高速破片致长白猪肝脏穿透伤模型的建立  

Establishment of a high-velocity fragment-induced penetrating liver injury model in landrace pigs

作　　者：高建新 单毅[2] 孙荣距[3] 钟兆明 赵阳[2,5] 黎檀实 Gao Jianxin;Shan Yi;Sun Rongju;Zhong Zhaoming;Zhao Yang;Li Tanshi(Department of Emergency of the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Emergency of the Sixth Medical Center,Chinese PLA General Hospital,Beijing 100048,China;Department of Emergency of the Eighth Medical Center,Chinese PLA General Hospital,Beijing 100091,China;The Second School of Clinical Medicine,Southern Medical University,Guangzhou 510280,Guangdong,China;School of Medicine South China University of Technology,Guangzhou 510006,Guangdong,China)

机构地区：[1]解放军总医院第一医学中心急诊科,北京100853 [2]解放军总医院第六医学中心急诊科,北京100048 [3]解放军总医院第八医学中心急诊科,北京100091 [4]南方医科大学第二临床医学院,广东广州510280 [5]华南理工大学医学院,广东广州510006

出　　处：《中华危重病急救医学》2022年第9期958-963,共6页Chinese Critical Care Medicine

基　　金：国防科技创新特区项目(19-163-15-ZD-009-001-07)。

摘　　要：目的建立稳定的破片模拟弹致长白猪肝脏穿透伤模型,评估深部组织损伤特点。方法根据瞄准点的不同定位方式将12只健康成年长白猪分为A组(瞄准点与描记线上的体表最高点的相对高度h设为5 cm)和B组(高度h设为6 cm),超声定位法确定破片投射方向,使用实验用弹道枪向瞄准点投射高速破片致伤动物。监测两组长白猪的生命体征并进行血常规、血气分析和肝肾功能等指标检测,对肝脏与临近器官的损伤情况以及出血量和生存时间进行分析。结果两组整体分析结果显示,破片模拟弹打击设定部位肝脏命中率为100%(以右前叶及右外侧叶损伤),腹腔其他器官命中率为25%(3/12),血胸或气胸发生率为8%(1/12)。肝脏创面主要表现为线状肝脏裂伤,肝叶远端全部或部分离断。A、B两组间创面长度和出血量比较差异均无统计学意义〔创面长度(cm):9.8±1.7比11.2±3.8,出血量(g):597.0±477.1比1032.0±390.3,均P>0.05〕。瞄准点更靠近前正中线的B组破片模拟肝脏实质裂伤深度明显大于A组(cm:2.8±0.4比1.9±0.6,P=0.015)。实验动物被破片击中后,平均动脉压(MAP)、pH值、动脉血碱剩余(BE)、血红蛋白(Hb)和血细胞比容(HCT)水平均呈下降趋势,在伤后1 h达谷值〔MAP(mmHg,1 mmHg≈0.133 kPa):87.0±33.6,pH值:7.26±0.15,BE(mmol/L):-6.65±8.48,Hb(g/L):9.86±1.10,HCT:0.309±0.029,均P<0.05〕;而血乳酸(Lac)、乳酸脱氢酶(LDH)和天冬氨酸转氨酶(AST)水平呈随时间升高的趋势,在伤后1 h达峰值〔Lac(mmol/L):10.21±4.40,LDH(U/L):1417.0±223.3,AST(U/L):234.5(162.5,357.5),均P<0.05〕。Pearson相关性分析提示,出血总量与肝脏实质裂伤的深度相关(r=0.684,P=0.014)。Kaplan-Meier生存曲线显示,A组3 h生存率高于B组,但差异无统计学意义〔83.3%(5/6)比33.3%(2/6),P>0.05〕。结论采用破片模拟弹在更靠近前正中线处打击长白猪的方法建立的高速破片致肝脏穿透伤模型重复性好,损伤程度具Objective To establish a stable fragment-induced penetrating liver injury model in landrace pigs and evaluate the characteristics of deep tissue injury.Methods According to the different positioning methods of aiming points,twelve healthy adult landrace pigs were divided into group A(the relative height"h"of the aiming point and the highest point of the body surface on the tracing line was set to 5 cm)and group B("h"was set to 6 cm).Ultrasonography was used to determine the direction of fragment projection,and an experimental ballistic gun was used to project high-velocity fragments to cause injury to animals.The vital signs of the two groups were monitored,and whole blood cell count,blood gas analysis,and liver and renal function were tested.Damages to the liver and adjacent organs,as well as the amount of bleeding and survival time were analyzed.Results For the overall analysis of the two groups,the liver hit rate of fragment simulating projectiles was 100%(right anterior lobe and right lateral lobe injury),the hit rate of other organs in the abdominal cavity was 25%(3/12),and the incidence of hemothorax or pneumothorax was 8%(1/12).The wounds were mainly characterized by liver lacerations,with total or partial disconnection of the distal liver lobe.There was no significant difference in wound length and bleeding amount between groups A and B[wound length(cm):9.8±1.7 vs.11.2±3.8,bleeding amount(g):597.0±477.1 vs.1032.0±390.3,both P>0.05].The depth of liver parenchymal laceration in group B with the aiming point closer to the anterior median line was significantly longer than that in group A(cm:2.8±0.4 vs.1.9±0.6,P=0.015).Mean arterial pressure(MAP),pH value,residual arterial blood base(BE),hemoglobin(Hb)and hematocrit(HCT)levels decreased after the fragment-induced injury,and then reached a trough level[MAP(mmHg,1 mmHg≈0.133 kPa):87.0±33.6,pH:7.26±0.15,BE(mmol/L):-6.65±8.48,Hb(g/L):9.86±1.10,HCT:0.309±0.029,all P<0.05]in the first hour.Blood lactate(Lac),lactate dehydrogenase(LDH)and aspartate amin

关 键 词：破片 肝脏穿透伤 火器伤 动物模型 

分 类 号：R-332[医药卫生] R826