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中华损伤与修复杂志(电子版) ›› 2017, Vol. 12 ›› Issue (04) : 262 -268. doi: 10.3877/cma.j.issn.1673-9450.2017.04.004

所属专题: 文献

论著

低渗丙酮酸钠口服补液盐对严重烧伤大鼠血流动力学、组织血流灌注水平及存活率的影响
刘锐1, 王树明2,(), 管秀红1, 张慧萍3, 李琰光3, 喻文4   
  1. 1. 150040 哈尔滨,黑龙江省医院烧伤科
    2. 150040 哈尔滨,黑龙江中医药大学附属第一医院急诊科
    3. 100048 北京,解放军总医院第一附属医院烧伤研究所休克与多器官障碍实验室
    4. 510120 广州,中山大学孙逸仙纪念医院重症医学科
  • 收稿日期:2017-05-16 出版日期:2017-08-01
  • 通信作者: 王树明
  • 基金资助:
    黑龙江省青年科学基金(QC2016101); 黑龙江省卫生计生委科研课题((2016-233)(2017-580))

Effect of hypotonic sodium pyruvate-oral rehydration salt on the hemodynamics, tissues blood perfusion and survival rate in rats after severe burns

Rui Liu1, Shuming Wang2,(), Xiuhong Gan1, Huiping Zhang3, Yanguang Li3, Wen Yu4   

  1. 1. Department of Burns, Heilongjiang Provincial Hospital, Harbin 150040, China
    2. Department of Emergency Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China
    3. Laboratory of Shock and Organ Dysfunction, Burns Institute, First Hospital Affiliated to the People′s Liberation Army General Hospital, Beijing 100048, China
    4. Department of Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
  • Received:2017-05-16 Published:2017-08-01
  • Corresponding author: Shuming Wang
  • About author:
    Corresponding author: Wang Shuming, Email:
引用本文:

刘锐, 王树明, 管秀红, 张慧萍, 李琰光, 喻文. 低渗丙酮酸钠口服补液盐对严重烧伤大鼠血流动力学、组织血流灌注水平及存活率的影响[J]. 中华损伤与修复杂志(电子版), 2017, 12(04): 262-268.

Rui Liu, Shuming Wang, Xiuhong Gan, Huiping Zhang, Yanguang Li, Wen Yu. Effect of hypotonic sodium pyruvate-oral rehydration salt on the hemodynamics, tissues blood perfusion and survival rate in rats after severe burns[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2017, 12(04): 262-268.

目的

探讨低渗丙酮酸钠口服补液盐对严重烧伤大鼠血流动力学、组织血流灌注水平以及存活率的影响。

方法

(1)取80只雄性SD大鼠,按随机数字表法分为假烫伤对照组、烫伤不补液组、低渗丙酮酸钠口服补液盐组及低渗枸橼酸钠口服补液盐组,每组20只;分别配制低渗丙酮酸钠口服补液盐与低渗枸橼酸钠口服补液盐,渗透压分别约为247、245 mOsm/L。烫伤不补液组、低渗丙酮酸钠口服补液盐组及低渗枸橼酸钠口服补液盐组采用96 ℃水浴浸泡大鼠背部15 s、双下肢15 s、腹部8 s,造成50%总体表面积(TBSA)Ⅲ度烫伤模型(经病理切片证实,为严重烧伤);假烫伤对照组采用37 ℃水浴浸泡相同时间。低渗丙酮酸钠口服补液盐组、低渗枸橼酸钠口服补液盐组于伤后即刻开始采用灌胃输入的方法口服补液,补液量和速度均依据Parkland公式,即每1%TBSA补液4 mL/kg,伤后第1个8 h补补液量一半,之后16 h补其另一半,每0.5 h均严格按照计算所得补液量灌注。假烫伤对照组自由饮水,烫伤不补液组不予口服补液。观察伤后8、24 h大鼠血流动力学指标平均动脉压(MAP)、心输出量(CO)、左心室内压最大变化速率(dp/dtmax)、外周血管阻力(SVR)及肝、肾及肠黏膜组织血流量(每组各时相点10只大鼠)。(2)另取80只雄性SD大鼠,按照实验(1)的分组、动物模型制备及补液方法,用于分析伤后8、24 h大鼠存活率。对数据进行单因素方差分析、t检验及χ2检验。

