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Objective To observe changes of venous blood gas when applying tourniquets to arterial bleeding dog models and compare the injury of the bundled tissues caused by three different tourniquets. Methods A total of 18 dogs were randomly divided to three groups and made into femoral artery bleeding model of the hind limbs. Then, rubber tubing, half-hitch tourniquet and multi-function pressure-control bandage (hemostatic bandage group) were employed respectively for femoral artery hemostasis in three groups. The pressure produced by the bandage and femoral vein blood gas indices were measured at 0.5, 1, 3 and 6 hours respectively after tourniquet application. Results The pressure produced by the hemostatic bandage group was 0.74 kg, which was obviously lower than 1.46 kg in the rubber tubing group and 2.09 kg in the half-hitch tourniquet group ( P < 0.05 ). At one hour after hemostasis, PvO2 was (36.45 ± 10.45 )mm Hg in the hemostatic bandage group and (28.73 ± 9.07 )mm Hg in the rubber tubing group, which was significantly higher than (21.87 ±4.30) mm Hg in the half-hitch tourniquet group ( P < 0.05 ). At 3 and 6 hours after hemostasis, PvCO2 was (50.67 ± 9.31 ) mm Hg and (60.02 ± 10.85)mm Hg respectively in the hemostatic bandage group, while (16.85 ± 16.51 )mm Hg and ( 60.02 ± 10.85) mm Hg respectively in the rubber tubing group, which were lower than that in the half-hitch tourniquet group ( P < 0.05 or 0.01 ) . Conclusion Compared with rubber tubing and Halfhitch tourniquet, the hemostatic bandage can efficiently stop bleeding under slight pressure, with the least injury to the bundled tissues. 相似文献
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Objective To observe changes of venous blood gas when applying tourniquets to arterial bleeding dog models and compare the injury of the bundled tissues caused by three different tourniquets. Methods A total of 18 dogs were randomly divided to three groups and made into femoral artery bleeding model of the hind limbs. Then, rubber tubing, half-hitch tourniquet and multi-function pressure-control bandage (hemostatic bandage group) were employed respectively for femoral artery hemostasis in three groups. The pressure produced by the bandage and femoral vein blood gas indices were measured at 0.5, 1, 3 and 6 hours respectively after tourniquet application. Results The pressure produced by the hemostatic bandage group was 0.74 kg, which was obviously lower than 1.46 kg in the rubber tubing group and 2.09 kg in the half-hitch tourniquet group ( P < 0.05 ). At one hour after hemostasis, PvO2 was (36.45 ± 10.45 )mm Hg in the hemostatic bandage group and (28.73 ± 9.07 )mm Hg in the rubber tubing group, which was significantly higher than (21.87 ±4.30) mm Hg in the half-hitch tourniquet group ( P < 0.05 ). At 3 and 6 hours after hemostasis, PvCO2 was (50.67 ± 9.31 ) mm Hg and (60.02 ± 10.85)mm Hg respectively in the hemostatic bandage group, while (16.85 ± 16.51 )mm Hg and ( 60.02 ± 10.85) mm Hg respectively in the rubber tubing group, which were lower than that in the half-hitch tourniquet group ( P < 0.05 or 0.01 ) . Conclusion Compared with rubber tubing and Halfhitch tourniquet, the hemostatic bandage can efficiently stop bleeding under slight pressure, with the least injury to the bundled tissues. 相似文献
