| Objective1.To perform a comparative study of effects of oral rehydration to vein rehydration on circulatoey parameters and survival rate in dogs with burns shock;2.To investigate the protective role of oral rehydration salt combined with carbachol on gastrointestinal function so as to develop a reasonable compounding of oral rehydration and improve therapeutic effect of oral rehydration in resuscitation of burns shock.Materials and methodsBurns model:Thirty-two health male dogs were used in the study.Animals were fasted 16 hours before surgery and anesthetized by intramuscular injection of ketamine(8mg/kg) and tacho-sleepⅡ(0.1mg/kg).Catheters were placed into the femoral artery and vein for monitoring hemodynamic parameters and infusing fluid.Gastrotomy was done to insert a tonometer for the measurement of pHi.A catheter was put through a small enterotomy on jejunal 10-15cm near Treiz ligament for measurement of intestinal cavity pressure.On back body of dogs(about 30%TBSA) was overlaid uniformly with 3%napalm four times,then blanketed after burning 50 seconds.Group and resuscitative project:Dogs were divided into four groups:Burns with no resuscitation(NR),burns+intravenous infusion of Ringer's solution(LVR,4ml.kg-1. %TBSA-1),burns+oral rehydration salt(OR),burns+oral rehydration salt combined with carbachol(OR+K).In first eight hours,a half of 24 hours volume of Ringer's solution (according to Parkland formula) was intravenously given to animals in LVR group,the rest fluids were given in left sixteen hours.On the next day,all volume of Ringer's solution was intravenously given to animals in sixteen hours.all Animals in OR group were enterally resuscitated with ORS fluid through a gastric tonometer begging from 0.5 h post burn(first given three times in eight hours,the rest given in left sixteen hours).On the next day,all volume of ORS fluid was given to animals through a gastric tonometer in sixteen hours.In OR+K group resuscitative project was performed as same as OR group except given carbachol enterally two times per day at dose of 0.025mg.kg-1.24hr. Results1.MAP in two groups of fluid replacement significantly decreased at three hours post burn.MAP were much lower in two oral rehydration groups than that in venous rehydration group(P＜0.05),but higher than that in NR group(P＜0.05),there was no significant differences between oral rehydration only and oral rehydration+carbachol(P＞0.05).2.Gastric mucosa pHi were higher in groups of OR and OR+K than that in NR group three hours post burn.,but lower than that in LVR group(P＜0.05).Gastric mucosa pHi was higher in OR+K group than that inOR group(P＜0.05).3.Intestinal pressure was not significantly changed in LVR group,while it did increase gradually in NR group compared with that before injury.Intestinal pressure was obviously higher in OR group than that in OR+K group at three hours post burn(P＜0.05).4.The changes of plasma DAO and D-lactic acid in all groups was significantly increased post burn,and gradually fall off after resuscitation accept NR group.It were much lower in OR+K group than those in OR group(P＜0.05),and higher than those in LVR group post burn(P＜0.05)5.The urinary volumes of 24h and 48h in OR and OR+K groups were much higher than those in NR group,and lower than those in LVR group.Mortality rate of 24 h and 48h were significantly higher with 62.5%and 100%in NR group than those in other three resuscitated groups(P＜0.05).6.Four of eight dogs in OR group vomited about 70-505ml with 346.3±142.2ml of residual fluid in stomach,which were significantly higher than those in OR+K group(two of eight dogs vomited about 55-120ml with 185.6±78.3ml of residual fluid in stomach P＜0.05).There were no significant differences in incidence and severity of vomiting and gastric residual fluid between NR group and LVR group(P＞0.05)Conclusion1.Early oral rehydration has significant improvements on mean artery pressure, gastrointestinal perfusion and survival rats in dogs with 30%TBSAⅢ°burn injury,which almost substitute the effects of venous resuscitation in 48 hours post burn.2.Burns shock may result in decreased gut tolerance to oral rehydration,manifesting sever vomiting,gut mucosa damage and elevation of intestinal cavity pressure,which were closely correlated with higher gastrointestinal pHi. 3.Enteral treatment of carbachol in resuscitation of burns shock significantly improve gut tolerance to oral rehydration salt by increasing gut motor and absorption,and alleviating pathological injury...
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