丙戊酸钠对严重烫伤合并海水浸泡损伤大鼠延迟补液时腹腔脏器功能和血流量的影响

孟祥熙; 田雨沫; 胡森; 王莉莉; 张慧苹; 钟毓贤; 王燕; 王宏伟; 孙奎; 丁宇

doi:10.3969/j.issn.2095-5227.2022.09.008

丙戊酸钠对严重烫伤合并海水浸泡损伤大鼠延迟补液时腹腔脏器功能和血流量的影响

Effects of valproic acid on abdominal organ function and blood flow in severely scalded rats with seawater immersion injury during delayed fluid rehydration

摘要

摘要:
背景近年来研究表明，严重烧伤早期应用丙戊酸钠对重要脏器功能有一定的保护作用。
目的研究丙戊酸钠(valproic acid，VPA)对严重烫伤合并海水浸泡损伤大鼠延迟补液时腹腔脏器功能和血流量的影响。
方法雄性SD大鼠180只，随机分三组：单纯烫伤 + 延迟补液组(S组)，烫伤 + 海水浸泡 + 延迟补液组(SS组)，烫伤 + 海水浸泡 + VPA + 延迟补液组(SSV组)，每组60只。各组大鼠100℃沸水浸泡背部、臀部15 s，致35％总体表面积Ⅲ°烫伤。S组烫伤后2 h静脉补液。SS组和SSV组烫伤后即刻浸泡于人工海水中(23℃，30 min)，SSV组浸泡后即刻皮下注射丙戊酸钠(300 mg/kg)，以上两组海水浸泡后2 h静脉补液。补液量根据1/2 Parkland公式静脉输入乳酸钠林格注射液(30 min完成)。各组选取 20 只大鼠计算24 h生存率。各组于伤前、海水浸泡后即刻、海水浸泡后2 h、海水浸泡后5 h选取10只大鼠，测定平均动脉压(mean arterial pressure，MAP)、直肠温度(rectal temperature，RT)、血乳酸(lactic acid，Lac)、腹腔脏器功能指标、脏器血流量，取组织标本，观察脏器病理变化。
结果 SS组24 h生存率较SSV组和S组均显著降低，差异均有统计学意义(55% vs 75%和90%，55% vs 90%，P均＜0.05)；伤后0 h、2 h、5 h，与S组比较，SS组MAP、RT和腹腔脏器血流量均明显降低(P均＜0.05)，Lac、腹腔脏器功能水平均明显升高(P均＜0.05)；伤后2 h、5 h，SSV组各项指标较SS组均明显改善(P均＜0.05)。
结论严重烫伤大鼠合并海水浸泡损伤延迟补液时，伤后立即皮下注射丙戊酸钠可升高平均动脉压，降低血乳酸水平，改善腹腔脏器血流量，保护腹腔脏器功能，提高24 h生存率。

Abstract:
Background In recent years, many studies have shown that valproic acid (VPA) can protect the function of important organs.
Objective To study the effects of VPA on abdominal organ function and blood flow in severely scalded rats with seawater immersion injury during delayed fluid rehydration.
Methods One hundred and eighty male SD rats were randomly divided into the simple scalds group + delayed fluid rehydration group (S group, n=60), scalds + seawater immersion + delayed fluid rehydration group (SS group, n=60) and scalds + seawater immersion + VPA + delayed fluid rehydration group (SSV group, n=60). All groups were soaked in boiling water at 100℃ for 15 seconds on their back and hip, which were inflicted with 35% of the total body surface area full-thickness scald. S group received intravenous rehydration at 2 h after scald. SS and SSV groups were immersed in artificial seawater (23℃, 30 min) immediately after scalding, and SSV group were subcutaneously injected with VPA (300 mg/kg) after seawater immersion, and these two groups received intravenous rehydration at 2 h after seawater immersion. The rehydration volume was based on 1/2 Parkland formula, and all groups were intravenously infused with lactated Ringer's solution (completed within 30 min). Twenty rats in each group were selected to observe the 24-hour survival rate. Four time observation points were set: pre-injury, immediately after seawater immersion (0 h), 2 h after seawater immersion (2 h) and 5 h after seawater immersion (5 h), ten rats were selected from each group to measure mean arterial pressure (MAP), rectal temperature (RT), lactic acid (Lac), abdominal organ function indexes, blood flow and histopathological changes at each time point.
Results The 24-hour survival rate of the SS group was significantly lower than that of the SS group and the S group (55% vs 75% and 90%, P＜0.05). At 0 h, 2 h, 5 h after injury, compared with the S group, MAP, RT and abdominal organ blood flow decreased significantly while the levels of Lac and abdominal organ function increased significantly in the SS group (all P＜0.05); At 2h, 5h after injury, the indexes and histopathology of the SSV group were significantly improved compared with those of the SS group (all P＜0.05).
Conclusion In severely scalded rats with seawater immersion injury during delayed fluid rehydration, subcutaneous injection of VPA immediately after injury can increase MAP, reduce Lac, improve abdominal organ blood flow, protect abdominal organ function and increase 24-hour survival rate.

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