高原高寒战时环境肢体枪弹伤伤道组织血液灌注的变化特点  

Dynamic change of hemoperfusion in wound track after gunshot wound of limbs in a simulated war environment at high altitude

作　　者：殷作明[1] 李素芝[1] 胡德耀[2] 叶峰[1] 石权贵[1] 杨志焕[2] 何代平[1] 宋俊[1] 林秀来[1] 袁文[1] 刘建伟[1] 

机构地区：[1]西藏军区总医院骨科,全军高原战创伤救治中心,西藏拉萨850003 [2]第三军医大学大坪医院野战外科研究所,创伤,烧伤和复合伤国家重点实验室,重庆400042

出　　处：《创伤外科杂志》2007年第1期64-67,共4页Journal of Traumatic Surgery

基　　金：军队"十五"指令性课题资助项目(01L008)

摘　　要：目的探讨高原高寒环境战时肢体火器伤后伤道组织血液灌注的特点。方法将24只实验猪随机分为高原战时致伤组(GZ)、高原平时致伤组(GP)和平原平时致伤组(PP),分别于伤前、伤后不同时相点取伤道入口内距伤道壁0．5～1．5 cm处伤道周围肌肉组织,匀浆后行6-酮-前列腺素F1α(PGF1α)、血栓烷B2(TXB2)含量的测定,并测定伤道周围组织血流量和血球运动速率。结果(1)3组伤后伤道组织中TXB2均显著升高,伤后12小时形成高峰,然后稍有降低,在2天时形成一个低点,在3天时再次升高;伤后PGF1α的变化趋势与TXB2的变化趋势基本相反。GZ组在伤前就出现PGF1α／TXB2下降,并且伤后PGF1α／TXB2变化的幅度最大;其次是GP组。(2)3组伤后2～6小时血流量和血流速率均显著降低,均在12小时时有所回升,PP组3天时达最低点、5天时开始逐渐回升,GZ及GP组均在5天时达最低点、7天开始回升。结论3组伤后血流灌注有相似的变化特点,但GZ组伤道组织发生的血液灌注障碍最重、血流恢复最慢;GP组次之。Objective To investigate the changes of hemoperfusion in muscle tissue of wound track after gunshot wound in pig limbs in high altitude,high cold and war environment. Methods Twenty-four pigs,divided into normal environment group （ PP, n = 8 ）, high altitude and cold environment group （ GP, n =8 ）, and high altitude, high cold and war environment group（ GZ, n = 8 ）. Gunshot wound in the posterior limbs were induced in different environment. The content of PGF1α ,TXB2 and the changes of blood flow and velocity of blood cell movement in the muscular tissues of the wound track were measured at different time points after injury. Results （ 1 ） The changes of TXB2 in the muscular tissues of the three groups rose significantly in 2-6h after injury, and peaked at 12h and 3d. The changes of PGF1α in the muscular tissues of the three groups were opposite to that of TXB2. PGF1α/TXB2 of GZ group decreased before injury, and had a biggest change in the three groups, and the next was GP group. （2） The changes of blood flow and velocity of blood cell movement in the muscular tissues of the three groups decreased significantly in 2-6h after injury,and had a slight rise in 12h. After that,PP group had a lowest point at 3d,and gradually rose after that time. But GP group and GZ group had a lowest point at 5d, and gradually rose after that time. Conclusion Dynamic change of hemoperfusion in the three groups is similar to each other. But the hemoperfusion in the muscular tissues of the wound track of GZ group is stronger than GP group which is in turn stronger than PP group.

关 键 词：高原 枪弹伤 血液灌注 

分 类 号：R826.26[医药卫生—临床医学]