掌上超声在枪弹伤致髂动脉破裂大出血建模中的应用研究  

Application of handheld ultrasound in establishment of a swine model of iliac artery hemorrhage from gunshot wound

作　　者：黄钰清 武杜杜 潘菲[4] 王俊康 钟兆明 黎檀实[4] 吕发勤 Huang Yuqing;Wu Dudu;Pan Fei;Wang Junkang;Zhong Zhaoming;Li Tanshi;Lyu Faqin(Medical School of Chinese PLA,Beijing 100853,China;Department of Ultrasound,the Third Medical Centre of PLA General Hospital,Beijing 100039,China;Department of Ultrasound,Hainan Hospital of PLA General Hospital,Sanya 572013,China;Emergency Department,the First Medical Centre of PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第三医学中心超声科,北京100039 [3]解放军总医院海南医院超声科,三亚572013 [4]解放军总医院第一医学中心急诊科,北京100853

出　　处：《中华医学超声杂志（电子版）》2022年第10期1112-1117,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：海南国际医学港科技创新平台应用-便携超声设备应用(ZDKJ2019012);军委科技委智能快救2019(19-163-12-ZT-006-007-04);解放军总医院军事医学创新研究项目(CX19025)。

摘　　要：目的探讨掌上超声在野战环境下建立髂动脉枪弹伤大出血动物模型的应用价值。方法在野战环境下,选择长白猪8只,实验前采集血压、心率等指标。采用掌上超声定位右侧髂动脉,并标记体表弹着点,由专业射手进行射击并保持自由出血30 s,通过连续监测生命体征变化确定是否出现失血性休克。在实验后处死动物,沿弹道进行解剖,明确髂动脉断裂情况。结果8只动物均一次性建模成功。与建模前相比,建模后收缩压降低[(144.38±14.74)mmHg vs(110.00±29.89)mmHg,P=0.001,1 mmHg=0.133 kPa],舒张压降低[(96.63±17.20)mmHg vs(74.63±22.06)mmHg,P<0.001],平均动脉压降低[(110.63±15.99)mmHg vs(88.38±27.12)mmHg,P=0.003],心率增快[(67.25±7.73)次/分vs(94.50±16.62)次/分,P=0.004],符合失血性休克表现。枪弹射击后,即刻见鲜红色血液喷射而出。解剖后大体观察7只(87.5%)动物髂动脉完全破裂,1只(12.5%)髂动脉不完全断裂,所有动物肌肉损伤严重,股骨均可见粉碎性骨折。结论在野战环境下,掌上超声引导髂动脉枪弹伤建模成功率高,动物模型稳定,为进一步探索枪弹伤致交界部位致命性大出血的研究奠定了基础。Objective To preliminarily explore the application value of handheld ultrasound in establishing an animal model of iliac artery hemorrhage from gunshot wound in the pre-hospital setting.Methods The experimental animals were 8 Landrace pigs in the battlefield environment.Basic vital signs such as blood pressure and heart rate were collected before the experiment.The right iliac artery was selected and marked on the body surface as the point of impact after localization by handheld ultrasound.After shooting,free bleeding was maintained for 30 s.Hemorrhagic shock was determined by continuous monitoring of changes in vital signs.The animals were dissected after execution to determine whether the iliac artery was dissected.Results All the 8 animals were in hemorrhagic shock.Compared with the values in the pre-experimental period,systolic pressure,diastolic pressure,and mean arterial pressure(in mmHg)were decreased(144.38±14.74 vs 110.00±29.89,P=0.001;96.63±17.20 vs 74.63±22.06,P<0.001;110.63±15.99 vs 88.38±27.12,P=0.003),and heart rate(in bmp)was increased(67.25±7.73 vs 94.50±16.62,P=0.004)after gunshot wounding.These were consistent with the clinical presentation of hemorrhagic shock.After the gunshot,bright red blood was visible in a jet-like gush.Seven(87.5%)animals had a complete rupture of the iliac artery and one(12.5%)had incomplete rupture of the iliac artery.All animals had severe muscle damage and comminuted fracture of the femur.Conclusion Handheld ultrasound can be used to establish animal models of bleeding from gunshot wounds with a high success rate.This lays a foundation for further exploration of fatal hemorrhage at junctional sites caused by gunshot wounds.

关 键 词：掌上超声 野战环境 枪弹伤 髂动脉 动物模型 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.5[医药卫生—诊断学]