摘要
目的探讨肝肺撞击伤伴失血后二氧化碳(CO_2)气腹对兔动脉血气的影响及其机制。方法制作创伤性失血兔模型,按不同失血量(6 mL/kg、12 ml/kg、22 ml/kg)及 CO_2 腹压(5 mm Hg、10 mm Hg、15 mmHg)将75只新西兰大白兔按随机数字表分为9组(每组6只)。观察建立气腹前、气腹0.5 h、2 h 及撤去气腹后0.5 h 呼吸频率(RR)、动脉血气(ABG)的变化和死亡率。结果大白兔在建立气腹前:随失血量的增加,RR、PaCO_2上升显著;pH 值先升高后降;PaO_2 则持续下降。大白兔在建立 CO_2气腹后:随时间延长,5 mm Hg、10 mm Hg 压力组的 RR 先增后降;pH 值、PaO_2持续下降,PaCO_2持续升高,而且在相同失血量的情况下各组间的 pH 值、PaO_2随压力升高而降低,15 mm Hg 气腹组 RR 及 PaCO_2显著高于其他组。在相同压力条件下,5 mm Hg、10 mm Hg 气腹压力组随失血增多RR 加快、PaCO_2增高,pH 值、PaO_2下降。撤去气腹后0.5 h,各组内 RR、PaO_2、pH、PaCO_2值向正常恢复。结论一定气腹压力(<10 mm Hg)对创伤伴失血(<12 ml/kg)自主呼吸兔 ABG 的影响是可逆的;而高气腹压力(15 mm Hg)或大白兔失血量在12 ml/kg 以上时建立气腹将引起致死性后果。
Objective To investigate arterial blood gas（ABG） changes induced by different intra- abdominal pressures during CO2 pneumoperitoneum in rabbits with lung and liver impact injury under controlled hemorrhage. Methods In this study 75 rabbits were randomized into nine groups （6 rabbits in each group） according to the amount of blood loss （6 ml/kg, 12 ml/kg,22 ml/kg） and intra-abdominal pressures （5 mm Hg, 10 mm Hg, 15 mm Hg）. After model was established successsfully, respiratory rates （RR）, ABG and death rates were observed at pre-pneumoperitoneum, after 0. 5 hour and 2 hours under pneumoperitoneum and 0. 5 hour after desufflation. Results Without pneumoperitoneum, different blood loss exerted different effect on arterial blood gas ： RR, PaCO2 increased （ P 〈 0. 05 ） ; pH decreased after an initial increase, PaO2 decreased proportionally to the amount of blood loss （6 ml/kg,12 ml/kg,22 ml/kg）. When pneumoperitoneum was established, RR decreased after an initial increase pH, PaO2 significantly decreased, PaCO2 increased with intraperitoneal pressure of 5 mm Hg and 10 mm Hg. Compared with the same blood loss group, pH, PaO2 were significantly decreased with pressure increasing, but RR and PaCO2 were higher than other group at 15 mm Hg pressure（P 〈0. 05） ; blood loss caused RR and PaCO2 increasing in groups of 5 mm Hg and 10 mm Hg pressure. 0. 5 hour after desufflation, RR, pH, Pa02 and PaCO2 significantly recoverd. Conclusions RR, pH, Pa02 and PaC02 changes were reversable in rabbits with lung and liver impact injury under controlled hemorrhage （ 〈 12 ml/kg） and certain CO2 pneumoperitoneum pressure（ 〈 10 mm Hg）, but rabbits can not survive beyond 12 ml/kg blood loss or under high pressure （ 15 mm Hg）.
出处
《中华普通外科杂志》
CSCD
北大核心
2007年第12期943-946,共4页
Chinese Journal of General Surgery
基金
全军"十一五"课题资助项目(06MA190)
关键词
创伤和损伤
气腹
动物实验
血气分析
Wounds and injuries
Pneumoperitoneum
Animal experimentation
Blood gas analysis
