筋膜切开减压术治疗挤压综合征家兔模型的实验研究
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摘要
目的:观察筋膜切开减压术在挤压综合征家兔模型的治疗中能否起到积极作用,并指导临床救治工作。方法:选取健康成年新西兰家兔(不分雌雄)70只。随机分为未行切开减压的实验对照组(10只)和切开减压组(即减压组60只),2组均在挤压4 h后解压,减压组根据解压后行筋膜切开减压时间将其分为6个亚组(每个亚组10只):即刻切开组(0 h)、2 h后切开组、4 h后切开组、6 h后切开组、8 h后切开组及10 h后切开组,分别标为A-F组,对照组设为G组;测量A-G组挤压4 h后及减压组(A-F组)减压术后第2 h、6 h、12 h的静脉血,检测血BUN、Cr、AST、ALT、CK、CK-MB、K~+、Ca~(2+)、MYO等生化指标;24小时后取挤压处的肌肉、肾脏、肝脏、心肌并立即做切片处理,并在光镜下进行检测分析。结果:两组挤压后4 h血BUN、Cr、AST、ALT、CK、CK-MB、K+、Ca2+、MYO差异无统计学意义(P>0.05);两组资料具有可比性。挤压伤组与对照组在各时间点生化指标差异均无统计学差异(P>0.05);各亚组之间在相同时刻生化指标也无统计学差异(P>0.05)。各亚组内随时间变动其BUN、Cr、AST、ALT、CK、CK-MB指标均呈上升趋向;而差异K~+、Ca~(2+)、MYO指标呈下降趋势;有统计学意义(P<0.05),有一定的时间依赖性。结论:早期行筋膜切开减压术在挤压综合征家兔模型的早期治疗中无明显的疗效;筋膜切开减压术并不可以改善患机体全身多脏器损伤情况。
Objective: Aim to observe the treatment effect of Fascia incision decompression in the crush syndrome of rabbit model,which could guide the clinical treatment. Methods: A total of 70 healthy adult New Zealand rabbits(both male and female) were selected,Randomly divided into control group without Incision decompression(10) and Incision group(60).In crush injury group the Squeezed limb was decompression after extrusion 4 hours, then according the times of Fascia incision decompression, we divided into six subgroups(10 in each group): 0 hour, after 2 hours, after 4 hours, after 6 hours, after 8 hours, labeled A-F group, Respectively, control group is set to group G. Measuring BUN, Cr, AST, ALT, CK, CK-MB, K+, Ca2+and MYO in group A-G after decompression 4 hours and Incision group(group A-F) after Incision decompression 2 hours, 6 hours and 12 hours. After 24 hours the location of the extrusion quadriceps, kidneys, liver, myocardium were taken for pathological analysis. Results: The BUN, Cr, AST, ALT, CK, CK-MB, K+, Ca2+, MYO after decompression 4 hours and at various time points after Incision decompression had no statistical significance in Incision group(including subgroups) and control group(P>0.05); Crush injury group and the control group at various time points and biochemical index difference had no statistical difference(P>0.05); The biochemical index such as BUN, Cr, AST, ALT, CK, and CK-MB was rising over the time in each subgroups and K+, Ca2+, MYO was decline, On the contrary(P<0.05). Conclusion: There is no obvious curative effect in the rabbit model with crush syndrome for incision decompression treatment in early time and multiple organ injury has no significance.
