筋膜切开术联合高渗盐水切口冲洗对大鼠挤压综合征的疗效  

Efficacy of fasciotomy combined with hypertonic saline flushing for crush syndrome in rats

作　　者：温亚乾 王晓戈 张杰 任文杰 田林强[1] 刘良明 WEN Yaqian;WANG Xiaoge;ZHANG Jie;REN Wenjie;TIAN Linqiang;LIU Liangming(Department of Orthopedic Surgery,Third Affiliated Hospital of Xinxiang Medical University,Xinxiang,Henan Province,453000;State Key Laboratory of Trauma and Chemical Poisoning,Department of Shock and Transfusion,Army Medical Center of PLA,Chongqing,400042,China)

机构地区：[1]新乡医学院第三附属医院骨科,河南新乡453000 [2]陆军特色医学中心战伤休克与输血研究室,创伤、与化学中毒全国重点实验室,重庆400042

出　　处：《陆军军医大学学报》2024年第24期2772-2780,共9页Journal of Army Medical University

摘　　要：目的探索筋膜切开术联合高渗NaCl溶液切口冲洗对挤压综合征的疗效。方法将6周龄雄性SD[体质量(250±20)g]大鼠臀部及双后肢以7.5 kg重物压迫4 h制作挤压综合征大鼠模型,以出现血尿或无尿作为建模成功标准。将24只SD大鼠[体质量(250±20)g]按随机数字表法分为2组:正常对照组(NC组)10只、挤压综合征组(CS组)14只。在挤压综合征建模完成后的6 h分别收集受挤压组织渗出的组织液,检测各组渗出液中钾离子、钙离子、肌红蛋白和乳酸的含量。另将63只6周龄雄性SD大鼠[体质量(250±20)g]按随机数字表法分为7组,每组9只:空白对照组(NC组)、挤压综合征组(CSS组)、挤压综合征筋膜切开术组(CSO组);挤压综合征筋膜切开术联合不同浓度NaCl溶液冲洗组(CSO+0.9%、3.0%、5.0%、7.0%NaCl组)。在挤压完成后的6 h,检测大鼠的肾脏血流情况;检测各组大鼠血浆中钾离子、钙离子、肌红蛋白、乳酸、AST、ALT、Cr、Urea含量,采集各组大鼠受挤压组织和肾脏组织行病理学检测。结果组织液检测结果表明,与NC组比较,CS组大鼠组织液中钾离子、肌红蛋白和乳酸含量明显升高,钙离子含量明显降低(P<0.001)。血浆检测结果表明,单纯进行筋膜切开术无明显的治疗作用,筋膜切开术后联合NaCl溶液冲洗可以使挤压综合征大鼠血浆中钾离子,肌红蛋白,乳酸,AST、ALT,Urea、Cr度显著降低,钙离子升高(P<0.05)。在使用激光血流散斑检测中,单纯使用筋膜切开术不能提高肾组织血流,筋膜切开术后联合NaCl溶液冲洗可以使挤压综合征大鼠的肾组织血流量显著提高(P<0.05)。单纯使用筋膜切开术不能减轻肾脏的病理损害,筋膜切开术后联合NaCl溶液冲洗可以减轻挤压综合征对肾脏的病理性损伤(P<0.05)。结论在大鼠实验中,筋膜切开术联合高浓度(3%)氯化钠溶液切口冲洗后能够显著减轻挤压综合征对机体的损伤。Objective To determine the therapeutic effect of fasciotomy+hypertonic saline flushing for crush syndrome(CS)in rats.Methods SD rats(weighing 250±20 g)were randomly divided into normal control group(NC group,n=10)and CS group(n=14).Rat CS model was established by compressing the buttocks and both hindlimbs with a weight of 7.5 kg for 4 h,and the presence of hematuria or anuria was defined as success of modeling.In 6 h after modeling,the fluid exuded from the compressed tissues was collected,and the contents of potassium ions(K+),calcium ions(Ca 2+),myoglobin(Mb),and lactic acid(Lac)in the exudate of each group were detected.Another 63 male SD rats(weighing 250±20 g)were randomly and equally divided into blank control group(NC group),CS group,CS+fasciotomy group(CSO group),and CS+fasciotomy+difference doses of NaCl solution irrigation groups(0.9%,3.0%,5.0%and 7.0%NaCl,respectively).At 6 h after modeling,the renal blood flow was measured,the contents of K+,Ca 2+,Mb,Lac,AST,ALT,Cr,and urea in the plasma of each group were detected,and the compressed tissues and kidney tissues were observed for pathological changes.Results Detection of exudates showed the contents of K+,Mb,and Lac were significantly higher,while that of Ca 2+content was obviously decreased in the CS group than the NC group(P<0.01).Plasma detection indicated that simple fasciotomy had no therapeutic effect,while it combined with NaCl solution flushing decreased the contents of K+,Mb,Lac,AST,ALT,urea and Cr,and increased the Ca 2+content in the blood of the CS group(P<0.05).Laser speckle contrast imaging revealed that simple fasciotomy could not increase renal blood flow,while the combination of fasciotomy and NaCl solution flushing notably increased the renal blood flow in the CS rats(P<0.05).In addition,the combination treatment reduced the pathological damage in the kidneys induced by CS,but fasciotomy alone had no such effect(P<0.5).Conclusion Fasciotomy combined with hypertonic NaCl solution(3%)flushing can significantly reduce the damage caused

关 键 词：挤压综合征 筋膜切开术 组织渗出液 高渗盐水 

分 类 号：R615[医药卫生—外科学] R642[医药卫生—临床医学] R686.3