结果

(1)伤后8、24 h,4组大鼠的血流动力学指标MAP、CO、dp/dtmax、SVR比较,差异均有统计学意义(P值均小于0.05);与烫伤不补液组比较,其余3组大鼠血流动力学指标均升高,差异均有统计学意义(P值均小于0.05);烫伤不补液组大鼠各指标持续下降,直至死亡;余各组在实施补液后血流动力学指标逐渐恢复。伤后8 h,低渗丙酮酸钠口服补液盐组MAP、CO和dp/dtmax分别为(96.34±8.23)mmHg、(1.68±0.08)L/min、(720.46±61.37)mmHg/s,均高于低渗枸橼酸钠口服补液盐组(75.35±7.63)mmHg、(0.97±0.05)L/min、(670.87±70.61)mmHg/s,差异均有统计学意义(t=5.125、2.375、2.412,P值均小于0.05);伤后24 h,低渗丙酮酸钠口服补液盐组MAP、CO和dp/dtmax分别为(112.78±9.32)mmHg、(1.89±0.11)L/min、(953.42±74.18)mmHg/s,均高于低渗枸橼酸钠口服补液盐组(93.12±10.22)mmHg、(1.13±0.09)L/min、(750.81±65.72)mmHg/s,差异均有统计学意义(t=5.127、2.641、2.981,P值均小于0.05)。伤后8、24 h,低渗丙酮酸钠口服补液盐组SVR(4088.03±271.83)、(3256.83±222.58)dyn·s·cm-5均低于低渗枸橼酸钠口服补液盐组(4643.17±263.72)、(4305.15±230.17)dyn·s·cm-5,差异均有统计学意义(t=5.387、4.213,P值均小于0.05)。与烫伤不补液组比较,低渗丙酮酸钠口服补液盐组和低渗枸橼酸钠口服补液盐组大鼠伤后8、24 h时各脏器血流量均显著回升,差异均有统计学意义(P值均小于0.05);伤后8 h,低渗丙酮酸钠口服补液盐组肝、肾及肠黏膜组织血流量(225.4±28.6)、(337.0±25.8)、(68.7±10.7)BPU高于低渗枸橼酸钠口服补液盐组(176.5±11.4)、(179.0±19.7)、(47.3±4.9)BPU,差异均有统计学意义(t= 0.168、2.462、2.432,P值均小于0.05);伤后24 h,低渗丙酮酸钠口服补液盐组肝、肾及肠黏膜组织血流量(272.8±35.2)、(319.0±20.1)、(49.4±3.1)BPU高于低渗枸橼酸钠口服补液盐组(152.8±14.1)、(128±12.7)、(35.7±4.7)BPU,差异均有统计学意义(t=3.163、3.428、2.314,P值均小于0.05)。(2)低渗丙酮酸钠口服补液盐组和低渗枸橼酸钠口服补液盐组大鼠伤后24 h存活率均显著高于烫伤不补液组,差异均有统计学意义(P值均小于0.05);伤后24 h,低渗丙酮酸钠口服补液盐组存活率(40.0%)高于低渗枸橼酸钠口服补液盐组(20.0%),差异有统计学意义(χ2=4.113,P=0.038)。

结论

低渗丙酮酸盐口服补液盐能显著改善严重烧伤大鼠血流动力学及组织血流灌注水平,从而提高生存率。

Objective

To explore the effect of hypotonic sodium pyruvate-oral rehydration salt on the hemodynamics, tissues blood perfusion and survival rate in rats after severe burns.

