摘要
目的 :探讨快速输液在海水浸泡性胸外伤致高渗血症治疗中的作用。方法 :实验犬致伤后随机分为对照组 (10只 )和治疗组 (10只 )。对照组于胸外伤后置入人工配制的海水中 ,观察期间不予任何治疗 ;治疗组于浸入海水 2 5分钟后捞出进行紧急救治 (包括关闭伤口、胸腔闭式引流以及于 4小时内快速输入低张液体 ,输液量为总补液量的 1/ 2 )。于不同时间点取血测定血浆渗透压、血钠、血钾、血氯和动脉血气。结果 :对照组和治疗组均于浸泡海水后出现严重高渗血症、高钠血症和高氯血症。对照组在实验期间的死亡率为 90 % ,平均生存时间为 45分钟。而治疗组经胸腔闭式引流和快速输入低张液体后 ,平均血浆渗透压于 2 4小时回落到伤前基础水平 ,全组平均存活时间为 40 .9小时 (治疗组中 5只犬存活时间 <2 4小时 ,死亡前平均血浆渗透压为377mm ol/ L,平均存活时间为 14.7小时 ;而存活时间超过 2 4小时的 5只犬平均血浆渗透压为 30 9mm ol/ L,平均存活时间为 6 7.2小时 )。结论 :胸外伤后海水浸泡对机体的血浆渗透压和电解质平衡有严重影响 ,是实验犬致死的重要原因之一。早期快速输入低张液体对降低血浆渗透压。
Objective:To evaluate the preliminary result of fluid therapy in the management of plasma hyperosmolarity due to seawater immersion after open chest injury.Methods:Twenty healthy dogs were divided into two groups.A model of right open pneumothorax was established.Control group ( n =10) had seawater immersion after open chest wound,and in the fluid treatment group ( n =10) the animals were infused with hypotonic solution after seawater immersion.Blood samples were taken at eight different time intervals to measure plasma osmotic pressure,serum electrolytes and arterial gas analysis.Results:Posttraumatic mortality was much higher in control group (90%) than that in fluid therapy group.One of the most important causes of death was hypernatremia and plasma hyperosmolarity.The mean survival time in nontreatment group was 45 minutes,while in fluid therapy group was 40 9 hours ( P <0 01).Conclusions:Seawater immersion after chest injury appears to be associated with severe electrolyte disturbance,chiefly in form of plasma hyperosmolarity.These may be the risk factors leading to fatal outcome.Early infusion of hypotonic solution could significantly reduce osmotic pressure and may prolong survival time.
出处
《中国危重病急救医学》
CAS
CSCD
2001年第7期433-435,共3页
Chinese Critical Care Medicine
基金
解放军总后勤部卫生部"九.五"指令性课题资助项目 (No.96L 0 0 4)
关键词
海水浸泡
胸外伤
电解质平衡
血浆渗透压
液体疗法
seawater immersion
open chest wound
electrolytes balance
osmotic pressure
fluid therapy