便携式腹腔灌洗装置的研制及其对海水浸泡腹腔开放伤犬的救治研究
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摘要
目的研制一种适合野战条件使用的便携式腹腔灌洗装置,了解运用其灌洗复温对海水浸泡腹腔开放伤犬生命体征、电解质及炎症反应的影响。方法将10只比格犬随机分为常规即时组和装置即时组,所有犬均经腹部开放伤并海水浸泡处理。常规即时组犬打捞出水后经腹部切口进行常规即时灌洗复温;装置即时组犬打捞出水后用腹腔灌洗装置即时灌洗复温。各组于致伤前、浸泡后以及冲洗后2 h、1 d、3 d和5 d分别观察2组犬生命体征、血清中炎症因子表达水平、组织黏膜的病理变化及显微结构的改变、血浆中Na~+、K~+、Cl~-、乳酸、乳酸脱氢酶等生化指标。结果常规即时组和装置即时组海水浸泡腹腔开放伤犬血液中肿瘤坏死因子-a(TNF-a)、白介素1b(IL-1b)、干扰素-γ(IFN-γ)、血管内皮生长因子(VEGF)、转化生长因子-b(TGF-b)的含量、炎症细胞浸润程度,组织、器官的损坏随着动物打捞出水时间的延长呈现先升高后降低的趋势,同一时间点组间差异无统计学意义(P>0.05)。腹部开放伤犬经海水浸泡3h后,血浆中Na~+、K~+、Cl-、乳酸、乳酸脱氢酶浓度相对于致伤前明显增高(P<0.05),Ca~(2+)、HCO_3~-浓度稍有降低,血浆p H降低;经常规即时灌洗复温和装置即时灌洗复温后,Na~+、K~+、Cl~-浓度相对于浸泡后在1 d、3 d、5 d的检测中逐步降低(P<0.05),同一时间点组间差异无统计学意义(P>0.05)。结论采用便携式腹腔灌洗装置即时灌洗复温能达到常规即时灌洗复温同等效果,降低多器官功能衰竭综合征(MODS)的发生,提高救治成功率。
Objective To develop a portable celiac lavage device suitable for field conditions,and to understand its effects on vital signs,electrolytes and inflammatory response of dogs after open abdominal injury and seawater immersion.Methods 10 dogs were divided into two groups randomly and all dogs were treated with open abdominal injury and seawater immersion.Dogs in routine group were salvaged from water then treated with routine real-time irrigation rewarming from the abdominal incision.The dogs in device group were salvaged from water then treated with real-time irrigation rewarming from the abdominal incision by using portable peritoneal lavage device.The levels of vital signs,inflammatory factors expression in serum,histopathological changes,microstructure changes and the concerntration of Na~+,K~+,Cl~-,lactic acid and lactic dehydrogenase in plasma were observed before immension,2 h after immension,1 day,3 days and 5 days after lavage,respectively.Results The levels of TNF-α,IL-1β,IFN-γ,VEGF,TGF-bgin the blood,the infiltration of inflammatory cells,the damage of tissues and organs in both groups were increased after immension,and decreased gradully at the later points of time after lavage.There was no significant difference between the two groups at the same time point(P>0.05).The concentration of Na~+,K~+,Cl-,lactate and lactate dehydrogenase in the plasma was significantly higher than that before immersion(P<0.05),and the concentration of Ca~(2+) and HCO_3~- and plasma p H decreased slightly(P<0.05).The concentration of Na~+,K~+ and Cl~- decreased gradually at 1 d,3 d and 5 d after immersion.There was no significant difference between the two groups at the same time point(P>0.05).Conclusion Immediate lavage and rewarming using the portable peritoneal lavage device can achieve the same effect of conventional real-time lavage and rewarming.It can reduce the occurrence of MODS and improve the success rate of treatment.