Objective: Aim to observe the treatment effect of Fascia incision decompression in the crush syndrome of rabbit model,which could guide the clinical treatment. Methods: A total of 70 healthy adult New Zealand rabbits(both male and female) were selected,Randomly divided into control group without Incision decompression(10) and Incision group(60).In crush injury group the Squeezed limb was decompression after extrusion 4 hours, then according the times of Fascia incision decompression, we divided into six subgroups(10 in each group): 0 hour, after 2 hours, after 4 hours, after 6 hours, after 8 hours, labeled A-F group, Respectively, control group is set to group G. Measuring BUN, Cr, AST, ALT, CK, CK-MB, K+, Ca2+and MYO in group A-G after decompression 4 hours and Incision group(group A-F) after Incision decompression 2 hours, 6 hours and 12 hours. After 24 hours the location of the extrusion quadriceps, kidneys, liver, myocardium were taken for pathological analysis. Results: The BUN, Cr, AST, ALT, CK, CK-MB, K+, Ca2+, MYO after decompression 4 hours and at various time points after Incision decompression had no statistical significance in Incision group(including subgroups) and control group(P>0.05); Crush injury group and the control group at various time points and biochemical index difference had no statistical difference(P>0.05); The biochemical index such as BUN, Cr, AST, ALT, CK, and CK-MB was rising over the time in each subgroups and K+, Ca2+, MYO was decline, On the contrary(P<0.05). Conclusion: There is no obvious curative effect in the rabbit model with crush syndrome for incision decompression treatment in early time and multiple organ injury has no significance.
引文
[1]Reis N D,Better O S.Crush Injury and Crush Syndrome in an Earthquake Disaster Zone[M].Orthopedics in Disasters,Springer Berlin Heidelberg,2016
[2]Yin Y,Zhu T.Ventricular fibrillation during anesthesia in a Wenchuan earthquake victim with crush syndrome[J].Anesthesia&Analgesia,2010,110(3):916-917
[3]Bartal C,Zeller L,Miskin I,et al.Crush Syndrome:Saving More Lives in Disasters:Lessons Learned From the Early-Response Phase in Haiti[J].Archives of Internal Medicine,2011,171(7):694
[4]秦春妮,黑飞龙.心脏术后急性肾损伤的防治研究进展[J].医学综述,2012,18(17):2807-2809Qin Chun-ni,Hei Fei-long.Dragon Research on the prevention and treatment of acute kidney injury after heart surgery[J].Medical review,2012,18(17):2807-2809
[5]姚光强.急性肾衰竭大鼠血小板功能变化及机制研究[D].华中科技大学,2016Yao Guang-qiang.Study on the changes and mechanism of platelet function in rats with acute renal failure[D].Huazhong university of science and technology,2016
[6]郭进春,赖小今,廖明松,等.家兔挤压伤后心肌组织与心功能变化的对比研究[J].西南国防医药,2012,22(5):473-476Guo Jin-chun,Lai Xiao-jin,Liao Ming-song,et al.Comparative study on the changes of myocardial tissue and cardiac function after the rabbit crush injury[J].Western defense medicine,2012,22(5):473-476
[7]郭进春,邓旦,梁燕,等.家兔挤压伤后心脏整体功能与心肌超微结构的变化[J].解放军医学杂志,2012,37(7):699-701Guo Jin-chun,Deng Dan,Liang Yan,et al.Changes in cardiac function and myocardial ultrastructure after the injury of rabbits in rabbits[J].PLA medical journal,2012,37(7):699-701
[8]刘涛,白祥军.挤压伤和挤压综合征[J].创伤外科杂志,2016,18(7):447-449Liu Tao,Bai Xiang-jun.Crush injury and crush syndrome[J].Trauma surgery journal,2016,18(7):447-449
