姜黄素纳米晶注射液联合损伤控制性外科对高原寒冷环境腹部火器伤救治的实验研究

Experimental study of curcumin nanocrystalline injection combined with damage control surgery for the treatment of abdominal firearm injury in cold environment at high altitude

目的观察姜黄素纳米晶注射液(CNI)、损伤控制性外科(DCS)和CNI联合DCS治疗对模拟高原寒冷环境下猪腹部肠管火器贯通伤的救治效果。方法40只健康长白仔猪,随机数字表法分为4组,每组10只,对照组为高原致伤组(HI),实验组分别为高原致伤+CNI治疗组(HIC)、高原致伤+DCS治疗组(HID)、高原致伤+DCS+CNI治疗组(HDC)。高原寒冷环境猪腹部火器肠管贯通伤模型建立:仔猪放入模拟高原寒冷环境的西北地区特殊环境人工实验舱48 h,并使用手枪射击右侧腹部。HIC组伤后2、8、16 h分别予以CNI静脉输注,此后每天输注3次。HID组伤后4 h予以DCS治疗。HDC组伤后CNI输注同HIC组,并于伤后4 h行DCS治疗。分别对比手术相关指标,术后并发症,伤后不同时间血液炎症相关指标、肝功能指标、24 h生命体征。结果HIC组较HI组血液学炎症指标改善,生存时间延长(P<0.05)。HID组和HDC组的腹腔积血、肠系膜损伤、弹孔直径、小肠挫伤、小肠破裂、结肠破裂差异无统计学意义(P>0.05)。HID组和HDC组的手术时间、术中失血量、术中补液量、麻醉复苏时间、首次排便时间差异无统计学意义(P>0.05)。伤后HIC组、HID组、HDC组比HI组的白细胞、ALT、AST、肿瘤坏死因子-α、IL-6水平低,且HDC组更明显(P<0.05)。HID组、HDC组生存率较对照组提高,但差异无统计学意义(P>0.05)。结论CNI联合损伤控制性外科可能是高原寒冷环境腹部火器伤救治的有效方法。

Objective To observe the therapeutic effect of curcumin nanocrystalline injection(CNI),damage control surgery(DCS)and CNI combined with DCS in the treatment of porcine abdominal firearm penetrating injury in simulated cold environment at high altitude.Methods 40 healthy landrace piglets were divided into 4 groups with 10 piglets in each group by random number table method.The control group was high-altitude injury group(HI),and the experimental group was high-altitude injury+CNI treatment group(HIC),high-altitude injury+DCS treatment group(HID),high-altitude injury+DCS+CNI treatment group(HDC).Establishment of porcine abdominal firearm penetrating injury in cold environment at high altitude:Piglets were put into artificial laboratory chamber of special environment in Northwest China to simulate high-altitude cold environment for 48 h,and shot right abdomen with pistol.The HIC group was given CNI intravenous infusion at 2,8 and 16 h after injury,and then 3 times a day.Results Compared with HI group,HIC group improved hematologic inflammation index and prolonged survival time(P<0.05).There were no significant differences in abdominal hematoma,mesenteric injury,bullet hole diameter,small intestine contusion,small intestine rupture and colon rupture between HID group and HDC group(P>0.05).There were no significant differences in operation time,intraoperative blood loss,intraoperative fluid rehydration,anesthesia resuscitation time and first defecation time between HID group and HDC group(P>0.05).The levels of leukocyte,ALT,AST,TNF-αand IL-6 in HIC,HID and HDC groups after injury were lower than those in HI group,and the levels were more significant in HDC group(P<0.05).The survival rate of HID and HDC groups was higher than that of control group,but the difference was not statistically significant(P>0.05).Conclusion CNI combined with DCS may be an effective method for the treatment of porcine abdominal firearm penetrating injury in cold environment at high altitude.