肺门火器伤伴大量出血的急症体外循环支持及呼吸模式选择
发布时间：2018-07-25 16:05
【摘要】：目的 探讨急症体外循环 ( ECC)对肺门火器伤的支持作用及呼吸模式的选择 .方法 杂种犬 18只 ,随机均分为对照组、ECC+定容控制呼吸救治组和 ECC+呼吸末正压通气 ( PEEP)救治组 .麻醉后用小口径步枪射击犬右肺门区 ,对照组仅行伤口封闭 ,输液及胸腔闭式引流 .定容控制呼吸组和PEEP组还于伤后分别行定容控制呼吸 ,PEEP,两组均于伤后 15 min开始急症 ECC.ECC支持 1h后行受伤肺叶切除术 ,伤后 1.5 h停 ECC,并于 4.5 h后处死取标本 .测量血流动力学指标 ,行血气分析 .检测血浆中 IL- 8和心 ,肺 ,肝 ,肠组织中髓过氧化物酶 ( MPO)的活性及肺含水量 .结果 对照组伤后Pa O2 ,平均动脉压 ( MAP)均显著降低 ,Pa CO2 显著升高 ,伤后 2min胸引血量达 ( 2 80± 86 ) m L.动物平均存活 ( 15 .0± 9.6 )min.治疗的两组 ECC期间 MAP维持于 ( 8～ 12 ) k Pa,血浆游离血红蛋白含量小于 0 .35 g.L- 1 .术后 3 h PEEP组与定容控制呼吸组相比 Pa O2 ,MAP显著升高 ;Pa CO2 和心率 ( HR)显著降低 ;血浆中 IL - 8和心 ,肺 ,肝 ,肠组织中 MPO活性及肺指数均降低 .结论 肺门火器伤犬早期即出现明显的呼吸 ,循环衰竭 .应用急症 ECC和呼吸支持可以维持动物血流动力学指标 ,为进一步的抢救争取了时间 ,并能改善肺脏气体交换功能 ;
[Abstract]:Objective to investigate the supportive effect and respiratory mode of acute cardiopulmonary bypass (ECC) on hilar firearm injury. Methods Eighteen mongrel dogs were randomly divided into two groups: the control group and the (PEEP) treatment group. After anesthesia, small caliber rifle was used to shoot the right lung portal area of dogs, while the control group was treated only with wound closure, infusion and thoracic closed drainage. The patients in the PEEP group and the control breathing group were treated with CPE respectively after injury. The patients in both groups were treated with acute ECC.ECC at 15 min after injury. The patients in both groups were treated with acute pulmonary lobectomy (ECC.ECC) for 1 h after injury. ECCs were stopped at 1.5 h after injury, and the specimens were sacrificed at 4.5 h after injury. Hemodynamic indexes were measured and blood gas analysis was performed. The activity of myeloperoxidase (MPO) and lung water content in heart, lung, liver and intestine were measured. Results in the control group, Pao 2 and mean arterial pressure (MAP) were significantly decreased after injury. The 2min chest blood volume was (280 卤86) m L.). The average survival time was (15.0 卤9.6) min. The level of plasma free hemoglobin in the two groups maintained at (8 ~ 12) k Pa,) during ECC (< 0.35 g 路L ~ (-1). Compared with the control group, Pa O 2 O 2 map significantly increased Pa CO2 and heart rate (HR) in PEEP group at 3 h after operation, and the activity of MPO in plasma, heart, lung, liver, intestine and lung index decreased significantly. Conclusion early respiratory and circulatory failure occurred in dogs with hilar firearm injury. The application of emergency ECC and respiratory support can maintain the hemodynamic indexes of animals, which can save time for further rescue and improve the function of pulmonary gas exchange.
【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 ，
本文编号：2144338
[Abstract]:Objective to investigate the supportive effect and respiratory mode of acute cardiopulmonary bypass (ECC) on hilar firearm injury. Methods Eighteen mongrel dogs were randomly divided into two groups: the control group and the (PEEP) treatment group. After anesthesia, small caliber rifle was used to shoot the right lung portal area of dogs, while the control group was treated only with wound closure, infusion and thoracic closed drainage. The patients in the PEEP group and the control breathing group were treated with CPE respectively after injury. The patients in both groups were treated with acute ECC.ECC at 15 min after injury. The patients in both groups were treated with acute pulmonary lobectomy (ECC.ECC) for 1 h after injury. ECCs were stopped at 1.5 h after injury, and the specimens were sacrificed at 4.5 h after injury. Hemodynamic indexes were measured and blood gas analysis was performed. The activity of myeloperoxidase (MPO) and lung water content in heart, lung, liver and intestine were measured. Results in the control group, Pao 2 and mean arterial pressure (MAP) were significantly decreased after injury. The 2min chest blood volume was (280 卤86) m L.). The average survival time was (15.0 卤9.6) min. The level of plasma free hemoglobin in the two groups maintained at (8 ~ 12) k Pa,) during ECC (< 0.35 g 路L ~ (-1). Compared with the control group, Pa O 2 O 2 map significantly increased Pa CO2 and heart rate (HR) in PEEP group at 3 h after operation, and the activity of MPO in plasma, heart, lung, liver, intestine and lung index decreased significantly. Conclusion early respiratory and circulatory failure occurred in dogs with hilar firearm injury. The application of emergency ECC and respiratory support can maintain the hemodynamic indexes of animals, which can save time for further rescue and improve the function of pulmonary gas exchange.
【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 ，
本文编号：2144338
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