[9]孙莉姬.挤压综合征的研究进展[C].中华中医药学会补肾活血法分会暨天津市中西医结合学会肾脏病分会学术会,2014Sun Li-ji.Research progress of crush syndrome[C].Chinese traditional Chinese medicine association and the association of kidney and blood circulation and the academic meeting of the association of Chinese and western medicine in tianjin,2014
[10]Sheng ZY.Medical support in the Tangshan earthquake:a review of The management of mass casualties and certain major in juries[J].J Trauma,1987,27:1130-1135
[11]Stein H,Hoerer D,Weisz L,et al.Musculoskeletal in juries in earthquake victim s:an update on orthopedic management[J].Orthopedics,2000,10:1085-1087
[12]Better OS,Stein JH.Early management of shock and prophylaxis of acute renal failure in trauma ticrhab domyolysis[J].N Eng l JM ed1990,322:825-829
[13]Huang KC,Lee TS,Shu K H.Clinical features and outcome of crush syndrome caused by the chi chi earthquake[J].J Formos Med Assoc,2002,101:249-256
[14]Nad jafi I,A ter MR,Broum B,et al.Suggested guidelines for treatment of acute renal failure in earthquake victims[J].Ren Fail,1997,19:655-664
[15]Dursun F E,Yildirim A M.Distribution of Infections and Bacteriological Spectrum in Crush Syndrome[J].Turkish Nephrology,2015,24(1):93-97
[16]Tetsuya M,Toshiharu Y,Tanaka H,et al.Long term physical outcome of patients who suffered crush syndrome after the 1995 hansh in-Awaji earthquake:prognostic indicators in retrospect[J].J Trauma,2002,52:33-39
[17]Reis ND,Better OS.Mechanical muscle crush injury and acute muscle crush compartment syndrome:with special reference to earthquake casualties[J].J Bone Joint Surg Br,2005,87(4):450-453
[18]赖小今,廖明松,郭进春,等.家兔挤压伤后心脏节段旋转功能评价的实验研究[J].西南国防医药,2012,22(6):585-588Lai Xiao-jin,Liao Ming-song,Guo Jin-chun,et al.An experimental study on the evaluation of the rotation function of the heart segment after the rabbit crush injury[J].Southwest defense medicine,2012,22(6):585-588
[19]陈曦,刘跃洪,徐巍,等.简易大鼠挤压伤.挤压综合征模型建立的实验研究[J].中国修复重建外科杂志,2013(1):77-82Chen Xi,Liu Yu-hong,Xu Wei,et al.Simple rat crush injury.Experimental study of crush syndrome model[J].Journal of China rehabilitation and reconstruction surgery,2013(1):77-82
[20]邹圣强,魏超,苏兆亮,等.大鼠下肢挤压伤模型不同挤压时间的生化指标观察[J].中华灾害救援医学,2015,3(2):72-75Zou Sheng-qiang,Wei Chao,Su Zhao-liang,et al.Observation of biochemical indexes of different squeezing time of lower extremity crush injury model of rats[J].Chinese disaster relief medicine,2015,3(2):72-75
[21]潘鑫,邹圣强,魏超,等.双下肢不同时间大鼠挤压伤-挤压综合征模型生化与病理观察[J].中国矫形外科杂志,2015,23(2):156-159Pan Xin,Zou Sheng-qiang,Wei Chao,et al.The model biochemical and pathological observation of the compression and crush syndrome model in different time[J].Chinese orthopaedic surgery journal,2015,23(2):156-159
[2]Yin Y,Zhu T.Ventricular fibrillation during anesthesia in a Wenchuan earthquake victim with crush syndrome[J].Anesthesia&Analgesia,2010,110(3):916-917
[3]Bartal C,Zeller L,Miskin I,et al.Crush Syndrome:Saving More Lives in Disasters:Lessons Learned From the Early-Response Phase in Haiti[J].Archives of Internal Medicine,2011,171(7):694
[4]秦春妮,黑飞龙.心脏术后急性肾损伤的防治研究进展[J].医学综述,2012,18(17):2807-2809Qin Chun-ni,Hei Fei-long.Dragon Research on the prevention and treatment of acute kidney injury after heart surgery[J].Medical review,2012,18(17):2807-2809
[5]姚光强.急性肾衰竭大鼠血小板功能变化及机制研究[D].华中科技大学,2016Yao Guang-qiang.Study on the changes and mechanism of platelet function in rats with acute renal failure[D].Huazhong university of science and technology,2016
