超声下止血剂局部注射对严重外伤止血效果的影响及其机制分析  

Influence and mechanism of local injection of hemostatic agents under ultrasound on hemostatic effect of severe trauma

作　　者：王建业 郑泽源 陈炎标 郁毅刚 WANG Jianye;ZHENG Zeyuan;CHEN Yanbiao;YU Yigang(Emergency Department,Hospital No 909,Joint Logistics Support Force of Chinese People′s Liberation Army,Zhangzhou Fujian 363000,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇九医院急诊科,福建漳州363000

出　　处：《中国急救复苏与灾害医学杂志》2022年第9期1202-1204,1233,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2018年度军队后勤科研重大项目(编号:BLB18J006);中国人民解放军联勤保障部队第九〇九医院青年苗圃计划项目(编号:17Y002)。

摘　　要：目的研究超声下止血剂局部注射对严重外伤止血效果。方法以20只雄性杂种犬作为研究对象,采取小型生物撞击器建立严重外伤模型后,观察组采取超声下止血剂局部注射,对照组采用生理盐水进行治疗,对两组实验动物的股动脉收缩压、超声造影(CEUS)指标以及肝功能进行评价。结果观察组有1例实验动物未达到肝脏损伤Ⅲ-Ⅳ级剔除。撞击前、撞击伤未处理前20 min两组实验动物股动脉收缩压之间的差异不存在统计学意义(P>0.05),经过治疗后,两组实验动物的股动脉收缩压均显著下降,且观察组股动脉收缩压显著高于对照组(t=18.755,P=0.000);两组实验动物治疗后即刻的病灶最大直径之间的差异不存在统计学意义(P>0.05),经过治疗后,观察组3 d(t=5.637,P=0.000)、7 d(t=2.419,P=0.027)、14 d(t=2.362,P=0.030)以及21 d(t=2.405,P=0.028)的实验动物的病灶最大直径显著低于对照组;经过治疗后,两组实验动物的丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转氨酶(AST)以及总胆红素(TBIL)显著下降,且观察组实验动物的ALT(t=16.026,P=0.000)、AST(t=7.722,P=0.000)以及TBIL(t=3.395,P=0.003)ALT、AST以及TBIL显著低于对照组。结论超声下止血剂局部注射对严重外伤止血效果显著,肝功能恢复显著,建议临床推广。Objective To study the influence and mechanism of local injection of hemostatic agent under the guidance of ultrasound on hemostatic effect of severe trauma.Methods In the study,20 male dogs were used as research objects and impacted with small biological impactor to establish severe trauma model.They were randomly divided into two groups,the control group received treatment with normal saline,and the experimental group received local injection of hemostatic agents guided by ultrasound.The femoral artery systolic pressure,CEUS indicators and liver function of experimental animals in the two groupswere evaluated.Results One dog in the experimental group,failed to achieve the liver injury gradeⅢ~Ⅳ,was eliminated.There was no significant difference in the femoral artery systolic pressure between the two groups before impact and 20 minutes before impact injury treatment(P>0.05).After treatment,the systolic pressure in the two groups decreased significantly,and the systolic pressure of the experimental group was significantly higher than that of the control group(t=18.755,P=0.000).There was no statistically difference in the maximum lesion diameters between the two groups immediately after treatment(P>0.05).The maximum lesion diameters of the experimental group were significantly smaller than those of the control group 3 d(t=5.637,P=0.000),7 d(t=2.419,P=0.027),14 d(t=2.362,P=0.030),and 21 d(t=2.405,P=0.028)after treatment,respectively.After treatment,the ALT,AST and TBIL levels of both groups were significantly decreased,and the ALT(t=16.026,P=0.000),AST(t=7.722,P=0.000),and TBIL(t=3.395,P=0.003)levels of the experimental group were significantly lower than those of the control group.Conclusion Local injection of hemostatic agents under ultrasound has remarkable hemostatic effects on severe trauma and improves remarkably liver function,which is worthy of clinical application.

关 键 词：CEUS 止血效果 肝功能 股动脉收缩压 

分 类 号：R641[医药卫生—外科学]