高原肢体枪弹伤对循环呼吸系统的影响  

Effects of gunshot wounds in swine's hind limbs on circulatory and respiratory systems at high altitude

作　　者：李素芝[1] 殷作明[1] 胡德耀[2] 叶峰[1] 林秀来[1] 杨志焕[2] 宋俊[1] 熊国忠[1] 汤建林[1] 陈永龙[1] 向小敏[1] 李楠[1] 何蓉城[1] 刘安[1] 

机构地区：[1]西藏军区总医院全军高原战创伤救治中心,拉萨850003 [2]第三军医大学大坪医院野战外科研究所

出　　处：《西南国防医药》2010年第10期1109-1112,共4页Medical Journal of National Defending Forces in Southwest China

基　　金：军队指令性课题资助项目(01L008)

摘　　要：目的探讨高原肢体枪弹伤后动物循环呼吸系统的改变情况。方法将24头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、伤后不同时相点进行心脏功能测定,抽动脉血进行血气分析。结果 (1)高原两组动物致伤后全身肌肉持续强烈痉挛,皮肤呈苍白色,程度较平原严重,持续时间较平原地区久,此后转变为红色并逐渐转为暗红色;大多在伤后几十秒钟后出现呼吸暂停,继之呼吸急促,以后逐渐平稳并慢慢转为深大呼吸,呼吸频率较正常明显减慢、呼吸幅度明显加大。(2)高原火器伤后早期心率加快、心肌收缩力显著增强,但是心肌的顺应性降低,心脏每博输出量和每分输出量均较伤前降低,1h时显著低于伤前水平。(3)高原战时组伤前动物就存在显著的呼吸性碱中毒和代谢性酸中毒,伤后早期呼吸频率较平原快,过度通气较为严重而持久,主要表现为呼吸性碱中毒,并出现失代偿;在酸碱紊乱的同时,动物也存在显著的低氧血症。(4)高原肺脏远达效应的发生率最高为53.85%,心脏发生率为19.23%。结论高原肢体枪弹伤后,外周血管收缩强烈,心肌顺应性降低,心功能下降,发生严重的酸碱紊乱和低氧血症,程度较平原地区重,持续时间较平原地区长。Objective To investigate the changes of circulatory and respiratory systems after gunshot wounds in swine＇s hind limbs at high altitude. Methods 24 pigs were randomly divided into GZ group （n = 8 ） , GP group （n = 8 ）and PP group（ n = 8 ）. Pigs in GZ group were sent to high altitude （ 3670 m above sea level ） from plain （ 351 m above sea level ） and lived in a simulated wartime environment for 3 days until their hind limbs were wounded by gunshot. Animals in GP group were also sent to the same high altitude hut lived in a normal environment for 14 days and then suffered from gunshot wounds, while those in PP group were fed under normal conditions in plain（ 351 m above sea level）and wounded thereafter. Heart function determination and arterial blood gas analysis of each pig were implemented at different time points before and after injury. Results （ 1 ） Pantosomatous muscle cramped strongly and continuously in GZ group and GP group after injury. The skin appeared pale and its extent was severer and duration was longer in GZ group and GP group than those in PP group. Then the skin turned into red and gradually into wine afterwards. Most animals in GZ group and GP group endured apnea in tens of seconds after injury, and then breathed urgently and changed gradually into deep breath with decreased frequency and increased extent. （ 2 ） The heart rate sped up and contraction force of myocardium increased significantly in early stage after firearm wound at high altitude. However, the compliance of myocardium and cardiac stroke volume as well as cardiac minute output decreased compared with pre - injury, and they were significantly lower at 1 h after injury than those before injury. （3） Significant respiratory alkalosis and metabolic acidosis existed before injury in GZ group. Early after injury, the respiratory frequency in GZ group was faster than that in PP group, the hyperventilation was severe and persistent, and respiratory alkalosis was the main manifestation and the decompensa

关 键 词：高原 枪弹伤 伤道 心功能 血气分析 

分 类 号：R594.3[医药卫生—内科学]