模拟野战腹部血管伤非控制性失血性休克模型的建立.doc

模拟野战腹部血管伤非控制性失血性休克模型的建立 作者：杨鹤鸣，李荣，徐迎新 作者单位：解放军总医院普通外科研究所暨野战外科研究所，北京 100853 【摘要】 　　目的 建立贴近野战实际的腹部血管伤非控制性失血性休克(uncontrolled hemorrhagic shock, UHS)模型。方法 SD大鼠38只，左股动、静脉及左心室插管。开腹，于腹主动脉中下段分别用22、25、28G 3种针头横行穿刺造成活动性出血。模拟野战实际，将动物分为受伤早期、早期救助期、后期救治期及观察期4个阶段。不同阶段分别给予输液、手术止血等处理。监测血压（MAP）、中心静脉压（CVP）及血乳酸及谷丙转氨酶（ALT）、肌苷（Cr）等，统计腹腔出血量及存活时间。结果 血管损伤后动物MAP、CVP急剧下降，在5分钟之内下降到最低值，然后缓慢升高。血乳酸均显著增高，损伤后4小时增高3～4倍，晚期ALT、Cr显著升高。腹腔出血量随着针头的增粗显著增加。三者平均存活时间分别为7、50、3860分钟。结论 本模型贴近实战，易于复制，是良好的腹部血管伤UHS模型。以上3种不同程度的创伤模型可以根据研究需要选择。 【关键词】 失血性休克 腹部损伤 血管 战伤 模型 　　AEstablishment of an uncontrolled hemorrhagic shock model simulating abdominal aorta injury in battle field 　　YANG Heming,LI Rong,XU Yingxin 　　Institute of General Surgery Research and Field Surgery Research,General Hospital of PLA,Beijing 100085,China 　　Abstract： Objective To establish an uncontrolled hemorrhagic shock (UHS) model which simulates abdominal aorta injury in battle field.Methods The left ventricle,femoral artery and femoral vein of 38 spraguedawley rats were canulated with PE 50 catheters.Catheters were connected to pressure transducers for MAP,CVP.Blood samples were analyzed for lactic acid,ALT and Cr.Animals were subjected to vascular injury leading to UHS by piercing through the infrarenal aorta with a 22G,25G or 28G needle respectively.After aorta injury,the models were divided into 4 stages: early injured stage,field aid stage,hospital stage and observation stage.The animals were treated with different methods according to practical field condition e.g. transfusion,operation et al.Results The MAP and CVP decreased remarkably after aorta injury and reached to the lowest level within 5 min and then increased slowly.The lactic acid increased and reached 34 times of baseline at 4h after injury.The ALT and Cr increased significantly at later stages.The blood in abdomen increased with the increase of needles thickness.The median survival time of 22G,25G and 28G was 7 min,50 min and 3860 min res