摘要
目的 探讨早期救治对犬胸部开放伤后海水浸泡所致肺损伤的影响。方法 实验动物致伤后随机分为海水浸泡组 (n =2 0 )和救治组 (n =2 0 )。两组均于胸外伤后置入人工配制的海水中 ,前者脱离海水后不予任何治疗 ,后者捞出后进行紧急救治 ,包括胸腔闭式引流、吸氧、纠正酸中毒和高渗性脱水。实验过程中动态监测呼吸、动脉血气分析、TNF α和IL 1β变化 ,取肺标本行光镜检查并测定肺含水量和肺湿干比值。结果 海水浸泡组肺损伤严重 ,实验期间死亡率为 95 % ,平均生存时间为 4 5分钟。救治组PaCO2 和代谢性酸中毒明显改善 ,死亡率明显下降 ,平均存活时间为 4 0 .9小时。但PaO2 和肺含水量无明显改善。血浆TNF α和IL 1β持续在高水平。结论 胸部开放伤后海水浸泡加剧了急性肺损伤的程度 ,导致呼吸及循环系统进行性衰竭 ,加速实验动物死亡。早期救治可明显改善实验动物的生存时间 ,改善肺的通气功能 ,但换气功能和肺水肿无明显改善 ,而且病理学显示肺脏有严重损伤 ,这可能对远期预后有重要影响。
Objective To evaluate the effect of early treament on acute lung injury after chest trauma and seawater immersion.?Methods Twenty healthy dogs were divided into two groups. A model of right open pneumothorax was established. Seawater immersion group(n=20) had seawater immersion following open chest trauma. Treatment group(n=20) was treated earlier following rescue from seawater. After induction of open chest trauma,animals in seawater immersion group were immersed in artificial seawater. Blood samples were taken at different time intervals for assessing blood gas, plasma level of TNF αand IL 1β. At the end of study,lung samples were taken for assessing lung water content,ratio of wet weight and dry weight. The lung was examined microscopically.?Results The post trauma mortality was 95% in seawater immersion group. The mean survival time in seawater immersion group was 45 minutes. The main cause of death were acute lung injury and secondary circulatory failure. Survival time was significantly improved after early treatment. The mean survival time was longer than 40 hours. PaCO 2 and metabolic acidosis were markedly improved, but PaO 2 and lung water content were not improved after treatment.?Conclusion The severity of acute lung injury were aggravated. It could result in high mortality rate and rapid death due to progressive dysfunction of respiratory and circulatory systems by seawater immersion after open chest trauma. Early treament can prolong survival time and improve ventilatory function,but can not affect oxygenation function and edema of lung. Further more, the pathologic changes after treament will affect long term outcome.
出处
《创伤外科杂志》
2003年第1期35-37,共3页
Journal of Traumatic Surgery
基金
解放军总后勤部卫生部"九五"指令性课题
(96 -L0 0 4 )
关键词
海水浸泡
胸部开放伤
肺损伤
早期救治
seawater immersion
open chest trauma
acute lung injury
early treatment
dogs
