间歇正压通气对犬胸部火器伤致肺损伤的救治作用  

Therapeutic Effect of Interval Positive Pressure Ventilation on Lung Injury Following Thoracic Gunshot Wounds in Dogs

作　　者：孙喜庆[1,2,3] 刘荫秋 蔡建辉[1,2,3] 李兵仓 郭建军[1,2,3] 李曙光 刘维永[1,2,3] 张良潮 王大田[1,2,3] 陈志强 

机构地区：[1]第四军医大学空军医学系航空生物动力学教研室 [2]第三军医大学附属大坪医院野战外科研究所 [3]第四军医大学附属西京医院胸心外科

出　　处：《中华创伤杂志》1999年第4期284-286,共3页Chinese Journal of Trauma

基　　金：全军"九五"医药卫生指令课题

摘　　要：目的探讨间歇正压通气（ＩＰＰＶ）对胸部火器伤致肺损伤犬的早期救治作用。方法杂种犬１４只，随机分为对照组（６只）和ＩＰＰＶ组（８只）。麻醉后得用０．４ｇ钢珠射击犬右侧胸部。对照组仅行伤口封闭，输液及胸腔闭式引流。ＩＰＰＶ组除进行上述操作外，于致伤后２０分钟行ＩＰＰＶ。测量血流动力学指标，并做血气分析。结果致伤即刻，对照组犬平均动脉血压（ＭＡＰ）和峰值气道压（ＰＩＰ）较致伤前显著升高（Ｐ＜０．０５），致伤后２０分钟，ＰａＯ２、ｐＨ、氧饱合度（ＳａＯ２）、平均动脉压（ＭＡＰ）及心率（ＨＲ）均显著降低（Ｐ＜０．０１），ＰａＣＯ２及ＰＩＰ显著升高（Ｐ＜０．０１），致伤后４０，６０分钟，上述变化呈渐进性加剧，动物平均存活时间为（３８±２５）分钟。ＩＰＰＶ组犬在致伤即刻及２０分钟，上述指标变化与对照组相似；应用ＩＰＰＶ后，ＰａＯ２，ＳａＯ２，ＭＡＰ，ＨＲ及ＰＩＰ较对照组增显著升高（Ｐ＜０．０１），ＰａＣＯ２显著降低（Ｐ＜０．０１），动物平均存活时间为（４６９±３２８）分钟。结论严重胸部火器伤致肺损伤犬早期即可出现明显的呼吸功能不全。应用ＩＰＰＶ可改善胸部火器伤致肺损伤犬的气体交换，显著延长存活时间。Objective To study the effect of interval positive pressure ventilation (IPPV) on thoracic gunshot wounds with lung injury in dogs. Methods Fourteen dogs were divided into control group ( n =6) and IPPV group ( n =8) at random. The dogs were shot in the right chest after anesthesia. The control dogs were only given hemostasis, infusion and closed thoracic drainage. In addition to the above-mentioned steps, the dogs in IPPV group were ventilated with IPPV for 20 minutes after wounding. Hemodynamic parameters and blood gases were measured. Results Mean arterial pressure (MAP) and peak inspiratory pressure (PIP) increased significantly immediately after wounding( P <0.05), and PaO 2, pH, SaO 2, MAP and heart rate (HR) decreased significantly, while PaCO 2 increased significantly 20 minutes after wounding in the control dogs ( P <0.01). These changes were further aggravated 40 and 60 minutes after wounding. The mean survival time was 38±25 minutes. No significant changes were found in IPPV group compared to controls immediately after wounding and 20 minutes later. PaO 2, SaO 2, MAP, HR and PIP elevated markedly ( P <0.01), but PaCO 2 declined compared to controls after IPPV was given ( P <0.01). The mean survival time was 469±328 minutes. Conclusions Respiratory insufficiency can occur in the early time of severe thoracic gunshot wounds with lung injury in dogs. IPPV may improve gas exchange and prolong survival time.

关 键 词：胸部损伤 机械通气 火器伤 肺损伤 

分 类 号：R655[医药卫生—外科学] R605.973[医药卫生—临床医学]