早期血流动力学监测在海水中火器伤初步救治中的应用  

Application of early hemodynamic monitoring to treatment of the dogs undergoing gunshot wound in seawater

作　　者：孟辉[1] 申洪[1] 刘高望[1] 陈钢[1] 朱天岭[1] 张鋆歆[1] 吴正蓉[1] 卜海激[1] 

机构地区：[1]中国人民解放军第一军医大学病理学教研室,广东广州510515

出　　处：《中国急救医学》2004年第6期414-416,共3页Chinese Journal of Critical Care Medicine

基　　金：全军"十五"医药卫生科研基金资助课题 ( 0 1MA12 6)

摘　　要：目的　探讨海水中火器伤伤后早期血流动力学的变化特点与初步救治 ,为提高海战救治水平及临床应用提供依据。方法　将 16只普通级毕格犬分为海水中致伤组 (n =14 )和地面致伤组 (n =2 ) ;海水组于海水中枪伤后救出 ,连续监测早期 ( 5 3.6 2± 12 .19min)血流动力学变化并采用相应救治措施。地面组作为观察对照。结果　海水组死亡率随头颅、胸、腹、肢体受伤部位不同而呈递减趋势 ,早期血流动力学出现紊乱的时间明显比地面组提前 15min ;黄金小时内死亡率 6 4 .3% ,6h内死亡率 78.6 % ,2 4h后死亡率 85 .7%。结论　海水中火器伤严重影响血流动力学的变化 ,对机体亦有损伤 ;监测黄金小时血流动力学并依据其变化进行临床救治有助于提高早期救治成功率 。Objective To explore the hemodynamic early changes and treatment of dogs wounded by gunshot in order to collect evidence for the methods and clinical application of sea fight in seawater. Method Fourteen conventional Beagles models of gunshot wound in seawater were established, and another 2 dogs receiving the wound without seawater immersion were looked as control group. After the whole of dogs in seawater were extricated, the respiration (R), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), the mean arterial pressure (MAP), central venous pressure (CVP), pulmonary arterial wedge pressure (PAWP), cardiac output (CO) of dogs undergoing gunshot wound were measured continually in the forepart (53.62±12.19)min, the measures of treatment were adopted, and then were set up on the basis of statistical analysis of the results. Results Compared with the control group, the hemodynamic turbulence degree in seawater were relative severity and ahead of 15 min. The mortality tended to descend along with the different position that the head-skull cervix, bosom, abdomen and limbs were injured by gunshot. The mortality was 64.3% within golden hour, 78.6% in 6 hours and 85.7% after 24 hours. Conclusions Gunshot wound in seawater appears to be associated with severe hemodynamic changes. It could result in progressive dysfunction of circulation and lead to fatal outcome. Initial treatment aimed at hemodynamic stabilization and early proper treatment can increse survival rate of dogs undergoing gunshot wound in seawater according to hemodynamic monitoring in golden hour. Furthermore, further therapy could not neglect.

关 键 词：火器伤 海水 血流动力学 远隔效应 早期救治 狗 

分 类 号：R826.3[医药卫生—临床医学] R641.02