非气性腹腔内加压对肝损伤大鼠的止血效应  

Hemostatic effect of non-insuffiation intra-abdominal compression on liver injury

作　　者：梁斌[1] 黄晓强[1] 黄志强[1] 陈明易[1] 陈文斌 高丽洁[1] 王彦斌[1] 董家鸿[1] 

机构地区：[1]解放军总医院全军肝胆外科研究所,北京100853 [2]解放军第二六四医院普外科

出　　处：《中华创伤杂志》2011年第11期1045-1049,共5页Chinese Journal of Trauma

基　　金：全军“十一五”医药卫生科研课题资助项目（06Z052-1）

摘　　要：目的评价非气性腹腔内加压作为肝脏损伤后院前救治手段的有效性和安全性。方法将Wistar大鼠29只按随机数字表法分配进入IAP0、IAP5、IAP10,IAP15组（每组鼠数分别为8，8，8，5只），建立抗凝大鼠严重肝损伤动物模型后，采用非可扩张性充气式气囊相应地行0，5，10，15mmHg（1mmHg=0．133kPa）等不同程度的腹腔内加压。实验过程中，如平均动脉压（MAP）〈95mmHg时，颈静脉内补充乳酸钠林格液（3．3ml·min^-1·k^-1）直至MAP达到100mmHg。持续30min后，以饱和氯化钾处死动物，记录各组动物死亡率、失血量、补液量、肝脏湿重以及MAP等指标。结果IAP0、IAP5、IAP10组动物无死亡，IAP15组4／5的大鼠于加压后10～15min内死亡。IAP0、IAP5、IAP10、IAP15组大鼠腹腔内失血量依次减少[（54．20±11．30）ml／kg、（43．98±9．20）mL／kg、（32．49±7．40）ml／kg、（25．77±14．16）ml／kg，P〈0．01]。IAP10组补液量高于IAP0、IAP5、IAP15组补液量[（31．06±3．14）ml、（24．94±6．67）ml、（23．06±7．98）ml、（16．50±7．27）ml，P〈0．05]。IAP5、IAP10、IAP15组中肝脏湿重明显大于IAP0组肝脏湿重[（11．18±1．45）g、（12．13±0．96）g、（11．41±1．20）g、（10．03±0．58）g，P〈0．05]。IAP5、IAP10两组MAP差异无统计学意义[（64．81±19．65）mmHg、（65．80±15．36）mmHg，P〉0．05）]，却明显高于IAP0及IAP15组MAP[（41．22±10．00）mmHg、（44．50±28．60）mmHg，P〈0．05）]。结论非气性腹腔内加压对于严重的大鼠肝脏损伤具有止血作用，但需注意避免腹腔内压力过高所致的副作用。Objective To assess the effectiveness and safety of non-insufflation intra-abdominal compression as a prehospital hemostatie technique in treatment of liver injury. Methods Twenty-nine male Wistar rats were enrolled and randomly assigned into four experimental groups ：IAP0 group （ n = 8） , IAP5 group （ n = 8 ） , IAP10 group （ n = 8 ） and IAP15 group （ n = 5 ）. Then, the anticoagulated rat models of severe liver injury were established with different intra-abdonfinal pressures （ 0, 5, 10 and 15 mm Hg） by using a non-expansible insufflated gas bag. Once the mean artery pressure （MAP） was less than 95 mm Hg, Lactated Ringer＇ s solution was infused through the right jugular vein at speed of 3.3 ml·min^-1·k^-1 until MAP reached 100 mm Hg. Thirty minutes later, the animals were killed by intravenous injection of 0.2 ml saturated potassium chloride solution to measure the intraperitoneal total blood loss, liver weight, volmne of infused solution and MAP. Results No death was observed in IAP0, IAP5 and IAP10 groups and four rats （4/5） died at 10-15 minutes following exposure to the 15 mm Hg intra-abdominal pressure in IAP15 group. Total blood loss was reduced to （ 54. 20 ± 11.30）ml/kg in IAP0 group, （43.98 ±9.2） mL/kg in IAP5 group, （32.49 ±7.40） mL/kg in IAP10 group and （25.77 ± 14.16） ml/kg in IAP15group （ P 〈0.01 ）. The infused volume of resuscitation solution was （31.06 ±3.14） ml in IAP10 group, which was higher than （24.94 ±6.67） ml in IAP0 group,（ 23.06 ± 7.98 ） ml in IAP5 group and （ 16.50 ± 7.27 ） ml in IAP15 group （ P 〈 0.05 ）. Liver weight was （11.18±1.45） g in IAP5 group, （12. 13±0.96） g in IAP10 group and （11.41 ±1.20） g in IAP15 group, which was significantly higher than （10.03 ±0.58 ） g in IAP0 group （P 〈 0.05 ）. The MAP was （64.81 ± 19.65） mm Hg in IAP5 group and （65.80 ± 15.36） mm Hg in IAP10 group （insignificant difference between groups, P 〉 0.05） , which was higher than （41.

关 键 词：肝 创伤和损伤 出血 止血 院前救治 

分 类 号：R65[医药卫生—外科学] R57[医药卫生—临床医学]