Objective To develop a portable celiac lavage device suitable for field conditions,and to understand its effects on vital signs,electrolytes and inflammatory response of dogs after open abdominal injury and seawater immersion.Methods 10 dogs were divided into two groups randomly and all dogs were treated with open abdominal injury and seawater immersion.Dogs in routine group were salvaged from water then treated with routine real-time irrigation rewarming from the abdominal incision.The dogs in device group were salvaged from water then treated with real-time irrigation rewarming from the abdominal incision by using portable peritoneal lavage device.The levels of vital signs,inflammatory factors expression in serum,histopathological changes,microstructure changes and the concerntration of Na~+,K~+,Cl~-,lactic acid and lactic dehydrogenase in plasma were observed before immension,2 h after immension,1 day,3 days and 5 days after lavage,respectively.Results The levels of TNF-α,IL-1β,IFN-γ,VEGF,TGF-bgin the blood,the infiltration of inflammatory cells,the damage of tissues and organs in both groups were increased after immension,and decreased gradully at the later points of time after lavage.There was no significant difference between the two groups at the same time point(P>0.05).The concentration of Na~+,K~+,Cl-,lactate and lactate dehydrogenase in the plasma was significantly higher than that before immersion(P<0.05),and the concentration of Ca~(2+) and HCO_3~- and plasma p H decreased slightly(P<0.05).The concentration of Na~+,K~+ and Cl~- decreased gradually at 1 d,3 d and 5 d after immersion.There was no significant difference between the two groups at the same time point(P>0.05).Conclusion Immediate lavage and rewarming using the portable peritoneal lavage device can achieve the same effect of conventional real-time lavage and rewarming.It can reduce the occurrence of MODS and improve the success rate of treatment.
引文
[1]庄永敬,谢培增,陈大军,等.海上环境下海战伤救治的实验研究[J].华南国防医学杂志,2010,24(2):141-144,153.
[2]尚立群,王伟,虞积耀,等.低温对兔海水浸泡腹部开放伤生存率的影响及早期复温的作用观察[J].解放军医学杂志,2010,35(12):1496-1498.
[3]杨兴东,王育红,虞积耀,等.不同复温方式对犬腹部开放伤合并海水浸泡救治时血流动力学的影响[J].解放军医学杂志,2004,29(12):1031-1033.
[4]高广周,李大伟,李欣,等.腹部开放伤后海水浸泡大鼠肠组织中MDA与So D含量变化及意义[J].河北医科大学学报,2010,31(10):1231-1233.
[5]虞积耀,赖西南.海战伤合并海水浸泡伤的伤情特点及救治技术研究进展[J].解放军医学杂志,2004,29(12):1017-1019.
[6]陈肖松,程迅生.海水浸泡开放性创伤损伤机制及治疗的研究进展[J].安徽医学,2011,32(10):1781-1783.
[7]姜福亭,王育红,段蕴铀,等.犬腹部开放伤合并人工海水浸泡后水、电解质的变化[J].创伤外科杂志,2003,5(5):360-363.
[8]周松,张文华,李冉冉,等.乌司他丁联合血必净对海水浸泡腹腔开放伤兔血流动力学的影响[J].西南国防医药,2013,23(3):236-239.
[9]王育红,鹿尔驯,虞积耀,等.海水浸泡腹部开放性损伤对大鼠体液代谢的影响[J].第二军医大学学报,2000,21(8):786-788.
[10]沈宏亮,王强.海水浸泡创伤病理生理变化和救治措施的研究进展[J].第二军医大学学报,2003,24(12):1365-1367.
[11]袁瑞,张志成.意外低体温症研究进展[J].解放军医学杂志,2016,41(4):339-342.
[12]王培,管云枫,徐添颖,等.G-CSF对大鼠烧伤合并海水浸泡后内皮祖细胞的影响[J].东南国防医药,2013,15(1):1-3.
[13]江朝光,毕建立,李佳春,等.3种方法对海水浸泡致重度体温过低症犬的复温效果研究[J].中华胸心血管外科杂志,2001,17(6):42-44.
[14]陈兵,陆中元,张骏,等.胸腔灌洗对海水浸泡胸部开放伤高渗状态的疗效[J].东南国防医药,2012,14(5):393-395.
