射频消融对肝火器伤合并海水浸泡的治疗效果

Curative effect of radiofrequency ablation for firearm injury in livers combined with seawater immersion

目的观察射频消融对肝火器伤合并海水浸泡的治疗效果。方法选用10条成年雄性比格犬作为研究对象，采取外科手术暴露加92式训练手枪射击的方法致肝左叶火器伤，致伤后置于海水中浸泡5min。打捞出水后采用射频消融技术进行肝脏止血。记录犬生存时间，统计存活率；监测致伤前和海水浸泡后的肛温变化；检测致伤前、术后第3天、术后第7天和术后第14天的血常规、血生化指标变化。结果犬均存活至术后第14天，存活率为100％。经海水浸泡后肛温显著下降（P=0．000）。在致伤前、术后第3天、术后第7天和术后第14天的静脉血红细胞计数、血红蛋白浓度和血小板计数差异均无统计学意义（P=0．081、0．264、0．070）。术后第3天谷丙转氨酶水平显著高于致伤前（P=0．000），术后第7天指标较术后第3天显著下降（P=0．000）但仍高于致伤前（P=0．000），至术后第14天恢复正常水平（P=0．218）；术后第3天谷草转氨酶水平较致伤前显著升高（P=0．002），至术后第7天即恢复正常水平（P=0．290）；术后第3天白蛋白浓度显著低于致伤前（P=0．005），至术后第14天仍未恢复（P=0．010）。结论成功建立肝脏火器伤合并海水浸泡的大型动物模型，并证实射频消融止血对此类创伤具有确切疗效。

Objective To observe the curative effect of radiofrequency ablation for fireman injury in livers combined with seawater immersion. Methods Ten adult male beagles were selected as the research objects. The method of surgical operation exposure combined with shooting by QSZ-92 training pistol was used to cause fireman injury in the left lobe of liver, and then animals were soaked in the seawater for 5 min. Radiofrequency ablation was applied to control hemorrhage of injured liver following animal was salvaged from seawater. The survival time of animals was recorded and the survival rate was statistically analyzed ; the rectal temperature was monitored and compared before and after the seawater immersion. Measurements of complete blood count and blood chemistries were performed at baseline, 3rd, 7th and 14th postoperative day. Results All animals survived to 14th postoperative day, with a survival rate of 100%. The rectal temperature decreased significantly after seawater immersion （P=0.000）. There was no significant difference in erythrocyte count, hemoglobin concentration and platelet count at baseline, 3rd, 7th and 14th postoperative day （P=0.081,0. 264, 0.070）. The level of alanine aminotransferase （ALT） at 3rd postoperative day was significantly higher than baseline （ P=0.000） ; the level of ALT at 7th postoperative day was significantly lower than that at 3rd postoperative day （P=0.000 ）, but still higher than baseline （P=0.000） ; the level of ALT restored to normal till 14th postoperative day （P =0. 218）. The level of aspartate aminotransferase （AST） at 3rd postoperative day was significantly higher than baseline （P=0.002 ） , and the level of AST restored to normal at 7th postoperative day （P=0.290）. The concentration of serum albumin at 3rd postoperative day was significantly lower than baseline （ P=0.005）, and didn＇ t restore to normal at 14th postoperative day （P=0.010）. Conclusion In this study, a large-scale animal model of firearm injury in liver combined with seawater immersion was successfully established, and the hemostasis efficacy of radiofrequency ablation on such trauma was confirmed.