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目的 比较肢体损伤综合征指数(mangled extremity syndrome index,MESI)、肢体严重损伤严重度评分(mangled extremity severity score,MESS)、截肢指数(limb salvage index,LSI)三种评分方法在判断严重肢体损伤截肢与保肢中的价值.方法 对两所医院近8年来收治的353例严重肢体损伤住院患者进行回顾性分析.患者包括95例截肢,258例保肢.应用三种评分方法评分,通过接收者工作特征曲线(ROC曲线)分析,找到截断点检验其判别能力.结果 三种评分均值在截肢和保肢者之间差异均有统计学意义(P<0.01).MESI、MESS、LSI三种评分方法的截断点分别为≥20分、≥7分、≥6分,灵敏度为89.47%、85.26%、83.15%,特异度为100%、96.89%、96.12%,符合率为97.16%、93.76%、92.63%,ROC曲线下面积为0.924,0.905,0.861.结论 三种评分方法对严重肢体损伤早期截肢与否均有较好预测能力,但MESI的预测能力最好.Abstract: Objective To compare the values of the mangled extremity syndrome index (MESI), the mangled extremity severity score (MESS) and the limb salvage index (LSI) in deciding amputation or salvage in the management of the mangled extremity syndrome (MES). Methods Clinical data of 353 MES patients including 95 with amputation and 258 with salvage admitted in recent eight years were retrospectively evaluated by using MESI, MESS and LSI, the value of which in deciding amputation or salvage was assessed with receiver operating characteristic ( ROC ). Results There was statistical difference in aspect of mean scores of three grading systems between patients with amputation or salvage (P<0. 01). For MESI, MESS and LSI, the sensitivities was 89.47%, 85.26% and 83.15% respectively, the specificities was 100%, 96.89% and 96.12% respectively, the coincidence was 97.16%,93.76% and 92.63% respectively, the areas under ROC curves was 0. 924, 0905 and 0. 861 respectively and the cut-off points were equal or over 20, 7 and 6 respectively. Conclusions Three scoring systems are all highly capable of predicting early amputation or not in MES management. The MESI is recommended as a quantitative criterion for determining amputation or salvage. 相似文献
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近几年由他院转来病人中有9例创伤患者,由于止血带使用不当,导致严重后果。为避免类似情况重演,现报告于下。 相似文献
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目的 探讨术中应用“血管内止血带”(即球囊导管暂时阻断动脉腔内血流)临时阻断动脉腔内血流控制颈部及邻近躯干部位动脉损伤出血的可行性及临床意义.方法 选择1987年5月-2009年2月收治的35例颈部及邻近躯干部位动脉损伤患者,术中先用“血管内止血带”临时阻断近端大动脉血流,每次阻断30~70min或间隔15~20 min再阻断,行手术治疗.结果 临时阻断近端大动脉血流后,术区出血极少,术野干净,解剖清晰,全部患者手术过程中出血量为100~400 ml.所有患者均治愈.随访3~14年,无脑缺血、肢体缺血或病变复发.结论 应用“血管内止血带”临时阻断近端大动脉血流可有效减少术中出血,提高手术的安全性,是治疗外伤性颈部及邻近躯干部位动脉损伤出血的非常可靠的辅助措施. 相似文献
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丹参对止血带致肢体肌损伤保护作用的研究 总被引:11,自引:0,他引:11
选用24条健康家犬,止血带40kPa压力下,观察了止血带1、2、4小时和2、4小时用丹参组血清Ca2+、CPK和止血带下及其以远不同部位肌组织形态学变化。结果发现止血带缺血期和再灌注后2小时,血清钙异常,CPK升高。丹参组血清钙无明显改变,CPK比未用丹参组低(P<0.05)。止血带1小时肌肉有形态学改变,4小时损伤最重。用丹参组与未用丹参组相比肌损伤程度轻,细胞结构变性指数小。结果表明丹参对止血带引起肢体肌损伤有一定的保护作用。 相似文献
