海水浸泡胸部开放伤早期救治效果的影响因素分析

目的对胸部开放伤后海水浸泡的实验动物进行早期紧急救治,探讨影响救治效果的因素.方法实验动物分为两组.单纯浸泡组(n=20)为胸外伤后海水浸泡不进行救治,治疗组(n=20)为胸外伤后海水浸泡25分钟进行救治.观察生存时间、血液动力学改变、血浆渗透压、血钠、血氯、动脉血气分析、胸腔进水量.并对治疗组中生存时间>24小时和<24小时的各项参数予以对比分析.结果电解质紊乱(高钠血症、高氯血症)、高渗血症、低氧血症和高碳酸血症、代谢性酸中毒以及肺动脉楔压对生存时间有重要影响,其它因素包括胸腔进水量、心率、呼吸频率、平均动脉压等对生存时间的影响无统计学意义.结论在海水浸泡胸部开放伤的早期紧急救治过程中,重点治疗高渗性脱水、低氧血症、高碳酸血症、代谢性酸中毒及改善心功能状况将对预后有重要影响.

Predictive factors of early treatment for open chest injury and seawater immersion

Objective To evaluate the predictive factors of early treament for open chest injury and seawater immersion.?Methods Twenty health dogs were divided into two groups. A model of right open pneumothorax was established. Seawater immersion group(n=20) had seawater immersion following open chest trauma. Treatment group(n=20) was treated earlier following rescue from seawater. The hemodynamic parameters including mean arterial pressure (MAP), pulmonary artery wedge pressure (PAWP), cardiac output (CO), cardiac index (CI) were recorded. Blood samples are taken at a series of time intervals to record blood gas, plasma osmotic pressure and electrolytes. At the end of the study, the treatment group were divided into two subgroups according to animals' survival time. All data were analysed and compared.?Results Post trauma mortality was 95% in seawater immersion group. The mean survival time in seawater immersion group was 45 minutes and was longer than 40 hours in treatment group. Among the treatment group 12 animals survived longer than 24 hours (mean 67.2 hrs) and 8 shorter than 24 hours (mean 14.7 hrs). The results showed that the survival time was closely related to hypoxemia, hypercapnia, higher osmolality, hypernatremia, hyperchloremia, PAWP, CO and CI. While the heart rate, respiratory rate, MAP, and the seawater volume of chest cavity seems to be not related to the outcome.?Conclusion Survival time was significantly improved after early treatment. The predictive factors are severe hypoxemia, hypercapnia, higher osmolality, hypernatremia, hyperchloremia,poor PAWP, CO and CI.