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

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(P<0.01),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。

Staged resuscitation for uncontrolled hemorrhagic shock induced by simulated abdominal tram in field battle

Objective To establish an abdominal-trauma-induced uncontrolled hemorrhagic shock (UHS) model, and explore the effect of staged resuscitation. Methods Indwelling catheters were inserted into left ventricle, femoral artery and femoral vein of 50 Sprague-Dawley rats, and then laparotomy was performed. 42 out of the 50 animals were subjected to vascular injury to simulate UHS by infra-renal arterial puncture with 25G needles, and the model was successfully established in 32 rats, for which the animals were divided into 3 groups: control group (n=10), with no resuscitation; hospital-resuscitation group (n=11), resuscitated in early injured stage; and staged-resuscitation group (n=11), resuscitated pre-hospital and then in-hospital. 8 out of the 50 rats, which were not subjected to vascular injury, served as sham-operated group. The mean aortic pressure (MAP), central venous pressure (CVP), serum lactic acid, alanine aminotransferase (ALT) and creatinine (Cr) were determined, and the volume of blood loss and survival time were recorded. Results The MAP decreased from 94.7mmHg to 28.9mmHg 15min after aortic injury in control group and rose slowly after continuous transfusion in staged-resuscitation group. Similar change was found in CVP. Serum lactic acid, ALT and Cr were increased in control group and hospital-resuscitation group at early injured stage, but the increase was delayed in staged-resuscitation group. The mean survival time in control group, hospital-resuscitation group and staged-resuscitation group were 76, 846 and 2480 min, respectively. The 72 h mortalities of the three groups were 100%, 72.7% and 36.4%, respectively. Conclusion Staged resuscitation which is characterized by slowly continuous transfusion at early aid stage cannot increase the blood pressure and circulating blood volume to normal level in UHS, but can reduce the level of serum lactic acid, ALT and Cr, and dose not increase the blood loss. The survival rate and mean survival time can be increased by this method.