CAJ | 학술논문

目的建立多发伤合并未控制性失血性休克模型,以满足多发伤基础研究的需要.方法选择40只新西兰雄兔并按随机数字表法分为假手术组(A组,无放血、无复苏)、未控制组(B组,放血但无复苏)、充分液体复苏组(C组,放血、止血及复苏)及限制性液体复苏组(D组,放血、止血及复苏),每组10只兔.3 kg重锤在45 cm处自由落下造成各组家兔右后肢骨折.2 min后(记为T0)放血各组(B、C、D组)经右颈总动脉放血20 min,约放出30％的全身血量.30 min时针刺放血各组回盲动脉分支造成未控制性出血,再采用乳酸林格液对C、D组分别进行充分和限制性液体复苏,维持此期1h.90 min时结扎出血动脉分支,再对C、D组进行回输血,另对D组输入3倍失血量的乳酸林格液,维持此期1h.150 min～7 h观察存活情况.各时相点采动脉血测血气分析与凝血功能并统计骨折类型、输液量、失血量及7h存活率. 结果骨折均为胫腓骨闭合性粉碎性骨折.30 min时放血组血压、心率及pH值均显著降低,K+、血糖及乳酸显著增加(P＜0.01),血压和心率在150 min时升至0 min时的水平.充分液体复苏显著增加腹腔失血量和输液量(P＜0.01),降低红细胞压积(P＜0.05)及延长凝血酶原时间与活化部分凝血活酶时间(P＜0.05).液体复苏显著提高7h存活率(P＜0.01). 结论本模型稳定性和可重复性高,适用于多发伤合并未控制性失血性休克的相关研究.
목적 건립다발상합병미공제성실혈성휴극모형,이만족다발상기출연구적수요.방법 선택40지신서란웅토병안수궤수자표법분위가수술조(A조,무방혈、무복소)、미공제조(B조,방혈단무복소)、충분액체복소조(C조,방혈、지혈급복소)급한제성액체복소조(D조,방혈、지혈급복소),매조10지토.3 kg중추재45 cm처자유락하조성각조가토우후지골절.2 min후(기위T0)방혈각조(B、C、D조)경우경총동맥방혈20 min,약방출30％적전신혈량.30 min시침자방혈각조회맹동맥분지조성미공제성출혈,재채용유산림격액대C、D조분별진행충분화한제성액체복소,유지차기1h.90 min시결찰출혈동맥분지,재대C、D조진행회수혈,령대D조수입3배실혈량적유산림격액,유지차기1h.150 min～7 h관찰존활정황.각시상점채동맥혈측혈기분석여응혈공능병통계골절류형、수액량、실혈량급7h존활솔. 결과 골절균위경비골폐합성분쇄성골절.30 min시방혈조혈압、심솔급pH치균현저강저,K+、혈당급유산현저증가(P＜0.01),혈압화심솔재150 min시승지0 min시적수평.충분액체복소현저증가복강실혈량화수액량(P＜0.01),강저홍세포압적(P＜0.05)급연장응혈매원시간여활화부분응혈활매시간(P＜0.05).액체복소현저제고7h존활솔(P＜0.01). 결론 본모형은정성화가중복성고,괄용우다발상합병미공제성실혈성휴극적상관연구.
Objective To establish a model of multiple trauma combined with uncontrolled hemorrhagic shock so as to provide basis for basic study of multiple trauma.Methods Forty New Zealand male rabbits were equally and randomly divided into four groups,ie,sham group (Group A,with no bloodletting or resuscitation),uncontrolled group (Group B,with bloodletting alone),aggressive fluid resuscitation and limited fluid resuscitation groups (Groups C and D,with bloodletting,hemostasis and resuscitation).Fractures of the right hind limb in rabbits of each group were induced by free drop of a 3 kg hammer from a height of 45 cm.An estimated 30％ of total blood was withdrawn from the right common carotid artery in 20 minutes in bloodletting groups (Groups B,C and D).Successively,the uncontrolled bleeding was caused via acupuncture bloodletting from ileocecal artery branch at 30 minutes in bloodletting groups.Progressive and limited fluid resuscitation using lactated Ringer' s solution (LR) were performed for Groups C and D in the next one hour respectively.Blood transfusion was performed in Groups C and D after ligation of bleeding artery branch at 90 minutes.In addition,LR of three folds more than blood loss was administered in Group D.Survivorship of rabbits in each group was observed at 150 minutes to seven hours.Arterial blood sample was taken at each time point for blood gas analysis and coagulation test.Fracture type,fluid requirements,intra-abdominal blood loss,and rabbits' survival rate at seven hours were recorded.Results Closed comminuted tibiofibular fractures were founded in all groups.Bloodletting groups showed an obvious reduction of MAP,heart rate and pH value and significantly increased levels of K+,blood glucose and lactic acid at 30 minutes (P ＜0.01),whereas MAP and heart rate were returned to baseline level at 150 minutes.Progressive fluid resuscitation significantly increased the intra-abdominal blood loss and fluid requirements (P＜0.01),decreased erythrocrit (P ＜ 0.05),prolonged prothrombin time and activated partial thromboplastin time (P ＜0.05).Survival rate of rabbits was improved significantly by fluid resuscitation at 7 hours (P ＜ 0.01).Conclusion The model is of high stability and reproducibility and therefore is fit for study of multiple trauma combined with uncontrolled hemorrhagic shock.