损害控制手术治疗高原寒冷环境猪腹部枪击肠管贯通伤的效果评价  

Evaluation of the effect of damage control surgery in the treatment of perforated intestinal injury caused by gunshot wound in the abdomen of pigs in cold environment at high altitude

作　　者：孙赳 杨雪 屈金权 杨欣悦 李佳佳[2] 刘江伟[2] Sun Jiu;Yang Xue;Qu Jinquan;Yang Xinyue;Li Jiajia;Liu Jiangwei(Graduate School of Xinjiang Medical University,Urumqi 830054,China;Key Laboratory of Special Environmental Medicine of Xinjiang,General Hospital of Xinjiang Military Command,Urumqi 830000,China)

机构地区：[1]新疆医科大学研究生学院,乌鲁木齐830054 [2]新疆军区总医院新疆特殊环境医学重点实验室,乌鲁木齐830000

出　　处：《创伤外科杂志》2024年第6期410-417,共8页Journal of Traumatic Surgery

基　　金：实验动物专项课题(SYDW[2017]11号)。

摘　　要：目的观察损害控制手术(DCS)与传统手术对于高原寒冷环境下猪腹部枪击肠管贯通伤的救治效果。方法本文前瞻性研究,将30头10~12周龄健康长白仔猪,随机分为3组(各10只),分别为高原致伤组(HI)、高原致伤+传统手术组(HIT)、高原致伤+DCS组(HID)。通过将仔猪放入模拟高原寒冷环境的西北地区特殊环境人工实验舱[设置舱内海拔6000 m,气压约4.7 kPa,温度(8±2)℃,模拟高原低压、低氧、寒冷环境]48 h,并使用警用制式QSZ92式手枪,9 mm手枪弹射击脐水平后方2 cm,右侧腹壁皱襞下缘交界处目标点制作高原寒冷环境猪腹部枪击肠管贯通伤模型。HI组受伤后予以伤口包扎后观察处理。HIT组伤后4 h予以断裂小肠或缺血坏死小肠切除后行肠管端端吻合的传统手术治疗。HID组伤后4 h行断裂小肠近端置入减压管,远端小肠封闭;连续多处穿孔小肠或缺血坏死小肠切除,近端置入减压管,远端小肠封闭的DCS治疗。分别观察并比较各组伤后不同时间一般情况、生命体征、手术相关指标,WBC、中性粒细胞计数(NEUT)、IL-6、TNF-α、ALT、AST、并发症发生率、存活率。结果HIT组和HID组的小肠挫伤、小肠破裂、肠系膜损伤、结肠破裂、弹孔直径、腹腔积血无明显差异(P>0.05)。HID组12 h开始呼吸(25.2±4.0)次/min、心率(129.9±9.8)次/min、体温(38.3±0.6)℃显著低于HI组[呼吸(38.7±4.7)次/min、心率(150.3±8.6)次/min、体温(40.2±1.0)℃]和HIT组[呼吸(32.0±4.0)次/min、心率(143.6±11.4)次/min,体温(38.8±0.6)℃];HID组48 h体温低于HIT组[(38.3±0.6)℃vs.(39.6±0.6)℃],差异有统计学意义(P<0.05),生命体征更快达到平稳状态。HID组的手术时间、呼吸恢复时间、拔管时间、自由活动时间和首次排便时间显著短于HIT组[(46.00±9.37)min vs.(146.00±14.68)min、(26.20±4.24)min vs.(46.10±3.84)min、(45.40±3.03)min vs.(95.70±3.30)min、(96.90±4.48)min vs.(198.20±4.80)min、(27.90±7.80)Objective To observe the rescue effect of damage control surgery(DCS)vs.traditional surgery in the treatment of penetrating intestinal injuries caused by abdominal gunshot wounds in pigs in simulated cold plateau environment.Methods A total of 30 healthy Landrace piglets aged 10-12 weeks were randomly divided into 3 groups(n=10 for each):respectively high-altitude injury(HI)group,high-altitude injury+traditional surgery(HIT)group,and high-altitude injury+DCS(HID)group.The cold plateau environment was achieved in our lab,with the altitude set at 6,000 m,air pressure of about 4.7 kPa,and temperature of 8℃±2℃.The model pigs were first located in the lab chamber for 48 h,then shot by a police standard QSZ92 pistol(9 mm bullet)at 2 cm horizontally behind the navel to create penetrating intestinal injuries.After injury,in HI group wound dressing and observation treatment were conducted;in HIT group,4 h after injury the damaged small intestine or ischemic necrosis small intestine was resected and then traditional surgery of end-to-end intestinal anastomosis was performed;In HID group,4 h after injury DCS was conducted:a decompression tube was placed at the proximal end of the broken small intestine and the distal end of the small intestine was closed.Small intestine with multiple perforations or ischemic necrosis was resected,together with proximal placement of decompression tube and distal intestinal closure.The general situation,vital signs,surgery-related indicators,white blood cell(WBC)count,neutrophil(NEUT)count,interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),alanine aminotransferase(ALT),aspartate aminotransferase(AST),complications,and survival were analyzed at 0,4,12,24,48 and 72 h after injury.Results Contusion and rupture of the small intestine,mesenteric injury,colon rupture,bullet hole diameter,and abdominal hematocele volume showed no significant differences between HIT and HID groups(all P>0.05).From 12 h,compared with HIT and HI groups,HID group showed much lower respiratory rate(breaths/min,25.

关 键 词：肠管贯通伤 枪击伤 损害控制手术 高原寒冷环境 

分 类 号：R641[医药卫生—外科学]