海水中火器伤犬早期动脉血气和酸碱平衡的变化

Study on early changes of blood gas and acid-base regulation in dogs with gunshot wound in seawater

目的观察海水中火器伤犬早期动脉血气和酸碱平衡的变化,为早期救活方案的拟定提供实验依据。方法将17只普通级比格犬分为海水组(n=14)和地面组(n=3)。两组于(33．75±25．29)min经右颈动脉导管采血检测动脉血气和酸碱平衡各指标,分析其致伤前后的变化。结果海水中火器伤伤后动脉血氧分压(PaO_2)、氧分压与肺泡氧分压之比(PaO_2/PAO_2)、氧分压与吸氧浓度之比(PaO_2/FiO_2)、二氧化碳分压(PaCO_2)、氧饱和度(SaO_2)、碱剩余(BE)、实际碳酸氢根(AB)和二氧化碳结合力(CO_2CP)升高,肺泡内动脉氧分压(PAO_2)、肺泡氧分压差[P(A-a)O_2]、pH、标准碳酸氢盐(SB)和总二氧化碳(T-CO_2)下降,上述变化之差异均具有统计学意义(P＜0．01),此外,血氧含量(CaO_2)下降且差异有统计学意义(P＜0．05),阴离子间隙(AG)的改变差异虽无统计学意义(P＞0．05),但有上升趋势。结论海水中火器伤伤后早期动脉血气和酸碱平衡明显失调,表现为低氧血症和高碳酸血症以及以代谢性酸中毒、呼吸性酸中毒代偿期和代谢性碱中毒为主的呼吸性酸中毒型三重酸碱失衡,临床救治时应纠正这些变化。

Objective To investigate the arterial - blood - gas and acid - base changes in the early stages of gunshot wound of dogs in seawater for exploring early treatment protocol. Method Fourteen conventional Beagles models undergoing gunshot wound in seawater were used along with another 3 dogs receiving the wound on land to serve as control. After the dogs were rescued from the seawater, the origin of blood coming from arterial vessel tube was measured （33.75 ±25.29） min before and after injured for indexes such as arterial partial pressure of oxygen （ PaO2 ）, arterial partial pressure of carbon dioxide （ PaCO2 ）, arterial saturation oxygen （ SaO2 ）, arterial oxygen content（ CaO2 ）, alveolar - arterial oxygen pressure（ PAO2 ）, difference of alveolar - arterial oxygen pressure（ P（ A - a） O2 ）, PaO/PAO2, PaO/FiO2 （ inhale oxygen ） and pH, actual bicarbonate （ AB ）, base excess （ BE ）, carbon dioxide combining power[ CO2CP）, standard bicarbonate（ SB）, total carbon dioxide[T- CO2）, anion gap（ AG） in the early stages of wound, followed by statistical analysis of the results. Results There was a decrease in blood PAO2, P（A-a）O2, pH, SB, T-CO2（P〈0.01） and CaO2 （P 〈0.05）, a increase in blood PaO2, PaO/PaO2, PaO2/FiO2, PaCO2, SaO2, -BE, AB, CO2CP（ P 〈0.01） and blood AG respectively, and no distinct alteration in blood AG（ P 〉 0. 05 ）. Conclusions One reason of the high mortality was the early converse changes of turbulence in arterial blood gas and acid - base balance that was triple acid - base disorders （ TABD ） - hypoxidosis, hyper- capnia, metabolic and respiratory acidosis （ compensation ） - after gunshot wound in seawater. The early proper treatment can conduce to survival rate of dogs with gunshot wound in seawater according to monitoring the arterial - blood - gas and acid - base changes in golden hour. So should these varieties be rectified when clinic save to cure.