摘要
目的比较重度腹部枪伤伴失血性休克行损伤控制手术与传统一期手术对全身炎症反应的影响。方法雌性本地杂种猪腹部枪伤及放血后建立肠袢多处伤及失血性休克模型后,32只动物随机分为2组(n=16):传统手术组(CS组)和损伤控制组(DCS组)。经适量晶体液复苏后行剖腹探查。CS组行损伤肠管切除端端吻合、腹腔冲洗、确定性关腹;DCS组行肠管残端血管钳夹闭、结扎、腹腔冲洗、临时关腹。记录手术时间、输液量、失血量、小时尿量,检测血流动力学参数、动脉血气、凝血指标等。术后6h,每组处死6只动物,取心肌、肺、小肠和肝组织行病理学检查。每组剩余10只动物用于观察创伤后24h生存率。结果两组间失血量、平均动脉压(MAP)无明显差异(P=0.05);与CS组比较,DCS组的手术时间(1.1±0.2hvs2.4±0.3h,P<0.01)短、输液量(3204±254mlvs3756±313ml)少(P<0.05)、小时尿量多、心率慢,酸中毒和凝血障碍较轻。DCS组的组织损伤及中性粒细胞浸润程度较CS组更低。尽管DCS组创伤后24h生存率(80%)的数值高于CS组(50%),但两组无统计学差异(P=0.175)。结论损伤控制手术较传统手术的手术时间短、输液量少,能更快纠正酸中毒、凝血障碍和低体温,避免进一步加重休克复苏后的再灌注损伤和炎症反应、维护多脏器功能。
Objective To compare the difference in systemic inflammatory response and early mortality between damage control surgery（DCS） and the traditional surgery in a pig model of severe abdominal gunshot injury.Methods Thirty-two female domestic outbreeding pigs with multiple bowel injury and exsanguination followed by lethal triad（low body temperature,acidosis and coagulopathy） were randomly divided into two groups（16 each）： conventional surgery（CS） and DCS groups.Laparotomy was performed after transfusion of appropriate amount of autologous blood and fluid infusion,pigs in CS group were then underwent end-to-end intestinal anastomosis,peritoneal lavage and definitive abdominal closure;while in DCS group the pigs received clamping of intestinal lumens,ligation of bleeding vessels,peritoneal lavage,and temporary abdominal closure.The operation time,blood loss and volume of fluid infusion were recorded.The hemodynamic parameters,arterial blood gases and coagulation parameters were examined.Six pigs of each group were sacrificed 6 hours after operation,and myocardium,lung,small intestine and liver were harvested for histological observation.The remaining 10 pigs of each group were used for assessment of 24h survival rate.Results No significant difference was detected in blood loss and mean arterial pressure（MAP） between the two groups.Compared with CS group,the operation time in DCS group was shorter（1.1±0.2h vs 2.4±0.3h,P〈0.01）,and the amount of infusion was less（3204±254ml vs 3756±313ml,P〈0.05）.Pigs in DCS group showed higher urinary output,lower heart rate,and lower dagree of acidosis and coagulopathy.The tissue injuries and neutrophil infiltration were milder in DCS group than in CS group.Although the 24h survival rate was higher in DCS group（80%） than in CS group（50%）,no significant difference was found with statistical analysis（P=0.175）.Conclusion Damage control surgery,compared with conventional surgery,may shorten the operation time,reduce fluid infusion,accelerate correction of metabolic acidosis,coagulopathy and hypothermia,avoid aggravation of accessory injuries and systemic inflammatory response induced by reperfusion,and prevent multiple organs dysfunction syndrome（MODS）.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2011年第5期447-451,共5页
Medical Journal of Chinese People's Liberation Army
基金
全军"十一五"卫生医药专项基金(06Z017)
关键词
损伤控制性外科
“致死三联征”
创伤
枪击
临时关腹
damage control surgery
lethal triad of death
wounds, gunshot~ temporary abdominal closure
