高原高寒战时环境肢体枪弹伤后电解质代谢的动物实验研究  

Features of electrolyte metabolism after gunshot wound in limbs in high altitude,high cold and war environment

作　　者：殷作明[1] 李素芝[1] 胡德耀[2] 叶峰[1] 杨志焕[2] 林秀来[1] 宋俊[1] 赖西南 石权贵[1] 何代平[1] 李楠[1] 何蓉城[1] 孙克勤[1] 

机构地区：[1]西藏军区总医院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,重庆400042

出　　处：《创伤外科杂志》2011年第2期155-158,共4页Journal of Traumatic Surgery

基　　金：军队指令性课题资助项目(01L008)

摘　　要：目的探讨高原高寒环境下平战时肢体枪弹伤后血浆电解质代谢的特点。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),每组8头。分别于伤前、伤后30分钟2、6、、12小时1、2、3、、5、7、10、14天采静脉血测定钾、钠、氯和钙、镁、磷的含量。结果伤后平原平时组和高原平时组血钙有明显的下降趋势,高原平时组整体血钙水平均较平原组低,但血清钙>2.25mmol/L。而高原战时组伤后3～5天有较严重的低钙血症。三组枪弹伤后均出现严重的低镁血症,严重程度依次为高原战时组>高原平时组>平原平时组。高原战时组伤后2小时即有显著降低,伤后12小时测不出,一直到伤后3天持续在低水平。三组伤后6小时血钠有一个显著的升高,受伤12小时后三组血钠逐渐降低,至伤后7天时高原战时组出现轻度低钠血症。三组K+、Cl-和Pi3+均在伤后12小时开始逐渐降低,严重程度依次为高原战时组>高原平时组>平原平时组,但都未低于正常值的低限。结论高原战时枪弹伤后3～5天机体有严重的低钙血症,6小时～1天和3天机体有严重的低镁血症;12小时后机体开始出现K+、Na+、Cl-和Pi3+的逐渐降低,至伤后7天出现轻度的低钠血症。Objective To investigate the features of electrolyte metabolism in plasma after gunshot wound in high altitude and high cold environment in peace and wartime.Methods Totally 24 pigs were divided randomly into normal environment group（PP,n=8）,high altitude group（GP,n=8）,and high altitude with war environment group（GZ,n=8）.Venous blood was collected for measurement of the content of potassium,sodium,chlorine,calcium,magnesium and phosphonium before injury and at 30 minutes,2,6,12 hours,1,2,3,5,7,10,14 days after injuryResults Blood calcium had an obvious decrease after injury in PP group and GP group.The level of blood calcium was lower in GP group than that in PP group,but it was no lower than 2.25mmol/L.Relatively severe hypocalcemia existed in GZ group within 3-5 days after injury.Severe hypomagnesemia appeared in all groups after gunshot injury and the extent was GZ〉GP〈PP in turn.Blood magnesium of GZ group decreased significantly at 2 hours after injury,which could not be detected at 12 hours after injury and was at a low level until 3 days after injury.Blood sodium increased significantly at 6 hours after injury in all groups,then decreased gradually since 12 hours after injury.Gentle hyponatremia appeared in GZ group at 7th days after injury.Blood potassium,chlorine and phosphonium decreased gradually since 12 hours after injury in all groups and the extent was GZ〉GP〉PP in turn,but it was no lower than normal value.Conclusion In high altitude and war environment,severe hypocalcemia exists within 3-5 days after gunshot injury and severe hypomagnesemia exists within 6 hours to 1day and at 3rd days after injury.Blood potassium,sodium,chlorine and phosphonium decreases gradually at 12 hours after injury and gentle hyponatremia appears at 7th days after injury.

关 键 词：枪弹伤 高海拔 电解质 代谢 

分 类 号：R641[医药卫生—外科学]