超早期复苏性主动脉球囊阻断术治疗失血性休克猪模型  

Ultra-early resuscitative endovasculaRballoon occlusion of the aorta foRhemorrhagic shock in a pig model

作　　者：郑泽源 张豪 熊星环 郁毅刚[1] Zheng Zeyuan;Zhang Hao;Xiong Xinghuan;Yu Yigang(Emergency Department,909th Hospital of PLA Joint Logistics Support Force(Southeast Hospital Affiliated to XianmenUniversity),Zhangzhou,Fujian Province 363000,China;Emergency Department,SiRRun Run Shaw Hospital,Zhejiang University School ofMedicine,Huangzhou 310016,China)

机构地区：[1]联勤保障部队第九〇九医院(厦门大学附属东南医院)急诊科,福建漳州363000 [2]浙江大学医学院附属邵逸夫医院急诊科,杭州310016

出　　处：《创伤外科杂志》2024年第8期600-607,共8页Journal of Traumatic Surgery

基　　金：全军重点科研项目(BLB18J006)。

摘　　要：目的构建标准化复苏性主动脉球囊阻断术(REBOA)进行损害控制性复苏治疗失血性休克猪模型。方法10只约克夏猪雌雄不限,平均体重(39.0±3.0)kg,随机选择2只作为预实验,其余按密封信封抽签的方法随机分成对照组和REBOA组,每组4只(最终各组成功入组2只)。两组通过肠系膜上动脉一级分支放血自体容量45%来制作失血性休克猪模型。两组均进行损害控制性液体复苏,包括输液扩容、药物升压等。其中REBOA组在此基础上予REBOA阻断控制出血,阻断40 min后在10 min内缓慢放松球囊,恢复膈肌以下血流灌注10 min,反复阻断3个周期。实验开始记为T0,开始救治时间记为T1,每间隔1 h记为时间点T2、T3、T4,观察终点记为T5,分别记录6个时间点的HR、MAP、pH、乳酸(Lac)、碱剩余(SBE);记录T0、T1、T4、T5共4个时间点的Hb、HCT、PT、APTT、纤维蛋白原(FIB)。结果与对照组相比较,REBOA组具有较好的血流动力学和循环代谢,主要表现在T1~T5期间HR、MAP、pH、Lac、SBE变化区间较小,区间差值小于对照组(HR53.0次/min vs.116.0次/min,MAP 47.0 mmHg vs.66.0 mmHg,pH 0.37 vs.0.50,Lac 10.6 mmol/L vs.15.0 mmol/L,SBE 21.6 mmol/L vs.25.1 mmol/L),且在观察终点T5时REBOA组优于对照组(HR89.0次/min vs.50.0次/min,MAP 78.0 mmHg vs.27.0 mmHg,pH 7.23 vs.6.90,Lac 6.6 mmol/L vs.16.9 mmol/L,SBE-6.1 mmol/L vs.-18.9 mmol/L)。REBOA组的Hb、HCT在T4、T5时均高于对照组。与对照组相比,REBOA组凝血功能更优,主要表现在观察终点T5时APTT低于对照组,FIB高于对照组,而两组PT差异不大。结论超早期应用REBOA进行损害控制性复苏是治疗严重创伤、不可压迫躯干出血的有效手段,本研究可为今后进一步研究REBOA提供标准化动物模型。Objective To construct a standardized resuscitative endovasculaRballoon occlusion of the aorta(REBOA)damage control resuscitation model foRhemorrhagic shock in pigs.Methods Ten Yorkshire pigs of eitheRsex weighing(39.0±3.0)kg were used.Two pigs were randomly selected foRpreliminary experiment,and the otheR8 pigs were randomly divided into control group and REBOA group by sealed envelope.FoReach group,4 pigs were designed but only 2 pigs succeeded in the hemorrhagic shock model,which was developed by bloodletting 45%of the autologous volume via the primary branches of the superioRmesenteric artery.Both groups received damage control fluid resuscitation,including fluid infusion to increase volume and medication to raise the blood pressure.In the REBOA group,REBOA was additionally conducted to control bleeding:40 min blockade+10 min balloon relaxation to restore blood perfusion below the diaphragm,and repeated foR3 cycles.The start of experiment was recorded as T0,start of damage control resuscitation as T1(10 min afteRmodeling),and T2,T3,T4 and T5(end observation timepoint)every 1 h afteRtreatment.The HR,MAP,PH,lactic acid(Lac)and standard base excess(SBE)were recorded at all the 6 time points while Hb,HCT,PT,APTT and FIB at T0,T1,T4,and T5.Results Compared with the control group,the REBOA group showed betteRhemodynamics and circulatory metabolism,mainly manifested as[JP2]mildeRchanges in HR,MAP,pH,Lac,and SBE during the period of T1-T5,with the difference being 53.0 vs.116.0[JP]foRHR(bpm),47.0 vs.66.0 foRMAP(mmHg),0.37 vs.0.50 foRpH,10.6 vs.15.0 foRLac(mmol/L),and 21.6 vs.25.1 foRSBE(mmol/L).Moreover,at the observation endpoint of T5,the REBOA group revealed betteRresults than the control group(HR,bpm,89.0 vs.50.0;MAP,mmHg,78.0 vs.27.0;pH 7.23 vs.6.90;Lac,mmol/L,6.6 vs.16.9;SBE,mmol/L,-6.1 vs.-18.9).The REBOA group also showed higheRlevels of Hb and HCT at T4 and T5,and betteRcoagulation function as higheRAPTT and FIB but similaRPT at the observation endpoint of T5.Conclusion Ultra-early application of REBOA foRd

关 键 词：严重创伤 复苏性主动脉球囊阻断术 失血性休克 损害控制性复苏 猪 

分 类 号：R641[医药卫生—外科学]