野战腹部创伤非控制性失血性休克的分阶段救治模拟研究

发布时间：2018-12-30 20:38

【摘要】：目的制作野战腹部血管损伤非控制性失血性休克(UHS)模型,探索在休克不同阶段给予不同复苏方案的治疗效果。方法SD大鼠50只,左股动、静脉及左心室插管后开腹,其中42只于腹主动脉中下段用25G针头穿刺造成活动性出血模拟UHS,32只造模成功。根据战创伤实际,将动物分为受伤早期、早期救助期、后期救治期及观察期4个阶段。大鼠随机分为以下4组:对照组(n=10),不进行治疗;院内治疗组(n=11),早期不复苏,后期救治期给予手术止血并输入林格液维持血压在90mmHg左右;分阶段救治组(n=11),于早期救助期以1ml/(kg.min)的速度持续缓慢输入林格液,后期救治期治疗同院内治疗组;假手术组(n=8)。监测大鼠平均动脉压(MAP)、中心静脉压(CVP)、血乳酸水平及肝肾功能等,并统计腹腔出血量及存活时间。结果血管损伤后15min对照组大鼠平均动脉压由94.7mmHg下降到28.9mmHg(P0.01),分阶段救治组早期持续性液体复苏后休克大鼠平均动脉压逐渐升高,但仍然未超过60mmHg。CVP的变化与MAP相似。对照组、院内治疗组伤后早期血乳酸水平、转氨酶活性及肌酐水平即升高,而分阶段救治组升高显著延迟。对照组、院内治疗组、分阶段救治组大鼠平均存活时间为分别为76、846、2480min,对照组大鼠均在24h内死亡,院内治疗组及分阶段救治组72h死亡率分别为72.7%和36.4%。结论采用以早期持续性缓慢液体复苏为特征的分阶段救治措施,虽然不能快速升高血压及有效循环血量,但可有效抑制血乳酸水平的升高,维持器官功能,且不会显著增加腹腔出血量,从而可延长UHS动物存活时间、提高存活率。
[Abstract]:Objective to establish an (UHS) model of uncontrolled hemorrhagic shock caused by abdominal vascular injury in the field, and to explore the effect of different resuscitation schemes in different stages of shock. Methods the left femoral artery, vein and left ventricle were intubated in 50 SD rats, 42 of them were operated on the middle and lower part of the abdominal aorta with 25G needle puncture to simulate the UHS,32. According to the actual situation of war trauma, the animals were divided into four stages: the early stage, the early period of rescue, the later period of rescue and the period of observation. Rats were randomly divided into the following four groups: control group (n = 10) without treatment, in-hospital treatment group (n = 11) with no resuscitation at early stage, operation hemostasis during later treatment period and infusion of ringer solution to maintain blood pressure at 90mmHg or so. 1ml/ (kg.min) was used to infuse Ringer's fluid slowly and continuously in the early relief period, and the treatment group was treated with the same hospital in the later period of treatment (n = 8), and the control group (n = 8) was given sham-operation group (n = 8). The mean arterial pressure (MAP),) central venous pressure (CVP),) blood lactate level and liver and kidney function were monitored and the intraperitoneal blood loss and survival time were counted. Results the mean arterial pressure in 15min control group decreased from 94.7mmHg to 28.9mmHg (P0.01) after vascular injury, and the mean arterial pressure increased gradually after early sustained fluid resuscitation in the treatment group. However, the change of 60mmHg.CVP was similar to that of MAP. In the control group, the level of lactic acid, the activity of transaminase and creatinine increased in the early posttraumatic period, but delayed in the treatment group. The average survival time of the rats in the control group, the in-hospital treatment group and the phased treatment group was 76.846U 2480 min, respectively. The rats in the control group died within 24 hours. The 72h mortality of the in-hospital treatment group and the phased treatment group were 72.7% and 36.4%, respectively. Conclusion although the early sustained slow fluid resuscitation can not raise blood pressure and effective circulation blood volume, it can effectively inhibit the increase of blood lactic acid level and maintain organ function. And no significant increase in the amount of intraperitoneal bleeding, which can prolong the survival time of UHS animals, improve the survival rate.
【作者单位】：
【分类号】：R82

【相似文献】