腹部创伤合并海水浸泡致重度体温过低症犬血液滤过复温的效果研究  

Effects of different hemofiltration rewarming on deep hypothermia induced by seawater immersion in dogs with abdominal trauma

作　　者：单毅[1] 周春华[1] 李大伟[1] 董珍[1] 李洪艳[1] 

机构地区：[1]海军总医院重症医学科,北京100048

出　　处：《中华航海医学与高气压医学杂志》2012年第1期9-12,共4页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的观察血液滤过不同复温速度对腹部创伤合并海水浸泡致重度体温过低症犬的救治效果，为海水浸泡伤员的救治提供理论基础和可行方案。方法建立腹部创伤合并海水浸泡致重度体温过低症[（27．5±0．5）℃]致伤模型，按数字表法随机分为快速血滤复温组[8只，3℃／h复温至（38．0±0．5）℃]、慢速血滤复温组[8只，1．5℃／h复温至（38．0±0．5）℃]和体外复温组[5只，复温至（38．0±0．5）℃]，复温过程中检测血生化、凝血功能和血气分析，同时观察各组死亡率。结果血温35℃和38℃时，快速血滤复温组对外源性凝血途径凝血功能障碍（1．53±0．38，1．02±0．25）的纠正优于慢速血滤复温组（2．63±0．13，1．91±0．17）（P〈0．05）；血温32℃和35℃时，快速血滤复温组低钾血症[（2．90±0．51）mmol／L，（3．05±0．45）mmoL／L]纠正逊于慢速血滤复温组[（3．42±0．94）mmol／L，（4．20±1．01）mmol／L]（P〈0．05）。快速血滤复温组的死亡率为12．5％，慢速血滤复温组的死亡率为37．5％，体外复温组死亡率为100％。结论对腹部创伤合并海水浸泡致重度体温过低症的患者，采用3℃／h的血液滤过复温可能更有利于提高救治效果和降低死亡率。Objective To observe the effects of different hemofihration rewarming velocity on deep hypothermia induced by seawater immersion in dogs with abdominal trauma and to provide a theoretical basis and practical treatment profile for the medical care of casualties with seawater immersion. Methods The animal model of abdominal trauma coupled with deep hypothermia （ 27.5 ± 0. 5 ℃ ） induced by seawater immersion was established and the animals were randomly divided into the rapid hemofiltration rewarming group （ n =8, rewarmed to 38.0 ± 0. 5 ℃ at a rate of 3℃/h） , the slow hemofihration rewarming group （ n = 8, rewarmed to 38.0±0.5 ℃ at a rate of 1.5 ℃/h） and the external rewarming group （ n = 5, rewarmed to 38.0 ± 0.5℃ ）. In the rewarming process, serum potassium, blood coagulation and blood gas analysis were detected in all the animal groups. Furthermore, mortality rates were also observed. Results The rectifcation of the extrinsic coagulation disorder and acidosis for the rapid hemofhration rewarming group （ 1.53 ± 0.38,1.02 ± 0.25 ） was superior to that of the slow hemofihration rewarming group （ 2.63 ± 0. 13,1.91 ± 0. 17 ） （ P 〈 0. 05 ） , while the rectification of hypokalemia for the former [ （ 2.90 ± 0.5 1 ） mmol/L, （ 3.05 ±0.45 ） mmol/L ] was inferior to that of the latter[ （3.42 ± 0.94 ） mmol/L, （4.20 .＋ 1.01 ） mmol/L ] （P 〈 0.05 ）. The mortality for the rapid hemofiltration rewarming group was 12. 5% , while the mortalities for the slow hemofiltration rewarming group and the external rewarming group were 37.5% and 100% respectively. Conclusions For medical care of the cases with abdominal trauma coupled with deep hypothermia induced by seawater immersion, hemofiltration rewarming at a rate of 3℃/ h might help to improve treatment effects and decrease mortality.

关 键 词：海水浸泡 重度体温过低症 血液滤过 复温 

分 类 号：R82[医药卫生—临床医学]