摘要
目的 探讨胸部火器伤除心脏大血管损伤以外的胸腔内失血的来源 .方法 家兔 2 4只 ,按是否预扎伤区肋间动脉分为 A,B两组 ,每组又按肺实质浅表损伤 ( s)抑或深层损伤 ( d)各分成两个亚组 ,所以共分 4组 :As组 ( n=7)、Ad组 ( n= 5 )、Bs组 ( n=7)、Bd组 ( n=5 ) .比较伤后各组死亡率、胸腔失血量、血压和心率变化 ,死后常规解剖 ,并测定断裂肋间动脉失血速度 .结果 与 Bs组 [( 2 1.7± 8.2 ) m L ]相比 ,As组胸腔失血量明显减少 [( 5 .0± 2 .3) m L ],死亡率 As组 ( 14% )比 Bs组 ( 43% )明显下降 .血压和心率伤后瞬即下降 ,在无明显失血兔于 30 s均恢复接近伤前水平 . 85 %的家兔有 2根以上肋间动脉断裂 ,单根肋间动脉失血速度在主动脉压为 10 .6k Pa时为 ( 4.9± 1.0 ) m L .min- 1 . Ad组和 Bd组的失血量较Bs组成倍增加 ( 41± 13.3) m L 和 ( 5 5 .7± 3.2 ) m L.结论 肋间动脉损伤是本组家兔伤后失血性休克和早期死亡的重要原因之一 .预结扎肋间动脉可以明显减少失血量 ,降低死亡率 .
AIM To explore the bleeding source in the rabbit thoracic cavity caused by firearm penetrating wound, not counting the heart and great vessel injuries. METHODS Twentyfour rabbits were divided into 2 groups, Group A and Group B according to ligation (A) or without ligation (B) of intercostal artery. And each group was redivided into 2 subgroups according to the superficial(s) or deeper(d) pulmonary parenchyma injury. So there were 4 groups: Group As (n=7), Group Bs (n=7), Group Ad (n=5), Group Bd (n=5). The mortality, hemorrhage quantity in thoracic cavity, blood pressure and heart rate changes after the trauma were observed. Autopsy and measurement of the injured intercostal artery hemorrhage velocity under different aortic pressure were taken. RESULTS Compared with group Bs, the hemorrhage quantity in thoracic cavity in group As decreased significantly [GAs/GBs: (5.0±2.3) mL/(21.7± 8.2 ) mL, P<0.05] and the mortality also declined distinctly (GA: 14.3%, GB: 42.8%, P<0.05). The blood pressure and heart rate dropped quickly after injury and restored near to normal level within 30 seconds in GAs. There were more than two costal fractures in 85% rabbits. The intercostal artery hemorrhage velocity was (4.9±1.0) mL·min -1 under 10.6 kPa aortic pressure. Compared with group Bs, the hemorrhage volume of the rabbits in group Ad and Bd increased dramatically [(41.0±13.3) mL and (55.7±3.2) mL]. CONCLUSION The intercostal artery injury was one of the major causes of hemorrhage shock and early death in these groups. Ligation of intercostal artery can decrease the hemorrhage volume and mortality distinctly while severe pulmonary parenchyma injury can increase hemorrhage shock and mortality of rabbits.
出处
《第四军医大学学报》
2000年第5期533-535,共3页
Journal of the Fourth Military Medical University
基金
全军"九五"指令性课题资助项目!(96L046)
关键词
火器伤
胸部穿透伤
肋间动脉
失血性休克
firearm wounds
thoracic penetrating wounds
intercostal artery
hemorrhage shock
