Ulinastatin On Severe Burns Early Organ Vascular Permeability And Hemodynamic Effects Of The Experiment

ObjectiveThe increase of vasopermeability after severe burn is the majoy factor leading to mass exosmosis of intravascular fluid,edema of organs and tissues, and occurance of hypovolemic shock.With regard to patients during shock stage after burnt,effective circulation volume could have been maitained through formulary and considerable fluid infusion,as largely reduced the mortality.However,we always lose the chance to perform effective fluid infusion during early stage after burn,which lead to patients' unstable living through shock stage,augment the difficulty of treatment afterward,and raise the case fatality ratio(CFR),in some special circumstances such as facing a great quantity of the wounded.One of the important reasons for the above is the deficiency of valid method to control the heightening of vasopermeability, as make the problem of losing intravascular fluid unresolved fundamentally. We haven't stop looking for effective methods to repress the rise of vasopermeability after burn,which may delay the development of shock,offer available life support,decrease the volume of resuscitation fluid,and improve the edema of organs and tissues by limiting the lose of intravascular fluid.In this study,we used begal dogs of 35%TBSAⅢ°as models.We observed the influence of ulinastatin,as used to the models early after burn,to their hemodynamic indexes,intestinal mucosa blood flow,and organ vasopermeability.We hope to provid experimental evidence for the anti-diosmosis effect of ulinastatin when it was used during early stage of burn shock.Methods 12 beagle dogs with 35%TBSA third degree burn(30 seconds burnt by napalm) were adopted in the study.Dogs were randomized to 2 groups(n=6):(1) control group(CG):non-remedy after burn;(2) ulinastatin group(UG): intravenous injection of ulinastatin by dose of 10000U/kg at 0.5h postburn(PB). Haemodynamics indexes,such as pulse circumsciption cardiac output index(PCCI),stroke volume index(SVI),mean arterial pressure(MAP),systemic vascular resistance index(SVRI),dp/dt max of left ventricular contractility(dP/dtmax),intrathoracic blood volume index(ITBI),extravascular lung water(EVLW),pulmonary vascular permeability index(PVPI),and(GEDI) were determined by PICCO before burn and at 0.5h,1h,2h,4h,6h,8h PB. Blood samples were drawn to determine HCT,TNF-αand MDA.Plasma volume(PV) were deduced through indocyanine green(ICG) method.Intestinal mucosa blood flow(IMBF) were determined by laser Doppler flowmetry.After 8 hours,animals were sacrificed,evans blue(EB) method was taken to determine the vasopermeability of heart,liver,spleen,kidney and jejunum,and dry/wet weight method was used to determine the rate of organ water content(ROWC).ResultIn UG,CI and MAP maintained stable after burn,and SVI declined at 4h PB(P＜0.05),whereas in CG,CI,MAP and SVI became sliding down at 1hPB, 8hPB,2hPB respectivwely(P＜0.01 or P＜0.05).SVRI in UG stepped up right after burn and then declined.And it rebounded to normal level at 6h PB (P＞0.05).SVRI in CG,which was markedly higher than that in UG(P＜0.01 or P＜0.05),remained higher after stepping up.DP/dtmax in both groups,which declined right after burn,had no difference from each other(P＞0.05 ).Both ITBI and GEDI lowered after burn in the two groups,but in UG the extent was less. And both ITBI and GEDI in UG were higher than those in CG(P＜0.01 or P＜0.05).EVLW and PVPI in UG became lower than those in CG from 6hPB and 4hPB respectively(P＜0.01 or P＜0.05).PV and IMBF in both groups declined,and HCT in both groups rose,while in UG the extent were less.There were significant difference between the two groups(P＜0.01 or P＜0.05).TNF-αand MDA rose after burn in both groups,but in UG were much higher(P＜0.01 or P＜0.05 ).Both EB content and ROWC of liver,spleen,kidney and jejunum in UG were much lower than that in CG(P＜0.01 or P＜0.05),except that there were no statistical difference of heart EB content and ROWC between the two groups(P＞0.05).Conclusion1.Ulinastatin used to beagle dogs with 35%TBSA third degree burn could moderate the quick loss of circulation volume,and be available to improve hemodynamics indexes.2.Ulinastatin used to beagle dogs with 35%TBSA third degree burn could make IMBF relatively stable,and be beneficial to ameliorate enteric ischemical reperfusion injury.3.Ulinastatin used to beagle dogs with 35%TBSA third degree burn could moderate vasopermeability and edema of distant organs.