摘要
本文通过检测57例烧伤病人心功能、心肌酶谱和病理检查结合临床情况对烧伤后心功能减退的原因进行了探讨。结果表明,伤后1/2天,每搏量(SV)和每搏指数(SVI)降到最低值,1天后逐渐回升,但整个观测期(5天)内均明显低于正常水平。伤后36h内,心输出量(CO)也明显降低,心肌酶谱明显增高者,SV、CO和SVI等降低更明显,外周阻力(SVR)伤后早期明显增高。伤后1/2天,心肌酶谱CPK、LDH和GOT即明显增高,5天内均有较大幅度增高,15例心功能衰竭病人心肌酶谱增高幅度更大。伤后早期血红蛋白(Hb)、红细胞计数(RBC)、血球压积(Ht)和全血粘度均大幅度增高。心功能衰竭死亡病人心脏增大,心肌纤维浊肿、断裂、结构紊乱、疏松、间质水肿、出血。这些结果表明,除了血容量减少和SVR增高是伤后早期心功能降低的原因外,烧伤后很早即可发生心肌的器质性损害,也是伤后早期心功能减退以至衰竭的重要原因。
Non-invasive cardiac monitoring, myocardic enzyme spectrum (CPK, LDH and GOT)and pathomorphological observations of myocardium in those patients succumbing to heart failure were investigated to probe into the changes of cardiac function and its etiolgical factors in 57 severely burnt natien ts (TBSA 61.2±22.1%).The findings manifested that stroke volume (SV) and stroek volume index(SVI) dropped abruptly to their valleys at 1/2 day post burn (PB) and picked up 1 day later,but were significantly lower than normal during the whole observation period (within 5 days PB) .Cardiac output (CO) reduced sigificantly within 36 hours PB. Moreover,more profound decrease of SV, SVI and CO was revealed in those patients with a greater increase of CPK, LDH and GOT. SVR(somatic vascular resistance) increased markedly within 36 hours PB. CPK, LDH and GOT, ascending at 1/2 day and sustaining at higher levels within 5 days PB, were more pronounced in the 15 patients succumbing to heart failure. At early stage PB, hemoglubin, red blood cell count, hematocrit and blood, viscosity all significantly increased .Cloudy swelling and fragmentation of myocardial fibers, interstitial edema and hemorrhage were common post-mortem findings in patients suffering from heart failure .These findings demonstrated that in addition to the decrease of plasma volume and the increase of SVR,the myocardial damage , occurring soon after severe burns may be an importanf factor for the early cardiac reduction and cardiac failure.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
1990年第4期269-274,共6页
Journal of Third Military Medical University
关键词
灼伤
心脏
心肌
心力衰竭
burns/CO
heart/PH
myocardium/IN
heart failure/ET
