中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2014年
1期
62-66
,共5页
丁威威%吴性江%李宁%黎介寿
丁威威%吳性江%李寧%黎介壽
정위위%오성강%리저%려개수
休克%肠系膜上动脉%损伤控制性外科
休剋%腸繫膜上動脈%損傷控製性外科
휴극%장계막상동맥%손상공제성외과
Shock%Mesenteric artery,superior%Damage control surgery
目的 通过比较不同手术方式对肠系膜上动脉(superior mesenteric artery,SMA)损伤后的血流动力学、全身主要脏器损伤和存活率的影响,探索一种符合损伤控制性外科(damage control surgery,DCS)的简便措施. 方法 本地杂种猪共30只,游离SMA,用无损伤血管钳阻断SMA血流后,按随机数字表法分为对照组、Ⅰ期血管吻合组(吻合组)、暂时血管腔内分流管(temporary intravascular shunt,TIVS)组,TIVS组又分为3个亚组:血管腔内分流管放置6h(TIVS-6 h)组、9h(TIVS-9 h)组和12 h(TIVS-12 h)组,行血管造影评价分流管的通畅程度,检测各时相点血流动力学指标,取各时相点末端回肠和SMA行病理学检查. 结果 各组均表现出危重的生理状态:低体温、严重酸中毒、低血压、低心输出量和氧供.与吻合组比较,TIVS-6 h组和TIVS-9h组需要更少的复苏液体量即可更快恢复SMA血流速度,较早清除血清乳酸,减轻肠道缺血再灌注损伤,提高早期存活率.TIVS-6 h、TIVS-9 h、TIVS-12 h组分别保持100％、50％和0％的通畅率.肠道病理结果提示:TIVS-12 h组出现广泛肠坏死,TIVS-6 h组和TIVS-9 h组肠缺血再灌注损伤为可逆性损伤. 结论 在血流动力学严重紊乱、濒危情况下的SMA损伤,与Ⅰ期血管吻合术比较,TIVS能缩短肠道缺血时间、维持全身血流动力学稳定、减轻肠道损伤、提高早期存活率,能有效维持较长的通畅时间.
目的 通過比較不同手術方式對腸繫膜上動脈(superior mesenteric artery,SMA)損傷後的血流動力學、全身主要髒器損傷和存活率的影響,探索一種符閤損傷控製性外科(damage control surgery,DCS)的簡便措施. 方法 本地雜種豬共30隻,遊離SMA,用無損傷血管鉗阻斷SMA血流後,按隨機數字錶法分為對照組、Ⅰ期血管吻閤組(吻閤組)、暫時血管腔內分流管(temporary intravascular shunt,TIVS)組,TIVS組又分為3箇亞組:血管腔內分流管放置6h(TIVS-6 h)組、9h(TIVS-9 h)組和12 h(TIVS-12 h)組,行血管造影評價分流管的通暢程度,檢測各時相點血流動力學指標,取各時相點末耑迴腸和SMA行病理學檢查. 結果 各組均錶現齣危重的生理狀態:低體溫、嚴重痠中毒、低血壓、低心輸齣量和氧供.與吻閤組比較,TIVS-6 h組和TIVS-9h組需要更少的複囌液體量即可更快恢複SMA血流速度,較早清除血清乳痠,減輕腸道缺血再灌註損傷,提高早期存活率.TIVS-6 h、TIVS-9 h、TIVS-12 h組分彆保持100％、50％和0％的通暢率.腸道病理結果提示:TIVS-12 h組齣現廣汎腸壞死,TIVS-6 h組和TIVS-9 h組腸缺血再灌註損傷為可逆性損傷. 結論 在血流動力學嚴重紊亂、瀕危情況下的SMA損傷,與Ⅰ期血管吻閤術比較,TIVS能縮短腸道缺血時間、維持全身血流動力學穩定、減輕腸道損傷、提高早期存活率,能有效維持較長的通暢時間.
목적 통과비교불동수술방식대장계막상동맥(superior mesenteric artery,SMA)손상후적혈류동역학、전신주요장기손상화존활솔적영향,탐색일충부합손상공제성외과(damage control surgery,DCS)적간편조시. 방법 본지잡충저공30지,유리SMA,용무손상혈관겸조단SMA혈류후,안수궤수자표법분위대조조、Ⅰ기혈관문합조(문합조)、잠시혈관강내분류관(temporary intravascular shunt,TIVS)조,TIVS조우분위3개아조:혈관강내분류관방치6h(TIVS-6 h)조、9h(TIVS-9 h)조화12 h(TIVS-12 h)조,행혈관조영평개분류관적통창정도,검측각시상점혈류동역학지표,취각시상점말단회장화SMA행병이학검사. 결과 각조균표현출위중적생리상태:저체온、엄중산중독、저혈압、저심수출량화양공.여문합조비교,TIVS-6 h조화TIVS-9h조수요경소적복소액체량즉가경쾌회복SMA혈류속도,교조청제혈청유산,감경장도결혈재관주손상,제고조기존활솔.TIVS-6 h、TIVS-9 h、TIVS-12 h조분별보지100％、50％화0％적통창솔.장도병리결과제시:TIVS-12 h조출현엄범장배사,TIVS-6 h조화TIVS-9 h조장결혈재관주손상위가역성손상. 결론 재혈류동역학엄중문란、빈위정황하적SMA손상,여Ⅰ기혈관문합술비교,TIVS능축단장도결혈시간、유지전신혈류동역학은정、감경장도손상、제고조기존활솔,능유효유지교장적통창시간.
Objective To determine the effect of different surgical modalities on hemodynamics,systemic major organ injury and survival rate following superior mesenteric artery (SMA) injury in an attempt to search a modality that conforms to principles of damage control surgery (DCS).Methods SMA was exposed in 30 domestic hybrid pigs,leaving the blood flow blocked using non-invasive vessel forceps.The animals were divided into control group,primary anastomosis group (anastomosis group) and temporary intravascular shunt (TIVS) group according to random number table.TIVS group was further divided into three subgroups:shunting for 6 hours group (TIVS-6 h group),9 hours group (TIVS-9 h group) and 12 hours group (TIVS-12 h group).At each time point,the angiography was performed for evaluation of shunt patency; hemodynamic parameters were detected,terminal ileum and SMA samples were harvested for pathological analysis.Results All groups suffered extreme physiological conditions including hypothermia,severe acidosis,hypotension,low cardiac output and low oxygen supply.Less requirement of resuscitation fluid,faster restoration of SMA blood flow,earlier clearance of lactate,milder intestinal ischemia-reperfusion injury and higher survival rate were observed in TIVS-6 h and TIVS-9 h groups,compared with anastomosis group.Patency rate in TIVS-6 h,9 h and 12 h groups was 100％,50％ and 0％ respectively.Pathologic outcome of intestine revealed diffuse intestinal necrosis in TIVS-12 h group and reversible intestinal ischemia-reperfusion injury in TIVS-6 h and 9 h groups.Conclusion For SMA injury in severe hemodynamic disarrangement and jeopardized condition,TIVS shortens intestinal ischemia time,maintains systemic hemodynamic stability,relieves intestinal injury,improves early survival rate and keeps long-term intestine patency when compared with primary vascular anastomosis.
