高原冲击伤、破片伤及冲击伤复合破片伤后血流动力学的变化  

Changes of hemodynamics after blast,fragment and blast-fragment injury in pigs at high altitude

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] 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第二研究室,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5期433-436,共4页Journal of Traumatic Surgery

基　　金：军队"十五"科研基金重点课题(01Z076)

摘　　要：目的探讨高原条件下猪冲击伤、破片伤及冲击伤复合破片伤后血流动力学的变化。方法分别于海拔3 500m(四川康定)和海拔380m处(重庆铜梁)采用铸型TNT炸药和五三式滑膛枪对长白山猪致冲击伤、破片伤和冲击伤复合破片伤,观察致伤后动物血流动力学指标变化及高原和平原致伤后的血流动力学变化差异。结果平原条件下致伤后,猪早期平均动脉压(MAP)一过性上升,随后呈下降趋势,中心静脉压(CVP)呈下降趋势;单纯冲击伤、破片伤后,右心室内压(RVSP)显著下降,心输出量(CO)显著增加;复合伤后RVSP、CO显著高于单纯致伤组。高原条件下致伤后,RVSP显著上升,CO显著下降,CVP和MAP呈升高趋势。结论破片伤可明显加重冲击伤伤情;在高原缺氧、低气压条件下,猪冲击伤、破片伤及复合伤伤情明显比平原条件下重,血流动力学损伤程度加重,其中以复合伤最为突出。Objective To study the changes of hemodynamics after blast, fragment and blast-fragment injury in pigs at high altitude. Methods Sichuan Changbaishan pigs were transported respectively to Kangding （3 500 meters above the sea level） and Tongliang（ 380 meters above the sea level）, and the pigs were divided into blast injury group, fragment injury group and blast-fragment injury group. Blast injury and fragment injury were induced by TNT explosive and smooth-bore gun. The hemodynamic parameters were measured after injury. Results In the low sea level groups, the mean arterial pressure （MAP） transiently increased after injury, and then decreased. The level of central venous pressure（CVP） decreased after injury in the all low sea level groups. The level of righ ventricular systolic pressure （ RVSP ） decreased, and the level of cardiac output （ CO ） increased after injury both in simple blast injury group and simple bragment injury group. Compared to the simple injury group, the level of RVSP and CO significantly increased after injury in the combined injury group. In the high altitude group, the levels of RVSP significantly increased, CO significantly decreased, and the CVP and MAP increased after injury. Conclusion Fragment injury could significantly intensify the blast injury. Blast injury,fragment injury and blast-fragment injury at the high altitude were more severe than that in the low sea level group. Blast-fragment injury was severe than blast or fragment simple injury.

关 键 词：冲击伤 破片伤 复合伤 血流动力学 高原 

分 类 号：R642[医药卫生—外科学]