质溶液容量治疗可减轻烫伤大鼠早期的心肌损伤,降低机体早期乳酸根水平,改善心肌收缩与舒张功能,提高心肌顺应性,提高生存率。
[abstract] objective To investigate the effect of different resuscitation fluid to the early stage of myocardial injury of the thermal injury shock rat. Methods 80 male rat, weighing 250-300g, were randomly divided into four groups (n=20), using a random number table: control group (group C), 0.9% normal saline group (group B), lactated Ringer’s solution group (group LR) and multiple electrolytes injection group (group CE).Group B, LR and CE were made a 25%-30% body surface and three degree burning model. The volume therapy began to intravenous infuse 4 hours by the rate of 0.33ml/kg and subsequently infuse 44 hours by the rate of 0.13 ml/kg after successfully making the model. 10 rat were chosen from each group to make ex-vivo heart models at the 24 hour volume therapy, and were recorded cardiac output (CO), maximum increase rate of left ventricular pressure(+dp/dt), maximum drop rate of left ventricular pressure(-dp/dt), stroke work, peak systolic pressure of aorta, and lactate ionic concentration while the perfusion pressure of left atrium was 7.5,10,12.5,15,20 cm H2O, and were taken the myocardial tissue to measure the contents of ATP and CP. The other 10 rat were recorded the survival condition after 48 hours volume therapy. Results: Compared with group C, the CO, +dp/dt, -dp/dt and the contents of ATP were significantly reduced but the lactate ionic concentration were significantly increased in group B and LR, the stroke work and peak systolic pressure of aorta were reduced obviously in group B(P<0.05 or 0.01). Compared with group B, the CO, +dp/dt and -dp/dt were increased in group CE, and the stroke work and peak systolic pressure of aorta were significantly increased in group CE and LR (P<0.05 or 0.01). Compared with group C, the survival rate of 24 hours and 48 hours were reduced in group B and that of 48 hours were reduced in group LR(P <0.05). Compared with group B, the survival rate of 24 hours were increased in group LR, and that of 24 hours and 48 hours were increased in group CE(P <0.05). Conclusion: Compared with normal saline and lactated Ringer’s solution, the volume therapy of multiple electrolytes injection can reduce the early stage of myocardial injury of the burning rat, reduce the level of the early lactate, improve the systolic and diastolic cardiac function and elevate the compliance of the myocardium, and improve the survival rate.
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