高频喷射通气对高原胸部火器贯通伤犬的早期救治作用

Effect of high frequency jet ventilation on early penetrating chest firearm trauma in dogs at high altitude

目的 :探讨高频喷射通气 (HFJV)对高原胸部火器贯通伤犬的早期救治作用。方法 :12只体重相近 ( 10kg～15kg)的高原杂种犬 ,随机分成HFJV治疗组和对照组 ,每组 6只 ,麻醉后用 0 4 4g钢珠弹通过滑镗枪以 80 0m/s的初速度造成犬右胸贯通伤。伤后立即封闭伤口 ,安放胸腔闭式引流 ,并以 2ml～ 3ml/(kg·h)的速度静脉滴注平衡液。HFJV组除进行上述操作外 ,于伤后 15min进行HFJV。所有犬于不同时相测量血液动力学指标 ,并作血气分析。结果 :致伤即刻 ,对照组平均动脉压 (MAP)和峰值气道压 (Ppi)较伤前显著增高 ,致伤后 15min ,PaO2 、pH、SaO2 、MAP及心率 (HR)等均下降 ,PaCO2 及Ppi明显升高 ;伤后 30min及 6 0min,上述变化逐渐加剧 ,动物平均存活时间为 ( 6 5± 2 8)min。HFJV组在致伤即刻及伤后 15min ,上述指标的变化与对照组相似 ,应用HFJV后PaO2 、pH、SaO2 、MAP及HR显著增高 ,PaCO2 则显著降低 ,动物平均存活时间为 ( 35 0± 175 )min。结论 :高原胸部火器贯通伤早期 ,应用HFJV可明显改善受伤犬的呼吸功能 ,显著延长存活时间。

objective:To study the effect of high frequency jet ventilation(HFJV)on early penetrating chest firearm trauma in dogs at high altitude.Methods:Twelve altitude mongrel dogs(10 to 15kg)were randomly divided into control group(n=6)and HFJV group(n=6).Anesthetized dogs were shot at the right chest by steel balls with the muzzle velocity of 800m/s.The wounds were immediately closed after injury and the dogs were given thoracic closed drainage and infusion by intravenous drip of balanced solution with the speed of 2ml-3ml/(kg·h).The dogs in HFJV group were ventilated with HFJV 15 minutes after injury.Hemodynamic parameters were measured at different phases with the analysis of blood gases.Results:Compared with that before injury,the mean arterial pressure(MAP)and peak respiratory pressure(Ppi)of the control group were significantly increased at the time of injury.Fifteen minutes after injury,the PaO 2,PH,SaO 2,MAP and heart rate(HR)of control group were all decreased while PaCO 2 and Ppi were remarkably increased.All the changes were gradually aggravated 30 minutes and 60 minutes after injury.The mean survival time of the dogs in control group was 65±28 minutes.The dogs in HFJV group showed similar changes at the time of injury and 15 minutes after injury as the dogs in control group.However,the PaO 2,PH,SaO 2,MAP and HR were significantly increased after using HFJV and PaCO 2 decreased.The mean survival time of the dogs in HFJV group was 350±175 minutes.Conclusion:In the early time after penetration chest firearm trauma in dogs at high altitude,HFJV can improve the respiratory function and prolong the survival time.