[15]Hu XH,Duan YY,LI Y,et al.Early responses of VEGF during acute lung injury induced by seawater immersion after open chest trauma[J].Respiration,2010,79(6):490-496.
[16]张文华,周松,张行健,等.乌司他丁联合血必净可抑制海水浸泡腹腔开放伤兔的炎症反应[J].中医临床研究,2014,(27):12-17.
[17]张炎,刘刚,王育红,等.肿瘤坏死因子-α、白介素-6、丙二醛、超氧化物歧化酶在大鼠腹腔海水浸泡伤中的表达[J].实用医学杂志,2009,25(22):3764-3766.
[18]曹建雄,谢培增,王克刚,等.平时海上灾害海水浸泡胸部开放伤患者的院前急救[J].广东医学,2011,32(4):463-465.
[2]尚立群,王伟,虞积耀,等.低温对兔海水浸泡腹部开放伤生存率的影响及早期复温的作用观察[J].解放军医学杂志,2010,35(12):1496-1498.
[3]杨兴东,王育红,虞积耀,等.不同复温方式对犬腹部开放伤合并海水浸泡救治时血流动力学的影响[J].解放军医学杂志,2004,29(12):1031-1033.
[4]高广周,李大伟,李欣,等.腹部开放伤后海水浸泡大鼠肠组织中MDA与So D含量变化及意义[J].河北医科大学学报,2010,31(10):1231-1233.
[5]虞积耀,赖西南.海战伤合并海水浸泡伤的伤情特点及救治技术研究进展[J].解放军医学杂志,2004,29(12):1017-1019.
[6]陈肖松,程迅生.海水浸泡开放性创伤损伤机制及治疗的研究进展[J].安徽医学,2011,32(10):1781-1783.
[7]姜福亭,王育红,段蕴铀,等.犬腹部开放伤合并人工海水浸泡后水、电解质的变化[J].创伤外科杂志,2003,5(5):360-363.
[8]周松,张文华,李冉冉,等.乌司他丁联合血必净对海水浸泡腹腔开放伤兔血流动力学的影响[J].西南国防医药,2013,23(3):236-239.
[9]王育红,鹿尔驯,虞积耀,等.海水浸泡腹部开放性损伤对大鼠体液代谢的影响[J].第二军医大学学报,2000,21(8):786-788.
[10]沈宏亮,王强.海水浸泡创伤病理生理变化和救治措施的研究进展[J].第二军医大学学报,2003,24(12):1365-1367.
[11]袁瑞,张志成.意外低体温症研究进展[J].解放军医学杂志,2016,41(4):339-342.
[12]王培,管云枫,徐添颖,等.G-CSF对大鼠烧伤合并海水浸泡后内皮祖细胞的影响[J].东南国防医药,2013,15(1):1-3.
[13]江朝光,毕建立,李佳春,等.3种方法对海水浸泡致重度体温过低症犬的复温效果研究[J].中华胸心血管外科杂志,2001,17(6):42-44.
[14]陈兵,陆中元,张骏,等.胸腔灌洗对海水浸泡胸部开放伤高渗状态的疗效[J].东南国防医药,2012,14(5):393-395.
[15]Hu XH,Duan YY,LI Y,et al.Early responses of VEGF during acute lung injury induced by seawater immersion after open chest trauma[J].Respiration,2010,79(6):490-496.
[16]张文华,周松,张行健,等.乌司他丁联合血必净可抑制海水浸泡腹腔开放伤兔的炎症反应[J].中医临床研究,2014,(27):12-17.
[17]张炎,刘刚,王育红,等.肿瘤坏死因子-α、白介素-6、丙二醛、超氧化物歧化酶在大鼠腹腔海水浸泡伤中的表达[J].实用医学杂志,2009,25(22):3764-3766.
[18]曹建雄,谢培增,王克刚,等.平时海上灾害海水浸泡胸部开放伤患者的院前急救[J].广东医学,2011,32(4):463-465.