多发伤合并未控制性失血性休克模型的建立  

Establishment of a model of multiple trauma combined with uncontrolled hemorrhagic shock

作　　者：蒋守银[1] 巴立[1] 杨俭新[1] 赵小纲[1] 张茂[1] 干建新[1] 

机构地区：[1]浙江大学医学院附属第二医院急诊医学科,浙江大学急救医学研究所,杭州310009

出　　处：《中华创伤杂志》2013年第1期15-20,共6页Chinese Journal of Trauma

基　　金：卫生部卫生公益性行业科研专项资助项目（201002014）

摘　　要：目的建立多发伤合并未控制性失血性休克模型，以满足多发伤基础研究的需要j方法选择40只新西兰雄兔并按随机数字表法分为假手术组（A组，无放血、无复苏）、未控制组（B组，放血但无复苏）、充分液体复苏组（C组，放血、止血及复苏）及限制性液体复苏组（D组，放血、止血及复苏），每组10只兔。3kg重锤在45cm处自由落下造成各组家兔右后肢骨折。2min后（记为TO）放血各组（B、C、D组）经右颈总动脉放血20min，约放出30％的全身血量。30min时针刺放血各组回盲动脉分支造成未控制性出血，再采用乳酸林格液对C、D组分别进行充分和限制性液体复苏，维持此期1h。90min时结扎出血动脉分支，再对c、D组进行回输血，另对D组输入3倍失血量的乳酸林格液，维持此期1h。150min～7h观察存活情况。各时相点采动脉血测血气分析与凝血功能并统计骨折类型、输液量、失血量及7h存活率。结果骨折均为胫腓骨闭合性粉碎性骨折。30min时放血组血压、心率及pH值均显著降低，K＋、血糖及乳酸显著增加（P〈0．01），血压和心率在150min时升至0min时的水平。充分液体复苏显著增加腹腔失血量和输液量（P〈0．01），降低红细胞压积（P〈0．05）及延长凝血酶原时间与活化部分凝血活酶时间（P〈0．05）。液体复苏显著提高7h存活率（P〈0．01）。结论本模型稳定性和可重复性高，适用于多发伤合并未控制性失血性休克的相关研究。Objective To establish a model of multiple trauma combined with uncontrolled hemorrhagic shock so as to provide basis for basic study of multiple trauma. Methods Forty New Zealand male rabbits were equally and randomly divided into four groups, ie, sham group （ Group A, with no bloodletting or resuscitation） , uncontrolled group （Group B, with bloodletting alone） , aggressive fluid resuscitation and limited fluid resuscitation groups （Groups C and D, with bloodletting, hemostasis and resuscitation）. Fractures of the right hind limb in rabbits of each group were induced by free drop of a 3 kg hammer from a height of 45 cm. An estimated 30% of total blood was withdrawn from the right common carotid artery in 20 minutes in bloodletting groups （Groups B, C and D ）. Successively, the uncontrolled bleeding was caused via acupuncture bloodletting from ileocecal artery branch at 30 minutes in bloodletting groups. Progressive and limited fluid resuscitation using lactated Ringer＇ s solution （LR） were performed for Groups C and D in the next one hour respectively. Blood transfusion was performed in Groups C and D after ligation of bleeding artery branch at 90 minutes. In addition, LR of three folds more than blood loss was administered in Group D. Survivorship of rabbits in each group was observed at 150 minutes to seven hours. Arterial blood sample was taken at each time point for blood gas analysis and coagulation test. Fracture type, fluid requirements, intra-abdominal blood loss, and rabbits＇ survival rate at seven hours were recorded. Results Closed comminuted tibiofibular fractures were founded in allgroups. Bloodletting groups showed an obvious reduction of MAP, heart rate and pH value and significantly increased levels of K~ , blood glucose and lactic acid at 30 minutes （P 〈 0.01 ） , whereas MAP and heart rate were returned to baseline level at 150 minutes. Progressive fluid resuscitation significantly increased the intra-abdominal blood loss and fluid requirements （P 〈0.01 ）, de

关 键 词：多处创伤 休克 出血性 模型 动物 

分 类 号：R605.971[医药卫生—急诊医学]