猪自由场初级肺爆震伤后动脉血气指标的变化及其应用价值  

Changes of arterial blood gas indexes of free-field primary blast lung injury of pigs and its application value

作　　者：王俊康 崔倩[3] 黄钰清 张红亮 王静[1,2] 郭程娱 冯聪[2] 潘菲 黎檀实[2] Wang Junkang;Cui Qian;Huang Yuqing;Zhang Hongliang;Wang Jing;Guo Chengyu;Feng Cong;Pan Fei;Li Tanshi(Medical School of Chinese PLA,Beijing 100039,China;Department of Emergency,the First Medical Centre,Chinese PLA General Hospital,Beijing 100039,China;Department of Radiology,Tianjin First Central Hospital,Tianjin 300192,China;Department of Ultrasound,the Third Medical Centre,Chinese PLA General Hospital,Beijing 100143,China;Nankai University School of Medicine,Tianjin 300071,China)

机构地区：[1]解放军医学院,北京100039 [2]解放军总医院第一医学中心急诊医学科,北京100039 [3]天津市第一中心医院放射科,天津300192 [4]解放军总医院第三医学中心超声科,北京100143 [5]南开大学医学院,天津300071

出　　处：《中华危重病急救医学》2021年第12期1466-1470,共5页Chinese Critical Care Medicine

基　　金：“十三五”军队重点学科建设项目(A350109);国家重点研发计划项目(2019YFF0302300);军队生物安全研究专项(19SWAQ28);军委科技委主题项目(19-163-12-ZT-006-008-08);解放军总医院军事医学转化项目(ZH19016)。

摘　　要：目的观察自由场初级肺爆震伤(PBLI)模型猪动脉血气指标的变化,并探讨动脉血气指标在预测中重度PBLI中的应用价值。方法选择成年健康长白猪9只,构建自由场PBLI猪模型,于爆炸前15 min(伤前)和爆炸后(伤后)10、30、60、120及180 min取动脉血,测定动脉血气指标及脉搏血氧饱和度(SpO_(2)),比较不同时间点血气分析指标和SpO_(2)水平的差异;观察肺组织大体损伤评分与病理损伤评分的变化,并分析各血气指标间的相关性。结果随时间延长,各时间点pH值、动脉血氧分压(PaO_(2))、SpO_(2)均较伤前降低,血乳酸(Lac)和动脉二氧化碳分压(PaCO_(2))较伤前升高。与伤前比较,伤后10 min血中pH值即明显下降(7.39±0.06比7.46±0.02,P<0.05),Lac即明显升高(mmol/L:3.61±2.89比1.10±0.28,P<0.05),持续到伤后180 min〔pH值:7.37±0.07比7.46±0.02,Lac(mmol/L):2.40±0.79比1.10±0.28,均P<0.05〕;而伤后180 min PaO_(2)、SpO_(2)明显下降〔PaO_(2)(mmHg,1 mmHg=0.133 kPa):59.40±10.94比74.81±9.39,P<0.05;SpO_(2):0.75±0.11比0.89±0.08,P<0.05〕,PaCO_(2)明显升高(mmHg:56.17±5.38比48.42±4.93,P<0.05)。相关性分析显示:肺爆震伤动物大体损伤评分与病理损伤评分呈正相关(r=0.866,P=0.005);PaO_(2)与SpO_(2)呈正相关(r=0.703,P=0.000);pH值与Lac呈负相关(r=-0.400,P=0.006);pH值与PaCO_(2)呈负相关(r=-0.844,P=0.000)。结论本研究成功建立了大型哺乳动物自由场PBLI模型,动脉血气分析有助于PBLI的早期诊断,SpO_(2)是否可用于评价肺损伤的严重程度有待于进一步验证。Objective To observe the changes of arterial blood gas indexes in pigs with the free-field primary blast lung injury(PBLI)model,and to explore the value of arterial blood gas indexes in predicting moderate to severe PBLI.Methods Nine adult healthy Landrace pigs were selected to construct the pig free-field PBLI model.Arterial blood samples were taken 15 minutes before the explosion(before injury)and 10,30,60,120,and 180 minutes after the explosion(after injury).Arterial blood gas indexes and pulse oxygen saturation(SpO_(2))were measured,compare the changes of blood gas analysis indexes and SpO_(2) levels at different time points,and observe the changes of gross injury scores and pathological injury scores of lung tissue.Analyze the correlation between the blood gas indicators.Results As time prolonged,at each time point,pH,arterial partial pressure of oxygen(PaO_(2)),and SpO_(2) were lower than those before the injury,and blood lactic acid(Lac)and arterial partial pressure of carbon dioxide(PaCO_(2))were higher than those before the injury.Compared with that before the injury,the pH value in the blood decreased significantly 10 minutes after the injury(7.39±0.06 vs.7.46±0.02,P<0.05),and the Lac increased significantly(mmol/L:3.61±2.89 vs.1.10±0.28,P<0.05),and lasts until 180 minutes after injury(pH value:7.37±0.07 vs.7.46±0.02,Lac(mmol/L):2.40±0.79 vs.1.10±0.28,both P<0.05);while PaO_(2) and SpO_(2) decreased significantly at 180 minutes after injury[PaO_(2)(mmHg,1 mmHg=0.133 kPa):59.40±10.94 vs.74.81±9.39,P<0.05;SpO_(2):0.75±0.11 vs.0.89±0.08,P<0.05],PaCO_(2) increased significantly(mmHg:56.17±5.38 vs.48.42±4.93,P<0.05).Correlation analysis showed that the gross injury score of lung blast injury animals was positively correlated with the pathological injury score(r=0.866,P=0.005);PaO_(2) and SpO_(2) were positively correlated(r=0.703,P=0.000);pH value and Lac were negative Correlation(r=-0.400,P=0.006);pH value is negatively correlated with PaCO_(2)(r=-0.844,P=0.000).Conclusion This study successfu

关 键 词：肺爆震伤 动物模型 动脉血气 

分 类 号：R826[医药卫生—临床医学]