犬颅脑爆震伤早期救治的实验研究  

Effect of treatment early after the injury on craniocerebral explosive injury in dogs

作　　者：张广林[1] 王本瀚[1] 高国栋[2] 贺世明[2] 于耀宇[2] 高立[2] 于嘉[2] 高波[2] 

机构地区：[1]解放军第153医院神经外科,郑州450042 [2]第四军医大学唐都医院神经外科,西安710038

出　　处：《中国临床神经外科杂志》2010年第11期672-675,共4页Chinese Journal of Clinical Neurosurgery

基　　金：全军"十一五"军事医学重点课题(NO:05XJM005)

摘　　要：目的观察早期运用大剂量青霉素钠、甘露醇对颅脑爆震伤实验犬的救治效果。方法杂种雄性犬30只,使用简单随机化的方法将犬分为:对照组(6只)、外伤组(12只)及治疗组(12只),外伤组和治疗组制作成颅脑爆震伤模型,治疗组运用大剂量青霉素钠、甘露醇进行治疗,然后观察每一组犬的血浆内皮素(ET)、肿瘤坏死因子(TNF)、谷丙转氨酶(ALT)、淀粉酶(AMY)、尿素氮(BUN)、肌酸激酶(CK)水平,以及颅内压(ICP)、头颅CT表现、细菌定性培养结果和犬生存时间。结果与对照组相比,外伤组伤后6h血浆ET、TNF及伤后12h血浆ALT、AMY、BUN、CK、ICP水平均显著升高(P<0.01),伤后24 和48h,治疗组的ET、TNF、ALTAMY、BUN和CK水平均明显低于外伤组(P<0.05)。头颅CT检查示治疗组脑水肿明显轻于外伤组;伤后48h,治疗组血液细菌培养阳性率8.33%(1/12),显著低于外伤组的83.33%(10/12)(P<0.01);治疗组的生存时间为(138.6±8.0)h,明显长于外伤组的(96.53.0)h(P<0.01)。结论颅脑爆震伤后早期运用大剂量青霉素钠、甘露醇治疗可减轻机体感染,降低颅内压,减轻脑组织水肿及机体继发损伤,延长动物的生存时间。Objective To observe the curative effect of high doses of penicillin sodium and mannitol on craniocerebral explosiveinjury in dogs. Methods Thirty mongrel male dogs were randomly divided into control group （n=6）, injury group （n= 12） and treatmentgroup （n=12）. The craniocerebral explosive injury in the dogs of both the injury and treatment groups was produced. The animals withcraniocerebral explosive injury were treated with high doses of penicillin sodium and mannitol early after the injury in the treatmentgroup. The plasma levels of endotoxin （ET）, tumor necrosis factor （TNF）, alanine transarninase （ALT）, amylase （AMY）, urea nitrogen（BUN） and creatine kinase （CK）, intracranial pressure （ICP）, and survival time were determined in all the groups, where head CTscanning was performed and the venous blood and secretory substance in the wound were taken for the bacterial culture. Results ① Theplasma levels of ET, TNF, ALT, AMY, BUN and CK and ICP level were significantly higher in the injury group than those in the controlgroup （P0.01）. The plasma levels of ET, TNF, ALT, AMY, BUN, and CK and ICP level in the treatment group were significantly lowerthan those in the injury group （P0.05）. CT showed that the cerebral edema in the treatment group was significantly lighter than that inthe injury group. ② The positive rate （1/12） of bacterial culture of the blood was significantly lower in the treatment group than that （10/12） in the injury group（P0.01）, and the survival time （138.6 h±8 h） of the animals in treatment group was significantly longer than that（96.5 h±3 h ） in the injury group（P0.01）. Conclusions The proper treatment early after the injury by high doses of penicillin sodiumand mannitol can decrease intracranial pressure, relieve the cerebral edema, infection and secondary injury, and prolong the survivaltime in the dogs with craniocerebral explosive injury.

关 键 词：爆震伤 早期救治 颅脑损伤 犬 

分 类 号：R651.15[医药卫生—外科学]