Methods

(1)Eighty male Sprague-Dawley (SD) rats were randomly divided into 4 groups (n=80): sham-scald group; burns with no rehydration group; burns with hypotonic sodium pyruvate-oral rehydration solution group and burns with hypotonic sodium citrate-oral rehydration solution group. Each group had 20 rats. The osmolarity of sodium pyruvate-oral rehydration solution and sodium citrate-oral rehydration solution were respectively about 247 mOsm/L and 245 mOsm/L. Except for the sham-scald group, the rats were subjected to 50% total body surface area(TBSA) third-degree burns by immersing the back of the backpart for 15 s, both lower extremities for 15 s and the abdomen for 8 s in 96 ℃ water. sham-scald rats were immersed in 37 ℃ water instead. Immediately after scalding, rehydrated animals received the oral rehydration solution treatment through the gavage. According to the Parkland formula, the total amount of crystalloids was 4mL/ kg × 1% TBSA. One half of volume was infused during the first 8 hours, the rest during the following 16 hours after burns. All rats received the oral rehydration solution treatment through the gavage in every 0.5 h strictly according to the coculation. The rats in the sham-scald group were treated with free drinking water and rats in burns with no rehydration group were not given with oral rehydration solution. Hemodynamic parameters [mean arterial pressure(MAP), cardiac outcome (CO), dp/dtmax, systemic vascular resistance (SVR)] and liver, kidney and intestinal mucosal blood perfusion were observed at 8 h and 24 h after injury. (2)Another set of 80 male SD rats in identical experimental procedures without tests was randomly assigned to sham control group; burns with no rehydration group; burns with hypotonic sodium citrate-oral rehydration solution group and burns with hypotonic sodium pyruvate-oral rehydration solution group (n=20, each group) for analyzing the survival rate at 8 h and 24 h after burn. Data were processed with one-way ANOVA, t test and Chi-square test.

Results

(1)The hemodynamic parameters (MAP, CO, dp/dtmax, SVR) were significantly different at 8 h and 24 h after burn, there were significant differences (with P values below 0.05). Compared with that in burns with no rehydration solution group, the hemodynamic parameters (MAP, CO, dp/dtmax) of other 3 groups were higher, there were significant differences (with P values below 0.05). The hemodynamic parameters in burns with no rehydration solution group continued to decline until death.MAP, CO and dp/dtmax were higher in burns with hypotonic sodium pyruvate-oral rehydration solution group[(96.34±8.23) mmHg, (1.68±0.08) L/min and (720.46±61.37) mmHg/s] than that in burns with hypotonic sodium citrate-oral rehydration solution group [(75.35±7.63) mmHg, (0.97±0.05) L/min and (670.87±70.61) mmHg/s] at 8 h postburn; the differences were statistically significant (t=5.125, 2.375, 2.412, with P values below 0.05). MAP, CO and dp/dtmax were also higher in burns with hypotonic sodium pyruvate-oral rehydration solution group [(112.78±9.32) mmHg, (1.89±0.11) L/min and (953.42±74.18) mmHg/s] than that in burns with hypotonic sodium citrate-oral rehydration solution group [(93.12±10.22) mmHg, (1.13±0.09) L/min and (750.81± 65.72) mmHg/s] at 24 h postburn and the differences were statistically significant(t=5.127, 2.641, 2.981, with P values below 0.05). SVR was lower in burns with hypotonic sodium pyruvate-oral rehydration solution group [(4088.03±271.83), (3256.83±222.58) dyn·s·cm-5] than that in burns with hypotonic sodium citrate-oral rehydration solution group [(4643.17±263.72), (4305.15±230.17) dyn·s·cm-5] at 8 h and 24 h time points postburn and the differences were statistically significant (t=5.387, 4.213, with P values below 0.05). The levels of tissue blood flows (hepatic, renal and intestinal mucosa) in rats subjected to scald dropped sharply after burns, which grew to a higher level in burns with hypotonic sodium citrate-oral rehydration solution group and burns with hypotonic sodium pyruvate-oral rehydration solution group than that in the burns with no rehydration group at 8 h and 24 h postburn; the differences were statistically significant (with P values below 0.05). The levels of tissue blood flows (hepatic, renal and intestinal mucosa) were higher in burns with hypotonic sodium pyruvate-oral rehydration solution group [(225.4±28.6), (337±25.8), (68.7±10.7) BPU] than that in burns with hypotonic sodium citrate-oral rehydration solution group [(176.5±11.4), (179±19.7), (47.3±4.9) BPU] at 8 h postburn; the differences were statistically significant (t=0.168, 2.462, 2.432, with P values below 0.05). The levels of tissue blood flows (hepatic, renal and intestinal mucosa) in burns with hypotonic sodium pyruvate-oral rehydration solution group [(272.78±35.2), (319±20.1), (49.4±3.1) BPU] were higher than that in burns with hypotonic sodium citrate-oral rehydration solution group [(152.8±14.1), (128±12.7), (35.7±4.7) BPU] at 24 h postburn; the differences were statistically significant (t=3.163, 3.428, 2.314, with P values below 0.05). (2)The 24-hour survival rates of burns with hypotonic sodium pyruvate-oral rehydration solution group and burns with hypotonic sodium citrate-oral rehydration solution group were both significantly higher than the rate of the burns with no rehydration group (with P values below 0.05); the survival rate of burns with hypotonic sodium pyruvate-oral rehydration solution group (40.0%) was also significantly higher than that in the hypotonic sodium citrate-oral rehydration solution group (20.0%) and the difference was statistically significant (χ2=4.113, P=0.038).

