低温胸部爆震伤模型的建立及早期体外膜肺氧合救治策略

Establishment of hypothermia chest blast injury model and early ECMO treatment strategies

目的建立低温胸部爆震伤巴马香猪动物模型,探讨利用体外膜肺氧合(ECMO)进行早期救治的可行性。方法取健康巴马香猪84只,雌雄不限,体质量(46.5±5.2)kg。根据不同爆炸效应及是否进行早期ECMO救治将所有动物随机分为:A组(救治组14只,非救治组14只),雷管×1.0根;B组(救治组14只,非救治组14只),雷管×1.5根;C组(救治组14只,非救治组14只),雷管×2.0根。爆炸后,迅速后送至野战医疗所进行早期ECMO救治。动态监测伤后各组基本生命体征并观察损伤情况。结果 A组受伤较轻:救治组致死率为0,非救治组7%;B组受伤程度明显高于A组:救治组致死率为14%,非救治组50%;C组损伤过重,救治困难:救治组致死率为93%,非救治组100%。ECMO对B组早期低温胸部爆震伤,可以进行有效的救治(P<0.05)。结论胸部爆震伤以多发伤和复合伤多见,伤情重而复杂,早期致死率高。B组受伤程度居中,能够反映胸部爆震伤病情变化特点,较为稳定,重复性较好,可作为理想的低温胸部爆震伤动物模型,且ECMO可对其进行有效的救治。

Objective To establish hypothermia chest blast injury model in Bama pigs and investigate the feasibility of early ECMO treatment strategies. Methods Totally 84 healthy Bama pigs[weight：（ 46. 5 ± 5. 2） kg,no matter the sex]were randomly divided into7 groups according to the explosive effects and whether early ECMO treatment： Group A（ treatment group,n = 14; non-treatment group,n = 14）,detonators × 1. 0. Group B（ treatment group,n = 14; non-treatment group,n = 14）,detonators × 1. 5. Group C（ treatment group,n = 14; the non-treatment group,n = 14）,detonators × 2. 0. After explosion,the injured animals were sent to the field medical station quickly and carried out early ECMO treatment. Dynamicly monitor basic vital signs and characteristics of injury. Results Chest blast injuries mainly arechest laceration,lung rupture and cardiac contusion. The more explosive effects will lead to the more severe injury. Group A was minor injurygroup： treatment group,mortality was 0,non-treatment group 7%. Group B was significantly higher degree of injury than Group A： treatment group,the mortality rate was 14%,non-treatment group 50%. Group C were serious injury group,the mortality rate was 93%,non-treatment group 100%. ECMO could be an effective treatment for Group B on the early hypothermia chest blast injury（ P 0. 05）. Conclusion The multiple and complicated wound are very common,which makes serious and complex wound. Most animals die rapidly and early mortality rate is high. The Group Bcan be used as the most suitable model group of the hypothermia explosive thoracic injury. It can be repeated well and can imitate the wound characteristics of the hypothermia explosive thoracic injury. ECMO can be effective treatment for Group B on the early hypothermia chest blast injury.