高原高寒地区腹腔严重感染及腹部外加压治疗腹腔创伤性大出血的实验研究

发布时间：2018-03-11 00:07

本文选题：高原高寒　切入点：治疗　出处：《兰州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨高原高寒地区腹腔严重感染特点及腹部外加压治疗腹腔创伤性大出血的可能性及其作用机制,为临床治疗高原高寒地区腹腔严重感染和腹部外加压治疗腹腔创伤性大出血提供理论依据。方法实验一:通过手术选取实验用家兔肠系膜上动脉,据肠系膜上动脉与腹主动脉分叉15cm处切断肠系膜上动脉,远端结扎,近端置管并引出体外,完成后关腹,制作实验兔腹腔创伤性大出血的动物模型,将动物模型随机分成2组,单纯出血(P)组和腹部外加压(T)组。单纯出血(P)组:通过肠系膜上动脉内导管进行放血,记录失血量、出血速度、观察动物的生命体征及记录存活时间。腹部外加压(T)组:用医用血压计腹部外加压,使血压计压力显示7mmHg后与单纯出血(P)组做相同的处理。实验在模拟高原环境动物实验舱中进行,模拟环境为海拔5500米,温度-25℃。实验二:将实验兔随机分成5组(A、B、C、D、E组)。通过手术造模,取腹部正中切口,在实验家兔肝脏右外叶中部距边缘2.0厘米处缝一针4号丝线,使线环绕的肝脏组织厚度相当于预期的肝脏破裂口大小,将缝线的末端标记后引出体外,操作完成后关腹。继续饲养家兔,对实验家兔血液分析,待血液分析恢复与手术前一致时进行以后实验。实验时将缝线向上拉出,拉出的缝线可在实验家兔肝脏上形成切割伤。对5组实验兔分别腹部外施加0mm Hg、3mmHg、7mmHg、11mmHg、15mmHg的压力。分别于实验前、腹部外加压后1、2、4、6h通过耳缘静脉取血检测血液中的炎症因子变化,比较各组血液中炎症水平。腹部加压6.5h后处死家兔取肝脏、肾脏、小肠标本,进行病理学观察,比较各组标本病理学变化。实验在模拟高原环境动物实验舱中进行,模拟环境为海拔5500米,温度-25℃。实验三:将实验兔随机分成2组,经手术制作实验家兔腹腔严重感染的动物模型。对实验兔术前禁食8 h,麻醉成功后备皮、消毒,以上腹部正中线依次切开皮肤、皮下、筋膜、肌肉及腹膜,距回盲部15 cm处用组织剪剪开小肠周径1/3,清理切口附近小肠内容物,距切缘上下各0.5 cm处用1号缝线将系膜缘肠壁悬吊于右侧腹壁,1号丝线分三层关腹。分别于实验前、术后12、18、24、36小时取血检测血液中的白细胞计数及炎症因子水平,36小时后处死家兔,取小肠、肝脏及肾脏进行病理学检查。比较手术前后血液中白细胞计数及炎症因子水平,及通过病理学检查了解两组实验兔机体炎症反应严重程度,实验在模拟高原环境动物实验舱中进行,实验组(T)组:高原高寒组模拟环境为海拔5500米,温度-25℃,对照组(P)组:平原组模拟环境为海拔100米,温度25℃。结果实验一:腹部外加压(T)组与单纯出血(P)组比较,其平均出血量分别为50.19±10.02ml与61.81±9.12,平均出血速度为1.06±0.21ml/min与1.93±0.48ml/min,平均存活时间为47.72±4.48min与33.45±7.00min,两组差异显著,差异有统计学意义(P0.05)。实验二:五组实验兔血液中炎症因子水平比较,A、B、C三组各时间段实验兔血液中炎症因子两两比较差异不明显,差异无统计学意义。D、E两组实验兔血液中炎症因子水平分别与C组比较,差异明显,差异有统计学意义(P0.05)。实验三:高原高寒环境下两组白细胞水平比较,差异无统计学意义(P0.05),TNF-α、IL-6与平原组比较,差异明显,差异有统计学意义(P0.05)。结论通过以上实验研究我们得出以下三点结论:1、在高原高寒地区实验兔腹部创伤性大出血的现场急救中,应用腹部外加压能显著减少实验兔的出血量、出血速度,延长存活时间,值得进一步深入研究讨论。2、应用不同腹部外压力治疗高原高寒地区实验兔腹部创伤性大出血,理论上压力越高腹腔出血量越少,但过高的压力增加了腹腔间隔室综合征的发生,7mmHg左右的压力既能有效减少腹腔创伤性大出血的出血量,又能使机体炎症反应降到最低,是较为理想的腹部外加压压力。为临床应用腹部外加压治疗腹腔创伤性大出血提供理论指导。3、高原高寒地区相较于平原地区,腹腔感染严重发生较早,感染较重,炎症因子水平较高,值得进一步研究。
[Abstract]:Objective to study the possibility of treatment of abdominal traumatic cold plateau region hemorrhage and its mechanism of serious infection and abdominal pressure, abdominal cavity for clinical treatment of plateau alpine region of serious infection and abdominal external pressure for the treatment of abdominal traumatic hemorrhage and provide a theoretical basis. Methods: the surgical selection of experimental rabbits according to the superior mesenteric artery, superior mesenteric artery with the abdominal aortic bifurcation 15cm cut the superior mesenteric artery and distal ligation, the proximal catheter and out of body, the abdomen was closed after the establishment of animal model of rabbit abdominal traumatic hemorrhage, the animal models were randomly divided into 2 groups, simple hemorrhage (P) group and external abdominal pressure (T) simple group. Hemorrhage (P) group: blood through superior mesenteric artery catheter, record the blood loss, bleeding rate, observation of animal life signs and record the survival time. External abdominal pressure (T) group: Abdominal medical sphygmomanometer with external pressure, the blood pressure pressure after 7mmHg and simple hemorrhage (P) group received the same treatment. Experiments were carried out in a simulated high altitude animal experiment module, the simulation environment is 5500 meters above sea level, temperature -25. Experiment two: the experimental rabbits were randomly divided into 5 groups (A, B, C D, E group). The operation model, take the middle abdominal incision, in experimental rabbit liver right lateral lobe at 2 cm from the edge of the central No. 4 sewing thread, the line around the liver tissue thickness is equivalent to the expected size of liver rupture, will end labeling suture after leading body, after the completion of the operation the abdomen was closed. Continue feeding rabbits, analysis of experimental rabbit blood, to be resumed after the experiment and analysis of blood before operation. The experiment will be favorable to pull out suture, the suture can be formed in the rabbit liver injury. The abdomen respectively in 5 groups of rabbits and applying 0mm Hg, 3mmHg 7mmHg, 11mmHg, 15mmHg, pressure. Respectively before experiment, external abdominal pressure after 1,2,4,6h through