[6]郭进春,赖小今,廖明松,等.家兔挤压伤后心肌组织与心功能变化的对比研究[J].西南国防医药,2012,22(5):473-476Guo Jin-chun,Lai Xiao-jin,Liao Ming-song,et al.Comparative study on the changes of myocardial tissue and cardiac function after the rabbit crush injury[J].Western defense medicine,2012,22(5):473-476
[7]郭进春,邓旦,梁燕,等.家兔挤压伤后心脏整体功能与心肌超微结构的变化[J].解放军医学杂志,2012,37(7):699-701Guo Jin-chun,Deng Dan,Liang Yan,et al.Changes in cardiac function and myocardial ultrastructure after the injury of rabbits in rabbits[J].PLA medical journal,2012,37(7):699-701
[8]刘涛,白祥军.挤压伤和挤压综合征[J].创伤外科杂志,2016,18(7):447-449Liu Tao,Bai Xiang-jun.Crush injury and crush syndrome[J].Trauma surgery journal,2016,18(7):447-449
[9]孙莉姬.挤压综合征的研究进展[C].中华中医药学会补肾活血法分会暨天津市中西医结合学会肾脏病分会学术会,2014Sun Li-ji.Research progress of crush syndrome[C].Chinese traditional Chinese medicine association and the association of kidney and blood circulation and the academic meeting of the association of Chinese and western medicine in tianjin,2014
[10]Sheng ZY.Medical support in the Tangshan earthquake:a review of The management of mass casualties and certain major in juries[J].J Trauma,1987,27:1130-1135
[11]Stein H,Hoerer D,Weisz L,et al.Musculoskeletal in juries in earthquake victim s:an update on orthopedic management[J].Orthopedics,2000,10:1085-1087
[12]Better OS,Stein JH.Early management of shock and prophylaxis of acute renal failure in trauma ticrhab domyolysis[J].N Eng l JM ed1990,322:825-829
[13]Huang KC,Lee TS,Shu K H.Clinical features and outcome of crush syndrome caused by the chi chi earthquake[J].J Formos Med Assoc,2002,101:249-256
[14]Nad jafi I,A ter MR,Broum B,et al.Suggested guidelines for treatment of acute renal failure in earthquake victims[J].Ren Fail,1997,19:655-664
[15]Dursun F E,Yildirim A M.Distribution of Infections and Bacteriological Spectrum in Crush Syndrome[J].Turkish Nephrology,2015,24(1):93-97
[16]Tetsuya M,Toshiharu Y,Tanaka H,et al.Long term physical outcome of patients who suffered crush syndrome after the 1995 hansh in-Awaji earthquake:prognostic indicators in retrospect[J].J Trauma,2002,52:33-39
[17]Reis ND,Better OS.Mechanical muscle crush injury and acute muscle crush compartment syndrome:with special reference to earthquake casualties[J].J Bone Joint Surg Br,2005,87(4):450-453
[18]赖小今,廖明松,郭进春,等.家兔挤压伤后心脏节段旋转功能评价的实验研究[J].西南国防医药,2012,22(6):585-588Lai Xiao-jin,Liao Ming-song,Guo Jin-chun,et al.An experimental study on the evaluation of the rotation function of the heart segment after the rabbit crush injury[J].Southwest defense medicine,2012,22(6):585-588
[19]陈曦,刘跃洪,徐巍,等.简易大鼠挤压伤.挤压综合征模型建立的实验研究[J].中国修复重建外科杂志,2013(1):77-82Chen Xi,Liu Yu-hong,Xu Wei,et al.Simple rat crush injury.Experimental study of crush syndrome model[J].Journal of China rehabilitation and reconstruction surgery,2013(1):77-82
[20]邹圣强,魏超,苏兆亮,等.大鼠下肢挤压伤模型不同挤压时间的生化指标观察[J].中华灾害救援医学,2015,3(2):72-75Zou Sheng-qiang,Wei Chao,Su Zhao-liang,et al.Observation of biochemical indexes of different squeezing time of lower extremity crush injury model of rats[J].Chinese disaster relief medicine,2015,3(2):72-75
[21]潘鑫,邹圣强,魏超,等.双下肢不同时间大鼠挤压伤-挤压综合征模型生化与病理观察[J].中国矫形外科杂志,2015,23(2):156-159Pan Xin,Zou Sheng-qiang,Wei Chao,et al.The model biochemical and pathological observation of the compression and crush syndrome model in different time[J].Chinese orthopaedic surgery journal,2015,23(2):156-159