新型严重肝外伤动物模型的建立及“腹部实质器官包扎绷带”的应用研究

发布时间：2018-01-21 07:00

  本文关键词： 肝外伤 动物模型 失血量 止血 规则性肝切除术 AAST分级　出处：《中国人民解放军军医进修学院》2007年博士论文　论文类型：学位论文

【摘要】： 背景长期以来，严重肝外伤的救治较少从动物实验中获益。这与缺乏规范、良好的(大型)动物模型有关。已有的体内钳夹法(“Crush-clamping”)及“体外致伤”法肝外伤模型或存伤情较轻、为非钝性伤，或存死亡率高、副损伤重、可重复性差等缺点。因此，重建“新型”严重肝外伤动物模型具有重要意义。 严重肝外伤的救治仍是严峻挑战。利用自行开发的可吸收“腹部实质器官包扎绷带”，对适选病例实施损伤肝叶的包扎治疗可能是一种极有前景的策略。它不但在理论上优于需二次手术、具较多并发症的“纱布填塞”以及死亡率较高的“规则性肝切除”，而且克服了已有“可吸收网套”的诸多不足(如：形态匹配欠佳、费工耗时等)。基于小型猪肝叶解剖特点及前期所建动物模型伤情，本研究将首先验证——与“规则性肝切除”相较，“腹部实质器官包扎绷带”所具有的理论优势。 目的建立新型严重肝外伤(大型)动物模型，并利用其研究“腹部实质器官包扎绷带”治疗和“规则性肝切除”手段孰优孰劣。 方法制作“MT-1型(远距离点火)爆炸致伤装置”，将爆炸物直接置于拟致伤肝叶表面，在对邻近器官施以隔离保护措施之后，遥控引爆。监测伤后MAP变化及测量肝脏毁损面积S(cm~2)、失血量等指标，用以衡量动物模型的“标准化”程度。其后，应用该法致小型猪Ⅳ级肝外伤(n=8)，随机分入“腹部实质器官包扎绷带”组(Group B，Bandage)及“规则性肝切除”组(Group R，Resection)，，选取手术止血时间(min)、失血量(ml)、术后肝功能恢复(TB、ALT、AST)等指标对比其优劣。 结果1、代表小型猪伤后早期(2～7min)MAP变化趋势的回归系数介于-3.94与-9.91之间；肝脏毁损面积为12.19±2.28(cm~2)，95％可信区间为[10.66，13.71](cm~2)。2、“包扎”组手术失血量小于“切除”组(86.3±25.0 vs.136.3±29.3，P=0.0407)；手术止血时间未显示差异(9.00±3.16 vs.10.88±2.39，P=0.3809)；术后即刻“包扎”组AST高于“切除”组(308.7±92.25vs.162.7±39.50，P=0.0270)，术后1天“包扎”组AST、ALT均高于“切除”组(400.6±107.26vs.181.7±75.50，P=0.0157、119.3±32.01vs.67.8±16.55，P=0.0289)，术后TB无差异。 结论成功建立了符合AASTⅣ级伤情、具有良好可重复性、并在一定程度上具有“钝性伤”特点的小型猪严重肝外伤模型。“腹部实质器官包扎绷带”应用于广泛星芒状肝脏损伤暨肝组织无缺血、失活表现时，与传统“规则性肝切除”手段相比具有一定的优势，主要表现为手术失血量减少。
[Abstract]:Background for a long time, the treatment of severe liver trauma has rarely benefited from animal experiments. Good (large) animal models are related. The existing in vivo clamp method ("Crush-clamping") and "in vitro injury" method liver injury model or the existence of light injury, is non-blunt injury. Therefore, it is of great significance to reconstruct the "new" animal model of severe liver injury. The treatment of severe liver trauma is still a serious challenge, using self-developed absorbable "abdominal parenchymal organ bandage". Bandaging of injured liver lobe may be a promising strategy for suitable cases. It is not only better than the need for secondary surgery in theory. The "gauze packing" with more complications and the "regular hepatectomy" with high mortality have overcome many shortcomings of the existing "absorbable mesh" (such as poor morphological matching). Based on the anatomical characteristics of the liver lobe of the small pig and the injury situation of the animal model established in the early stage, this study will first verify the comparison between "regular hepatectomy" and "regular hepatectomy". The theoretical advantage of "abdominal solid organ bandage". Objective to establish a new type of animal model of severe liver trauma and to study the advantages and disadvantages of "abdominal parenchymal organ bandage" and "regular hepatectomy". Methods the "MT-1" explosive injury device was made. The explosive was placed directly on the surface of the liver lobe, and the adjacent organs were protected by isolation. Remote detonation. Monitoring the changes of MAP after injury and measuring the liver damage area (Sch), blood loss and other indicators to measure the "standardized" degree of animal models. The method was used to induce liver trauma of grade 鈪

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