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26条健康家犬在止血带40kPa条件下,观察了持续1、2、4小时和2、4小时用丹参组止血带下及其以远不同部位神经超微结构变化.结果是:未用丹参组1小时后神经就有轻微形态学改变,4小时后损伤最重,止血带下神经损伤比其以远部位还重,且两侧边缘最明显,用丹参组神经损伤比未用丹参组轻,线粒体数量多且较完整,症状恢复快.证明丹参对止血带引起的神经损伤具有一定保护作用. 相似文献
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四氧化二氮和偏二甲基肼染毒复合冲击伤大鼠血气及病理形态学的变化 总被引:3,自引:0,他引:3
目的 观察四氧化二氮(N2O4)和偏二甲基肼(UDMH)染毒复合冲击伤(冲毒复合伤)大鼠气及病理形态学的变化。方法 健康雄性Wistar大鼠168只,随机分为:(1)UDMH冲毒复合伤组(BU组);(2)N2O4 毒复合伤组(BN组);(3)UDMH及N2O4冲毒复合伤组(BUN组),每组56只大鼠。大鼠在冲伤后后10min相继吸入UDMH和(或)N2O4造成重度冲击伤复中毒模型。于伤后及伤后3,6,12,48,72h进行血气分析和主要器官病理形态学检查。结果 BUN组大鼠临床症状进行性加重,肺泡内弥漫性充满淡粉色渗出物及大片状出血,肺出血和水肿均加重。心肌细胞不同程度冲肿/透明性变,可见个别心肌纤维断裂,心肌间质疏松及出血水肿,心肌病变加重。肝血窦扩张/充知,肝细胞冲肝等。三组动物伤后3-12h动脉血氧分压(PaO2)均显著下降,其中3-6h下降最为显著。BUN组大鼠PaO2下降持续时间最长,恢复较前两组慢。结论 UDMH及N2O4冲毒复合伤时,大鼠呼吸系统症状更严重,其主要的病理学改变和血气变化也最明显,表明这类损伤最救治。 相似文献
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创伤患者呼气末和动脉血二氧化碳分压的关系 总被引:2,自引:0,他引:2
目的 研究创伤患者呼气末二氧化碳分压 (PetCO2 )和动脉血二氧化碳分压 (PaCO2 )间的关系。 方法 分别测定 18例择期手术患者 (Ⅰ组 )及 36例创伤患者的PaCO2 及PetCO2 ,其中估计失血量 <2 5 %的为Ⅱ组 (18例 ) ,失血量≥ 2 5 %为Ⅲ组 (18例 )。 结果 正常血容量及失血量 <2 5 %的患者 ,PetCO2 和PaCO2 之间差异无显著性意义 (P >0 .0 5 ) ,PetCO2 能可靠反映PaCO2 ;而失血量超过 2 5 %的患者 ,PetCO2 和PaCO2 差异有非常显著性意义 (P <0 .0 1) ,此时PetCO2 不能可靠反映PaCO2 。 结论 在临床上对失血量 <2 5 %的创伤患者 ,可用PetCO2 推断PaCO2 ,但对失血量≥ 2 5 %的创伤患者 ,PetCO2 不能可靠反映PaCO2 。 相似文献
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四肢骨折、脱位伴主要血管损伤的临床观察 总被引:10,自引:2,他引:8
目的 对1989-2001年救治的69例四肢骨折,脱位伴主要血管损伤进行回顾分析。方法 69例中,男57例,女12例;年龄13-62岁,平均31.6岁,确诊和手术探查后,先分别用带锁髓内针,钢板螺钉和外固定支架固定骨折和脱位,再针对不同的情况选择血管直接修补术,血管端端吻合术和血管移植术等。结果 本组无死亡,肾功能衰竭2例,截肢7例;手术成功修复62例;43例获得平均3.1年的随访,4例骨不连。结论 四肢骨折,脱位伴主要血管损伤较单纯血管损伤并发休克率高,漏诊率高,救治原则是生命第一,肢体第二;既要有稳固的骨支架,又要修复好血管,这样才能获得良好的结果。 相似文献
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目的通过对进人不同海拔地区作业的电网联网职工肺功能及动脉血气变化的研究。分析高原环境对肺功能和动脉血气的影响,探讨高原环境下工作人员肺功能和动脉血气的变化规律及机体调节机制。方法随机选择在海拔2960~4200m地区(新都桥一甘孜县一石渠沿线)工作的电网联网职工468例,进行肺通气功能测试和血气分析检测,并对数据进行统计分析。结果①进入高原2~3个月后,用力肺活量(FVC)、Is用力呼气容积(FEV,)显著降低;1秒率(FEV。o/FVC)、最大呼气高峰流量(PEF)、最大通气量(MVV)、25%肺活量位最大呼气流速(FEF25%)、50%肺活量位最大呼气流速(FEF50%)、75%肺活量位最大呼气流速(FEF75%)明显升高;②进入高原前后肺功能差值受海拔高度影响变化明显,海拔越高,PEF、FEF"/5%升高幅度越多,MVV升高幅度越小;③吸烟人群进入高原前后肺功能差值受吸烟量影响显著。进入高原后FEVl、FVC降低,吸烟量越大,降低程度越大。FEV。dFVC、FEF25%、Mvv升高,吸烟量越大,升高程度越小;④年龄因素对进入高原前后肺功能差值影响明显。年龄越大,FEV。加vC、MVV的升高幅度越小,FVC降低幅度越大;⑤进入高原前后血气指标pH、PaCO2、AB、BE均有一定的变化,其中反映机体缺氧程度的Pa02、Sa02的变化显著。结论①平原健康人群进入高原后由于小支气管与细支气管扩张,外周气道阻力降低,肺通气能力增强。缺氧导致用力肺活量及1秒钟用力呼气容积降低。其变化程度受海拔高度、年龄和吸烟量的影响。②海拔越高反映机体缺氧程度的Pa02、SaO2下降越明显。 相似文献
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外伤性血管损伤的手术及介入治疗 总被引:1,自引:0,他引:1
目的 探讨外伤性血管损伤的外科手术及介入治疗方法 . 方法 分组回顾分析85例血管损伤的1临床资料.损伤部位包括颈静脉、椎动脉、四肢主干血管、肠系膜上动脉.其中交通伤25例、锐器伤60例.行手术治疗62例(血管移植术37例,血管修补术25例),介入治疗23例. 结果 死亡1例,截肢1例.两组共随访58例,所有患者损伤血管通畅情况良好. 结论 及时止确的诊断对于血管损伤的救冶意义重大.介入治疗血管损伤具有创伤小、手术时间短、操作简单、术后恢复快的优点.介入与手术方法 可联合应用丁血管损伤的治疗. 相似文献
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目的比较中心静脉血和肘静脉血血气值与混合静脉血正常血气值的相关性。方法监测54名马拉松赛业余选手(活动组)赛前的动脉血、肘静脉血血气和30名无心肺疾患的术后病人(静息组)全麻拔管前动脉血、中心静脉血和肘静脉血血气。比较肘静脉血、中心静脉血血气值与混合静脉血正常血气值的相关性。结果 84名被测者动脉PO2和PaCO2均正常;肘静脉血PO2均值30.1 mmHg(1 mmHg=0.133 kPa)低于混合静脉血氧分压(P vO2)23%,低于中心静脉PO218%左右。结论混合静脉血、中心静脉血和肘静脉的血气三者具有一定的相关性,在无条件监测PvO2时可用中心静脉或肘静脉血气值作参考。 相似文献