急进高原火器伤血流动力学改变及丹参、地塞米松的治疗作用  

Hemodynamic changes of firearm injury at high altitude and therapy effects of Salvia Miltiorrliza and Dexamethasone

作　　者：刘建仓[1] 肖南[1] 李素芝[2] 刘良明[1] 周学武[1] 田昆仑[1] 殷作明[2] 霍小萍[1] 李萍[1] 杨志焕[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所二室,重庆400042 [2]成都军区西藏总医院,西藏拉萨850003

出　　处：《创伤外科杂志》2006年第4期301-304,共4页Journal of Traumatic Surgery

基　　金：军队"十五"科研基金重点课题(01Z076)

摘　　要：目的探讨急进高原火器伤血流动力学、血气及血生化指标的改变及丹参(SM)、地塞米松(DEX)单用或伍用对其的疗效。方法在西藏拉萨(海拔3 658m),采用五三式滑膛枪发射1.03g钢珠致伤急进高原的四川长白山猪后肢,观察火器伤后血流动力学、血气及血生化指标的改变及SM、DEX单用和伍用的治疗作用。结果急进高原猪火器伤后,平均肺动脉压(MPAP)、肺动脉楔压(PAWP)呈上升趋势,伤后6小时达最高,心输出量(CO)伤后1小时呈升高趋势,随后呈下降趋势;平均动脉压(MAP)、心率(HR)各组致伤前后无显著变化;单纯致伤组伤后动脉血PaO2、PaCO2显著下降,6小时最低(P<0.05);24小时血肌酐(Cr)水平显著升高(P<0.05);谷丙转氨酶(ALT)活性呈上升趋势;各组伤后K+均呈升高趋势,但Na+、C l-及血氧饱和度(O2STA)致伤前后无显著变化。SM、DEX单用和伍用均可不同程度地降低MPAP、PAWP,增加CO;伤后24小时动脉血PaO2基本恢复至伤前水平;血液Cr水平降低(P<0.05),其中以DEX单用和SM、DEX合用组效果最好。结论SM、DEX能改善急进高原火器伤的血流动力学指标,减轻缺氧及创伤所致的组织损伤,改善重要脏器的功能。Objective To study hemodynamic changes of firearm injuried pigs at acute exposed high altitude,and the effects of treatment with salvia-miltiorrliza （ SM ） and dexamethasone （ DEX ）. Methods Sichuan Changbaishan pigs acutely exposed to Lhase, Tibet （3 658 meters above the sea level ） were injured with steel balls. The hemodynamics, blood gas and blood biochemical parameters were measured after bullet wound, and all of the changes above after the treatment of SM or DEX alone and combined were observed. Results The level of mean pulmonary arterial pressure （ MPAP ）, pulmonary arterial wedge pressure （ PAWP ） and cardiac output （ CO ） were in- creased after injury. There was no change in MAP and HR after injury. The level of PaO2 and PaCO2 of simple injury group significantly decreased after injury. The level of creatine（Cr） significantly increased after injury. K^＋ increased in all the groups after injury. Na^＋ ,C1^- and O2STA were not changed in all the groups during the observation. Compared with the injury group,SM or DEX and combined use of both drugs could decrease the MPAP,and PAWP, and increase CO. PaO2of arterial blood was restored to the normal level, and the level of Cr decreased after the treatment. The most beneficial effects were found in DEX group and DEX combined with SM group. Conclusion SM and DEX can improve the hemodynamic parameters in the pigs after bullet wound at high altitude, and improve the vital or organ functions.

关 键 词：高原 火器伤 血流动力学 丹参 地塞米松 

分 类 号：R641[医药卫生—外科学] R826.5[医药卫生—临床医学]