急诊体外循环用于心脏火器贯穿伤伴肺门部损伤的支持治疗

发布时间：2018-06-03 19:33

  本文选题：心脏损伤 + 火器　； 参考：《第四军医大学学报》2000年05期

【摘要】：目的　探讨急诊体外循环 ( ECC)对于心脏火器贯穿伤的支持治疗 .方法　杂种犬 2 1只 ,随机分为对照组、ECC组和 ECC+手术治疗组 .麻醉后用小口径步枪射击犬心前区 ,对照组仅行伤口封闭 ,输液及胸腔闭式引流 .其余两组于伤后 5～ 7min内开始急诊 ECC. ECC组持续 ECC 3 h;ECC+手术治疗组于 ECC支持 0 .5 h后行受伤肺叶切除、心脏修补术 ,术后停 ECC,观察 3 h.实验结束后处死动物取标本 .测量血流动力学指标 ,行血气分析 .检测血浆 AL T,BUN,Cr,CK含量 .结果　各组动物心脏伤均以右室贯穿伤为主 ,伤后 2 min时胸引量为 ( 388± 6 5 ) m L .右室贯穿伤的动物平均动脉压均在 1min内降至 4k Pa以下 .应用体外循环支持可以维持动脉压为8～ 12 k Pa,循环后 1h,3 h血液中游离 Hb含量分别是 0 .2 9g.L- 1 和 0 .7g.L- 1 .ECC+手术治疗组动物脱离体外后 1,3h心率、平均动脉压和中心静脉压均与术前无显著性差异 .结论　急诊体外循环可以维持心脏火器贯穿伤动物在伤后 3 h的各项生命指标 ,并能保护各重要脏器功能 .及时地进行手术修补治疗可以明显提高心脏贯穿伤后的救治效果
[Abstract]:Objective To explore the support and treatment of cardiopulmonary bypass ( ECC ) in patients with cardiac burn . Methods Twenty - one hybrid dogs were randomly divided into control group , ECC group and ECC + surgical treatment group . After anesthesia , a small caliber rifle was used to shoot the anterior chamber of the dog . The control group only had wound closure , infusion and closed thoracic drainage . Emergency ECC was started in the remaining two groups from 5 to 7 minutes after injury . ECC group continued ECC for 3 h ; ECC + surgical treatment group was treated with ECC for 0.5 h , injured pulmonary lobe was removed , heart repair was performed , ECC was stopped after operation , and 3 hours were observed . The animals were sacrificed after the experiment was completed . The hemodynamic parameters were measured and blood gas analysis was performed . The contents of plasma AL T , BUN , Cr and CK were measured . Results The cardiac injury of each group was mainly in the right ventricle , and the chest lead was ( 388 卤 65 ) m L at 2 min after injury . The mean arterial pressure in the right ventricle was reduced to less than 4 K Pa within 1 min . The contents of free Hb in blood were 0.9g 路 L - 1 and 0.7 g 路 L - 1 , respectively . The rate of heart rate , mean arterial pressure and central venous pressure were not significantly different before operation . Conclusion Emergency cardiopulmonary bypass can maintain the life index of the injured animal after wounding three hours after injury , and can protect the function of each important organ . Timely repair of surgical repair can significantly improve the treatment effect after penetrating injury of the heart
【作者单位】： 第四军医大学西京医院心血管外科中心!陕西西安710033 第四军医大学西京医院心血管外科中心!陕西西安710033 第四军医大学西京医院心血管外科中心!陕西西安710033 第四军医大学西京医院心血管外科中心!陕西西安710033 第四军医大学西京医院心血管外科中心!陕西西安710033 ，

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