Conclusion

Hypotonic sodium pyruvate-oral rehydration solution can significantly improve the systemic hemodynamics, tissues blood perfusion and survival in rats subjected with severe burn.

表1 假烫伤对照组与3组烫伤大鼠各时相点血流动力学指标MAP、CO、dp/dtmax和SVR的变化(±s)
组别 鼠数 MAP(mmHg) CO(L/min)
伤后8 h 伤后24 h 伤后8 h 伤后24 h
烫伤不补液组 10 29.45±7.65 23.32±7.54 0.31±0.03 0.22±0.05
低渗枸橼酸钠口服补液盐组 10 75.35±7.63 93.12±10.22 0.97±0.05 1.13±0.09
低渗丙酮酸钠口服补液盐组 10 96.34±8.23 112.78±9.32a 1.68±0.08 1.89±0.11a
假烫伤对照组 10 132.42±10.5 138.81±9.46 2.13±0.18 2.16±0.17
F ? 11.017 41.231 31.612 8.431
P ? 0.000 0.000 0.001 0.000
t1 ? 4.164 2.756 6.513 3.278
P1 ? <0.05 <0.05 <0.05 <0.05
t2 ? 4.312 3.764 3.668 4.129
P2 ? <0.05 <0.05 <0.05 <0.05
t3 ? 3.617 4.632 6.314 4.296
P3 ? <0.05 <0.05 <0.05 <0.05
t4 ? 5.125 5.127 2.375 2.641
P4 ? <0.05 <0.05 <0.05 <0.05
t5 ? 3.642 7.314 4.184 3.128
P5 ? <0.05 <0.05 <0.05 <0.05
t6 ? 4.871 6.349 3.247 2.914
P6 ? <0.05 <0.05 <0.05 <0.05
组别 鼠数 dp/dtmax(mmHg/s) SVR(dyn·s·cm-5)
伤后8 h 伤后24 h 伤后8 h 伤后24 h
烫伤不补液组 10 267.87±7 0.86 133.51±58.04 6203.31±281.92 5958.33±240.61
低渗枸橼酸钠口服补液盐组 10 670.87±7 0.61 750.81±65.72a 4643.17±263.72 4305.15±230.17a
低渗丙酮酸钠口服补液盐组 10 720.46±6 1.37 953.42±74.18a 4088.03±271.83 3256.83±222.58a
假烫伤对照组 10 1213.50±62.72 1320.65±64.09 2134.51±72.31 2103.33±67.31
F ? 13.741 15.642 217.028 372.091
P ? 0.000 0.000 0.000 0.000
t1 ? 6.184 2.613 6.587 3.669
P1 ? <0.05 <0.05 <0.05 <0.05
t2 ? 2.462 3.164 2.754 3.125
P2 ? <0.05 <0.05 <0.05 <0.05
t3 ? 4.218 3.698 2.643 2.638
P3 ? <0.05 <0.05 <0.05 <0.05
t4 ? 2.412 2.981 5.387 4.213
P4 ? <0.05 <0.05 <0.05 <0.05
t5 ? 5.161 4.152 2.865 3.361
P5 ? <0.05 <0.05 <0.05 <0.05
t6 ? 3.281 3.641 2.963 2.379
P6 ? <0.05 <0.05 <0.05 <0.05
表2 假烫伤对照组与3组烫伤大鼠各时相点各脏器组织血流量的变化(BPU,±s)
表3 假烫伤对照组与3组烫伤大鼠各时相点的存活率比较[n(%)]
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