the ear vein blood was collected to detect the changes of inflammatory factors in the blood levels of inflammation were compared in blood. After 6.5h abdominal pressure of rabbits liver, kidney, small intestine were collected for pathological observation, histological changes were compared pathology. Experiments were carried out in a simulated high altitude animal experiment module, the simulation environment is 5500 meters above sea level, temperature -25. Experiment three: the experimental rabbits were randomly divided into 2 groups, the animal model establishment of rabbit surgery of severe abdominal infection. The rabbits were fasted for 8 h, the success of anesthesia reserve skin disinfection, above the abdominal midline followed by skin incision, skin, fascia, muscle and peritoneum from the ileocecal valve 15 cm tissue cut the circumference of small intestine 1/3, clean up the incision near the small intestine contents, from the cut edge of the upper and lower 0.5 cm with 1 stitches will mesovarial margin The intestinal wall hanging on the right side of the abdominal wall, 1 silk three layers respectively in closed abdomen. Before the experiment, after 12,18,24,36 hours in serum were detected in blood leukocyte count and inflammatory factor levels, 36 hours after the rabbits were killed, intestine, liver and kidney pathology. Surgery before and after blood white cell count and the levels of inflammatory factors, and by pathological examination two rabbits were inflammatory reaction severity, experiments were carried out in a simulated high altitude animal experiment module, experimental group (T group): alpine plateau group simulation environment for 5500 meters above sea level, the temperature of -25 DEG C, the control group (P group): plain simulation environment for 100 meters above sea level, temperature is 25 degrees centigrade. Results: abdominal external pressure (T) group and simple hemorrhage (P) group, the average amount of bleeding was 50.19 + 10.02ml and 61.81 + 9.12, the average rate of bleeding was 1.06 + 0.21ml/ min 1.93 + 0.48ml/min, average survival Time is 47.72 + 4.48min and 33.45 + 7.00min, the significant differences between the two groups, the difference was statistically significant (P0.05). Experiment two: comparison of five groups of rabbits in the blood levels of inflammatory factors A, B, C three inflammation group each time experimental rabbit blood factor 22 is no obvious difference, the difference was statistically significant.D, E two groups of experimental rabbit blood inflammatory factor levels were compared with C group, significant difference, the difference was statistically significant (P0.05). Experiment three: To compare the levels of white blood cells of two groups of alpine environment, there was no statistically significant difference (P0.05), TNF- alpha, IL-6, and plain group differences, there are statistically significant difference (P0.05). Conclusion through the above experimental research we draw the following three conclusions: 1, first aid in cold plateau region of rabbits abdominal traumatic hemorrhage, application of abdominal external pressure can significantly reduce the amount of bleeding, the bleeding rate of rabbits, prolonged storage Live time, it is worth further study to discuss.2, application of different abdominal pressure in plateau alpine region of rabbit abdominal traumatic bleeding, the higher the pressure on the theory of abdominal bleeding is less, but the high pressure increased abdominal compartment syndrome, 7mmHg left and right pressure can effectively reduce abdominal traumatic bleeding bleeding, and can cause the inflammatory reaction to a minimum, is the ideal abdominal external pressure pressure. Pressure for the treatment of abdominal traumatic hemorrhage and provide theoretical guidance for the clinical application of abdominal.3, plateau alpine region compared to the plain area, severe abdominal infection occurred earlier, severe infection, inflammatory factor level is high, it is worth further study.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656

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