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Carbachol promotes gastrointestinal function during oral resuscitation of burn shock

摘要AIM: To investigate the effect of carbachol on gastrointestinal function in a dog model of oral resuscitation for burn shock.METHODS: Twenty Beagle dogs with intubation of the carotid artery, jugular vein and jejunum for 24 h were subjected to 35% total body surface area fullthicknessburns, and were divided into three groups:no fluid resuscitation (NR, n = 10), in which animals did not receive fluid by any means in the first 24 h postburn;oral fluid resuscitation (OR, n = 8), in which dogs were gavaged with glucose-electrolyte solution (GES)with volume and rate consistent with the Parkland formula; and oral fluid with carbachol group (OR/CAR,n = 8), in which dogs were gavaged with GES containing carbachol (20 μg/kg), with the same volume and rate as the OR group. Twenty-four hours after burns, all animals were given intravenous fluid replacement, and 72 h after injury, they received nutritional support. Hemodynamic and gastrointestinal parameters were measured serially with animals in conscious and cooperative state.RESULTS: The mean arterial pressure, cardiac output and plasma volume dropped markedly, and gastrointestinal tissue perfusion was reduced obviouslyafter the burn injury in all the three groups. Hemodynamic parameters and gastrointestinal tissue perfusion in the OR and OR/CAR groupswere promoted to pre-injury level at 48 and 72 h,respectively, while hemodynamic parameters in the NR group did not return to pre-injury level till 72 h,and gastrointestinal tissue perfusion remained lower than pre-injury level until 120 h post-burn. CO2 of the gastric mucosa and intestinal mucosa blood flow of OR/CAR groups were 56.4 ± 4.7 mmHg and 157.7 ± 17.7 blood perfusion units (BPU) at 24 h postburn,respectively, which were significantly superior to those in the OR group (65.8 ± 5.8 mmHg and 127.7 ± 11.9 BPU, respectively, all P < 0.05). Gastricemptying and intestinal absorption rates of GES were significantly reduced to the lowest level (52.8% and23.7% of pre-injury levels) in the OR group at about2 and 4 h post-burn, and did not return to 80% of pre-injury level until 24 h. In the first 24 h postburn,the rate of gastric emptying and intestinal water absorption were elevated by a mean 15.7% and 11.5%,respectively, in the OR/CAR group compared with the OR group. At 5 days, the mortality in the NR group was30% (3/10), 12.5% in the OR group (1/8), and none in the OR/CAR group.CONCLUSION: Carbachol had a beneficial effect on oral resuscitation of burn shock by promoting gastric emptying and intestinal absorption in our canine model.

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作者单位 Research Laboratory of Shock and Multiple Organ Dysfunction, Burns Institute, First Hospital Affiliated to the PLA General Hospital, Beijing 100048, China [1]
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DOI 10.3748/wjg.v17.i13.1746
发布时间 2012-03-21(万方平台首次上网日期,不代表论文的发表时间)
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