不同瘤夹时间对颅内动脉瘤模型制作中失血性休克影响  

Influence of different tumor clipping time on the hemorrhagic shock in the production of intracranial aneurysm model

作　　者：方志成[1] 张浩明[1] 郑翔[1] 闵利[1] 李海涛[1] 

机构地区：[1]湖北医药学院附属太和医院,湖北十堰442000

出　　处：《现代中西医结合杂志》2016年第6期574-577,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：湖北省自然科学基金面上项目(2014CFB314)

摘　　要：目的观察不同瘤夹时间对颅内动脉瘤模型制作期间失血性休克的影响。方法将80只日本大耳白兔随机分为A、B、C、D 4组,每组20只,除A组外,B、C、D组采用改良胰弹性蛋白酶诱导动脉瘤方法制作动脉瘤模型,瘤夹时间分别为20,25,30 min,瘤夹松开即刻和术后1 h监测动脉血气分析及凝血功能,评估失血性休克和动物自身凝血功能变化;颈总动脉多普勒超声观察动脉瘤形态,测定血流速度,评估不同瘤夹时间对动脉瘤模型成瘤的影响。结果 B、C组术中和术后血气分析p H值明显低于A组和D组(P均<0.05),碱剩余和乳酸水平明显高于A组和D组(P均<0.05)。B、C、D组血浆凝血酶原时间、部分活化凝血酶原时间及凝血时间均明显短于A组(P均<0.05),B、C组间比较差异无统计学意义,D组明显短于B、C组(P均<0.05),各组组内术中和术后比较差异无统计学意义。A、B、C、D 4组分别有0,8,6,2只兔发生失血性休克,D组失血性休克发生比例明显低于B、C组(P均<0.05)。3周后彩色多普勒超声显示B、C、D组颈总动脉瘤夹部位血管内径均明显大于A组(P均<0.05),近心端和远心端局部瘤样扩张血管血流速度均明显高于A组(P均<0.05),且近心端局部瘤样扩张血管血流速度明显高于远心端(P均<0.05);B、C、D组3组间比较差异均无统计学意义。结论延长瘤夹时间可有效预防动物动脉瘤模型失血性休克发生,减少死亡,其机制可能与促进血液高凝状态有关。Objective It is to observe the influence of different tumor clipping time on the hemorrhagic shock during the production of intracranial aneurysm model. Methods 80 Japanese big ear rabbits were randomly divided into group A,group B,group C and group D,20 cases in each group. Except group A,the aneurysm model were produced by modified pancreatic elastase induced aneurysm model method with tumor clipping time as 20,25,30 min in group B,C,D respectively. The arterial blood gas analysis and blood coagulation function were observed at tumor clamp loosen immediate and postoperative 1 h,the changes of hemorrhagic shock and animal blood coagulation function were evaluated; the aneurysm shape was observed and the blood flow velocity was detected by carotid artery Doppler ultrasound,the influence of different tumor clipping time on aneurysm model into a tumor was evaluated. Results The blood gas analysis of p H values of intraoperative and postoperative in Group B and C were lower than those in group A and D（ all P〈0. 05）,the residual alkali and lactic acid level were significantly higher than those in group A and D（ all P〈0. 05）. The plasma prothrombin time,partial activation prothrombin time and clotting time in group B,C,D were significantly shorter than those in group A（ all P〈0. 05）,there was no significant difference between group B and C,and which in group D was obviously shorter than those in group B and C（ all P〈0. 05）;there was no significant difference between intraoperative and postoperative in all groups. There were 0,8,6,2 rabbits with hemorrhagic shock in group A,B,C and D respectively,the incidence of hemorrhagic shock in group D were significantly lower than those in group B and C（ all P〈0. 05）. After three weeks,color Doppler ultrasonography showed that the blood vessel diameter of carotid aneurysm clip part in group B,C and D were significantly greater than that in group A（ all P〈0. 05）; the blood flow velocity in blood vessels of local tumor like dilation in group B,C

关 键 词：颅内动脉瘤 失血性休克 

分 类 号：R332[医药卫生—人体生理学]