肠管连接装置在犬肠断裂伴休克模型中的应用  

Application of intestinal connection device on the intestinal rupture with shock in a dog model

作　　者：吴伟航 蔡志聪 林楠 杨为锦 王烈[1] 林晨[1] 洪杰 林丽 林志雄 陈东生 王瑜[1] Wu Weihang;Cai Zhicong;Lin Nan;Yang Weijin;Wang Lie;Lin Chen;Hong Jie;Lin Li;Lin Zhixiong;Chen Dongsheng;Wang Yu(Department of General Surgery, Fuzhou General Hospital of the Chinese People’s Liberation Army, Fuzhou 350025, China;Department of Gastroenterological Surgery, Jinjiang Municipal Hospital, Quanzhou, 362200, China;Department of General Surgery, Clinical Institute of Fuzhou General Hospital, Fuzhou, Fujian University of Traditional Chinese Medicine, Fuzhou 350025, China;Department of General Surgery, Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou 350025, China;Department of Anesthesiology, Fuzhou General Hospital of the Chinese peopl’s Liberation Army, Fuzhou 350025, China)

机构地区：[1]中国人民解放军福州总医院普外科,福州350025 [2]晋江市医院胃肠外科,362200 [3]福建中医药大学福总临床医学院普外科,福州350025 [4]福建医科大学福总临床医学院普外科,福州350025 [5]中国人民解放军福州总医院麻醉科,350025

出　　处：《中华实验外科杂志》2019年第2期229-231,共3页Chinese Journal of Experimental Surgery

基　　金：全军医学科技重点项目 (CNJ15J004);南京军区重大课题项目 (14ZX25);军事医学研究专项 (2016J02);福建省科技厅社会发展引导性(重点)项目 (2016Y0072).

摘　　要：目的 探讨肠管连接装置(ICD)在犬肠断裂伴失血休克模型中应用的可行性。方法 将10只Beagle犬随机分成2组,并予横断肠管及动脉放血建立肠管断裂伤伴失血性休克模型。实验组(n=5)采用ICD重建肠管,对照组(n=5)结扎肠管,随后暂时关腹,48 h后行确定性手术。观察相关指标(DCS用时、每个断端肠管处理时间、放血量、最初24 h液体复苏量)、确定性手术术中情况及生存情况。在损伤控制手术(DCS)后(0 h)、1、2、4、8、24 h测定血清内毒素浓度。实验组行消化道造影检查。取末端回肠组织行病理学检查。结果 实验组与对照组的DCS用时[(37.82±11.83) min比(38.85±12.90) min]、肠管断端的处理时间[(5.09±1.46) min比(4.45±1.28) min]、放血量[(364.45±37.92) ml比(372.54±43.43) ml]及最初24 h补液量[(1 686.87±157.69) ml比(1 729.58±176.23) ml]比较差异均无统计学意义。确定性手术中见实验组肠管血运良好,而对照组肠管出现缺血性改变。确定性手术后24 h,实验组动物均存活,而对照组仅存2只。DCS后4 h起,对照组内毒素浓度明显高于实验组(P<0.05)。消化道造影显示实验组肠管通畅性良好。实验组的末端回肠病理炎症改变明显轻于对照组。结论 在严重创伤中,使用ICD重建断裂肠管是可行的,可保留肠道生理功能,减少内毒素移位和肠管损伤。Objective To determine the feasibility of the self-developed intestinal connection device (ICD) in a intestinal rupture of Beagle with hemorrhagic shock model.Methods 10 beagle dogs were randomly divided into two groups. Dogs were subjected to intestinal transections and arterial bloodletting to establish intestinal rupture with hemorrhagic shock model. In experimental group (n=5), the broken intestine was reconstructed using ICD, and the broken intestine in control group (n=5) was ligated by suture. Then abdominal cavity was temporarily closed. 48 h after surgery, definitive surgery was performed. Related parameters of damage control surgery (DCS) (operation time, the time spent in managing each resection, blood loss and fluid resuscitation within the first 24 h), intraoperative situation of definitive surgery and survival situation of dogs were recorded.0, 1, 2, 4, 8, 24 h after DCS, the endotoxin concentration was detected. The upper digestive tract was examined in the animals of experimental group. In definitive operation, the terminal ileum tissue was removed for pathological examination.Results There was no statistical difference between the experimental group and the control group in the operation time of the damage control surgery [(37.82±11.83) min vs. (38.85±12.90) min], the time spent in managing each resection [(5.09±1.46) min vs. (4.45±1.28) min], blood loss [(364.45±37.92) min vs. (372.54±43.43) min] and fluid resuscitation within the first 24 h [(1 686.87±157.69) min vs. (1 729.58±176.23) min]. In definitive surgery, intestinal blood supply in experimental group was rich, but the intestines in control group showed ischemic change.24 h after definitive surgery, all the animals in the experimental group survived, but only 2 in the control group. 4 h since DCS, the concentration of endotoxin in the control group was significantly higher than that of the experimental group (P<0.05). Digestive tract radiography showed the intestines in experimental group were reserved good patency. Microscopic e

关 键 词：肠管断裂伤 失血性休克 肠管重建 肠管结扎 内毒素移位 

分 类 号：R-332[医药卫生] R641