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目的:观察超早期(伤后6h)切痂疗法对小型猪严重烧伤后血流动力学、血液流变学及氧供氧耗的影响,并与休克期(伤后24h)切痂进行比较。方法:实验于2005-09/12在唐山工人医院烧伤研究所进行。取30只小型猪,将其背部置入80℃热水中1min,造成35%Ⅲ度烫伤(病理切片证实)。烫伤后将30只动物单纯随机分为伤后6,24h切痂组2组(n=15),分别于伤后6,24h麻醉后一次切除全部Ⅲ度焦痂。于伤前、伤后6,8,16,24,48,72h等不同时相点检测两组猪的血流动力学、血液流变学以及氧供和氧耗等指标的变化。结果:30只猪全部进入结果分析。①伤后6,24h切痂组猪心输出量和右心房压在伤后6h分别降至伤前值的66%和68%,组间比较差异不显著(P>0.05)。伤后6h切痂组在伤后8h即开始恢复,伤后48h已基本恢复正常。伤后24h切痂组在伤后8h时此2项指标均已降至伤前值的59%,随液体复苏右心房压缓慢升高,至切痂前(伤后24h)仍低于伤前值(P<0.05),伤后72h基本恢复正常;心输出量则持续下降,至伤后24h达伤前值的41%,切痂后有较大幅度回升,伤后48h基本达到伤前水平,此后继续升高,伤后72h已明显高于伤前值。②两组动物伤后低切变全血黏度和红细胞聚集指数均升高,切痂后两组各指标均逐渐降低,两指标的组间差异不显著(P>0.05)。③两组氧供在伤后6和8h均较伤前显著下降,伤后16h时,伤后6,24h切痂组分别为(398.83±3.56),(391.20±7.80)L/min,已恢复至伤前水平,并稳步上升。④两组氧耗各时相均较伤前有所下降,伤后6,24h切痂组分别于伤后8和16h达最低值[(138.46±1.49),(137.09±1.67)L/min];切痂治疗后有了明显改善,逐渐恢复至伤前水平。结论:①与休克期切痂比,超早期切痂能提高心输出量、右心房压等血流动力学指标,改善机体供氧和利用氧的能力。②超早期与休克期切痂对血液流变学的影响差异并无显著性意义,说明两个时间段切痂同样安全可行。
Objective: To observe the effect of ultra-early esophageal escharectomy (6h after injury) on the hemodynamics, hemorheology and oxygenation oxygen consumption of mini-pigs after severe burn, and compare with the escharectomy (24h after injury). Methods: The experiment was performed at Tangshan Workers Hospital Institute of Burns from September to September 2005. Thirty miniature pigs were placed in the hot water at 80 ℃ for 1 min, resulting in 35% degree Ⅲ burns (confirmed by biopsy). Thirty animals were randomly divided into 2 groups (n = 15) at 6 and 24 h after escharectomy. All the esophageal lesions were excised at 6 and 24 h after anesthesia. The hemodynamics, hemorheology, oxygen supply and oxygen consumption of the two groups were measured before injury, 6, 8, 16, 24, 48, 72h after injury. Results: All 30 pigs entered the result analysis. ① The pig’s cardiac output and right atrial pressure decreased to 66% and 68% of the pre-injury value at 6 and 24 hours after wound injury respectively. There was no significant difference between the two groups (P> 0.05). The escharectomy group recovered at 8h after injury and returned to normal at 48h after injury. 24h after injury, the esophageal mucosa of the escharectomy group had dropped to 59% of the pre-injury value at 8h after injury. The right atrial pressure increased slowly with liquid resuscitation and was still lower than that before injury (24h after injury) (P <0.05), and returned to normal at 72h after injury. The cardiac output continued to drop to 41% of the pre-injury value at 24 hours after injury, with a significant recovery after escharectomy, and reached the pre-injury level 48 hours after injury , Then continue to rise, 72h after injury has been significantly higher than the pre-injury value. ② The whole blood viscosity and erythrocyte aggregation index of low shear blood of both groups increased after injury, and the indexes of both groups decreased gradually after escharectomy. There was no significant difference between two groups (P> 0.05). ③ The oxygen supply of both groups decreased significantly at 6 and 8 h after injury compared with pre-injury, and at 16 h and 6 h and 24 h post-injury, the escharectomy group was (398.83 ± 3.56) and (391.20 ± 7.80) L / min, resumed Pre-injury level, and steadily increased. (4) The oxygen consumption of the two groups decreased at different time points compared with those before the injury, and reached the lowest values at 8 and 16 h after injury (P <0.05) [(138.46 ± 1.49) and (137.09 ± 1.67) L / min, ; After escharectomy treatment has been significantly improved, and gradually restored to pre-injury level. Conclusion: Compared with the shock-induced escharectomy, ultra-early escharectomy can improve cardiac output, right atrial pressure and other hemodynamic parameters to improve the body’s ability to supply oxygen and use oxygen. (2) There was no significant difference between the effect of escharectomy and hemorrhagic shock in the ultra-early stage and the shock stage, which indicated that escharectomy was equally safe and feasible in both time periods.