Effects Of Toss On Shock And Fluid Replacement Regimens For Severe Burn Injury Under Toss Condition

ObjectiveTo clarify the effects of toss on shock and fluid replacement regimens for severe burn injury under toss conditionMaterial and method1. The effects of simulated toss on shock following burn injury in rabbitsA total of 84 rabbits were subjected to 40 % total body surface areaⅢburn injury, and randomly divided into simple burn group (S group) and burn-toss group (DS group). 48 rabbits without burn injury were randomly divided into simple toss group (DN group) and normal control group. All rabbits in the non-burn groups received no fluid resuscitation. The myocardial mechanic parameters, the level of Cr, Bun, urine output, Hct and LA in serum, and the histologic changes in myocardium and nephros were observed.2. Therapeutic effects of different fluid replacement regimens for severe burn injury under simulated toss condition in rabbitsA total of 288 rabbits were subjected to 40 % total body surface areaⅢburn injury, and randomly divided into prompt resuscitation by fluid A group (4AL group) , delayed resuscitation by fluid A group (4AY group), prompt resuscitation by fluid B group (4BL group), delayed resuscitation by fluid B group (4BY group), toss after prompt resuscitation by fluid A group (4DAL group) , toss after delayed resuscitation by fluid A group (4DAY group), toss after prompt resuscitation by fluid B group (4DBL group) , toss after delayed resuscitation by fluid B group (4DBY group). Another 6 rabbits without burn were used as normal control. Fluid A contains balanced solution and 5% glucose, Fluid B contains Fluid A and astragalus membranaceus injection. The fluid amount needed both for immediate and delayed resuscitation was estimated according to formula developed in the Third Millitary Medical University. Parameters were determined as in part 1.3. Therapeutic effects of different fluid replacement regimens for severe burn injury under sea condition in rabbitsA total of 120 rabbits were subjected to 40 % total body surface areaⅢburn injury, and randomly divided into toss on sea after burn group (HS group), toss on sea after prompt resuscitation by fluid A group (HAL group) , toss on sea after delayed resuscitation by fluid A group (HAY group), toss on sea after prompt resuscitation by fluid B group (HBL group), toss on sea after delayed resuscitation by fluid B group (HBY group). Another 6 rabbits without burn were used as normal control. Fluid A and B were the same as in part 2. Parameters were determined as in part 1.Results1. The effects of simulated toss on shock following early burn injury in rabbitsAOSP,AODP,MAP,LV+dp/dt max in DS group were significantly lower than those in S group from 12 hours. LVSP and LV-dp/dt max in DS group were obviously lower than those in S group from 6 hours. LVEDP in DS group was also predominantly lower than those in S group only from 2 hours. The levels of Cr and Bun in DS group were significantly higher than those in S group from 24 hours. Levels of Hct and LA in DS group were also obviously higher than those in S group from 2 hours, the level of average urinary volume per 24h in DS group was predominantly lower than those in S group. The myocardial mechanic parameters in DS group was the lowest in the three experimental groups, and the level of Cr, Bun, Hct and LA in DS group were the highest in the three experimental groups at 2, 6, 8, 12, 24, 36 and 48h, the average urinary volume per 24h in DS group was the lowest among the three experimental groups. The pathological lesions of myocardium, acinus renis and nephric tubule in DS group were more marked than those in S group.2. Therapeutic effects of different fluid replacement regimens for severe burn injury under simulated toss condition in rabbitsAOSP,AODP,MAP,LVSP,LVEDP and LV±dp/dt max in all treated groups were significantly higher than those in burn control group. The levels of Cr, Bun, LA and Hct in all treated groups were significantly lower than those in burn control group. The average urinary volume per 24h in all treated group were predominantly higher than those in burn control group. Especially, all of the above parameters about shock in the resuscitation by fluid B groups were better than those in the resuscitation only by fluid A group, and there were no difference between prompt and delayed resuscitation groups 24h postburn, but those in toss after resuscitation groups became worse than those in resuscitation control groups on island. Pathological lesions of myocardium, acinus renis and nephric tubule showed the same tendency of changes.3. Therapeutic effects of different fluid replacement regimens for severe burn injury under sea condition in rabbitsUnder toss on sea condition , AOSP,AODP,MAP,LVSP,LVEDP and LV±dp/dt max in simple burn control group were significantly lower than those in normal control group, and The levels of Cr,Bun,Hct and LA was significantly higher than those in normal control group. The average urinary volume per 24h was predominantly lower than that in normal control group. AOSP,AODP,MAP,LVSP,LVEDP and LV±dp/dt max in all treated groups were significantly higher than those in toss on sea after burn control group. The levels of Cr, Bun, LA and Hct in all treated group were significantly lower than that in toss on sea after burn control group. The average urinary volume per 24h in all treated group were predominantly higher than those in toss on sea after burn control group. Especially, all of the above indicatrixes about shock in the resuscitation by fluid B groups were better than those in the resuscitation only by fluid A group, and there were no difference between prompt and delayed resuscitation groups 24h postburn, but those in toss after resuscitation groups became worse than those in resuscitation control groups on island. Pathological lesions of myocardium, acinus renis and nephric tubule showed the same tendency of changes.Discussion and conclusion1. Both simulated toss and toss on sea can significantly aggravate shock following early burn injury.The urinary volume decreased, haemodynamics was disturbed, the level of Cr, BUN, Hct and LA increased, and the cardiac and renal funtion even descended. The pathological lesions of myocardium, acinus renis and nephric tubule were more marked.2. Under simulated toss or toss on sea condition, fluid replacement can keep haemodynamics stable, palliate shock obviously. The curative effects of prompt and delayed resuscitation had no difference after 24h postburn. It is beneficial for treating shock after burn to use astragalus membranaceus injection appropriately and early in order to uphold the cardiac funtion and improve haemodynamics. The curative effects of astragalus membranaceus injection groups were better than the therpy control groups.3. Under simulated toss or toss on sea condition, the fluid amount of prompt and delayed resuscitation were estimated according to the formula developed by Third Millitery Medical University, in order to make the blood volume sufficient enough. Astragalus membranaceus injection(1ml/kg*d) was used appropriately and early in order to palliate ischemic and hypoxic injury of myocardium, which improved the curative effects. Even under delayed resuscitation condition, the curative effects of fluid replacement according to the delayed resuscitation formula were the same as prompt resuscitation 24 h postburn.