胸部枪伤瞬时及早期心血管效应的实验研究

发布时间：2018-05-05 09:59

  本文选题：胸部损伤 + 创伤　； 参考：《中华创伤杂志》2000年11期

【摘要】：目的　探讨胸部枪伤瞬时及早期心血管效应及其机制。　方法　 30只家兔随机平均分为A :胸部贯穿伤组 (模型组 )、B :预扎肋间动脉致伤组、C :人工气胸后致伤组、D :预扎肋间动脉 +人工气胸后致伤组、E :胸壁切线伤组。分别用 5 .5 6mm小口径步枪致伤 ,连续监测动脉压、心率、静脉压、心电图、左室内压等。　结果　A组伤前血压峰值为 ( 14.80± 1.2 9)kPa ( 1kPa =7.5mmHg) ,枪伤瞬间血压即刻呈单波峰升高 ,达伤前的 ( 1.5 8± 0 .0 8)倍 ,而后迅速降低至伤前水平以下 ,10s下降到最低点 ,30s开始回升 ,1min后回升至伤前的 ( 0 .80± 0 .0 7)倍 ,并逐渐稳定。静脉压瞬时升高后随即下降 ,左室内压和心率出现瞬时下降、而后逐渐恢复 ,B组和C组变化幅度较小。D组和E组仅枪击瞬间有短暂变化。　结论　胸部枪伤瞬间动、静脉压升高 ,而左室内压无变化 ,为枪弹冲击波直接引起。伤后数秒内血压下降 ,心动过缓 ,心肌受抑制和左室内压下降 ,而中心静脉压尚正常 ,提示与迷走反射有关。模型组于伤后 2h血压再度下降 ,则可能与胸内失血和肺损伤有关 ,缺氧也造成了心肌收缩力下降。预扎肋间动脉及临时造成人工气胸防止肺实质损伤 ,可减轻枪伤早期的心血管功能障碍。
[Abstract]:Objective to investigate the transient and early cardiovascular effects of thoracic gunshot injury and its mechanism. Methods Thirty rabbits were randomly divided into two groups: group A: group B: group C: group D: group C: group D: group C: group D: group C: group Arterial pressure, heart rate, venous pressure, electrocardiogram and left ventricular pressure were continuously monitored with 5. 5 6mm small caliber rifle. Results the peak value of blood pressure in group A was (14.80 卤1.2 9)kPa) (1kPa 7.5mmHg), and the peak of blood pressure was increased immediately after gunshot injury (1.58 卤0.08) times. However, it decreased rapidly to the lowest level in 10 s below the pre-injury level and began to rise 1 min after 30 s, and then increased to 0. 80 卤0. 07 times of that before injury, and gradually stabilized. The venous pressure immediately decreased, left ventricular pressure and heart rate decreased, and then gradually recovered to B and C groups. The range of change was smaller. Group D and group E had only a brief change in the instant of shooting. Conclusion the venous pressure of chest gunshot wound was increased, but the left ventricular pressure was not changed, which was directly caused by gunshot shock wave. The decrease of blood pressure, bradycardia, myocardial inhibition and left ventricular pressure decrease within a few seconds after injury, but the central venous pressure is normal, suggesting that it is related to vagal reflex. The decrease of blood pressure at 2 h after injury may be related to intrathoracic blood loss and lung injury, and hypoxia also resulted in a decrease in myocardial contractility. Preligation of intercostal artery and temporary artificial pneumothorax can prevent lung parenchyma injury and reduce cardiovascular dysfunction in the early stage of gunshot injury.
【作者单位】： 第四军医大学附属西京医院胸心外科中心 第四军医大学附属西京医院胸心外科中心 第四军医大学附属西京医院胸心外科中心 第四军医大学附属西京医院胸心外科中心 第四军医大学附属西京医院胸心外科中心 第四军医大学附属西京医院胸心外科中心 ，

本文编号：1847244