血气分析装置用于模拟后送途中肢体骨折伤员伤情的动物模型评价研究

Feasibility of blood gas analysis device for injury assessment following limb fracture in rabbits:simulation of the combat casualty evacuation scenario

目的研究战现场血气分析装置帮助判断伤员肢体骨折失血程度及复苏效果的有效性,探索在后送肢体骨折伤员途中将该装置用于伤情判断指导复苏的可行性。方法家兔15只分为3组(n=5):单纯骨折组,骨折伴大量出血组,骨折出血复苏组。用圆锯切割家兔胫骨中部,骨折伴出血组及骨折出血复苏组从股动脉抽取家兔总血容量的20%,骨折出血复苏组抽取的血液保存并在伤后30min回输。用战现场血气分析仪在各组模型制成的0 min,30 min,1 h,2 h分别检测实验对象的乳酸值,碱剩余值和pH值,数据分析使用t检验和方差分析。结果战现场血气分析设备测得的碱剩余值在骨折伴大出血的情况下30 min可测出明显变化,单纯骨折状态需要2 h,对骨折伴大出血伤情复苏的效果可以在2 h体现出来;乳酸值在骨折伴大出血的情况30 min可以测出明显变化,单纯骨折仍然需要2 h测出,而对骨折伴大出血伤情复苏效果的体现未出现统计学意义;pH值在该时间段未测出明显变化。结论肢体骨折伤的出血严重程度,可在伤员后送时期由战现场血气分析设备通过检测乳酸和碱剩余值得到体现,伤者接受院前复苏后所测得的碱剩余值也可体现损伤控制复苏的效果。

Objective To study the value of point-of-care blood gas analyzer for evaluation of blood loss and the effect of resuscitation following limb fracture in rabbits and explore the feasibility of using the device for injury assessment and guiding resuscitation measures in the scenario of evacuation of combat casualties with limb fractures.Methods Fifteen rabbits were randomized equally into simple fracture group,fracture with massive hemorrhage group,and fracture with hemorrhage resuscitation group(n=5).Models of tibial fracture were established in all the rabbits by cutting the middle part of tibia with a circular saw.Twenty percent of the total blood volume was extracted from the femoral artery in the fracture with hemorrhage group,and in the resuscitation group,the extracted blood was transfused back 30 min after the injury.The level of lactate,base excess value and pH value of the rabbits were measured at 0 and 30 min,and 1 and 2 h using a point-of-care blood gas analyzer.Results The point-of-care blood gas analyzer detected significant changes in base excess value in the rabbits as early as 30 min after tibial fracture with massive hemorrhage,as compared with 2 h following a simple tibial fracture;significant changes in base excess value occurred 2 h after resuscitation for fracture with massive hemorrhage.Significant changes in lactate level were observed 30 min after fracture with massive hemorrhage and 2 h after simple fracture,but not found following resuscitation in the case of fracture with massive hemorrhage.pH value did not show significant variations after the injuries.Conclusion Lactate level and base excess value measured by point-of-care blood gas analysis can be indicative of the severity of limb fracture and blood loss in the course of patient evacuation,and the base excess value following resuscitation before admission can reflect the effect of injury control and resuscitation.