黄健翔, 柴家科, 魏斌, 郑金光, 曲毅睿, 胡方超, 荀浩怡, 苏小薇, 迟云飞. 限制性复苏对烧伤合并失血性休克的影响——一项猪模型研究[J]. 解放军医学院学报. DOI: 10.12435/j.issn.2095-5227.2023.054
引用本文: 黄健翔, 柴家科, 魏斌, 郑金光, 曲毅睿, 胡方超, 荀浩怡, 苏小薇, 迟云飞. 限制性复苏对烧伤合并失血性休克的影响——一项猪模型研究[J]. 解放军医学院学报. DOI: 10.12435/j.issn.2095-5227.2023.054
HUANG Jianxiang, CHAI Jiake, WEI Bin, ZHENG Jinguang, QU Yirui, HU Fangchao, XUN Haoyi, SU Xiaowei, CHI Yunfei. Effect of restrictive resuscitation on burn-hemorrhagic shock combined injury: a study of porcine model[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL. DOI: 10.12435/j.issn.2095-5227.2023.054
Citation: HUANG Jianxiang, CHAI Jiake, WEI Bin, ZHENG Jinguang, QU Yirui, HU Fangchao, XUN Haoyi, SU Xiaowei, CHI Yunfei. Effect of restrictive resuscitation on burn-hemorrhagic shock combined injury: a study of porcine model[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL. DOI: 10.12435/j.issn.2095-5227.2023.054

限制性复苏对烧伤合并失血性休克的影响——一项猪模型研究

Effect of restrictive resuscitation on burn-hemorrhagic shock combined injury: a study of porcine model

  • 摘要:
      背景  随着简易爆炸装置(Improved explosive devices,IED)在现代局部战争中使用的增加,烧伤合并失血性休克成为了战创伤的重要形式之一,在资源有限的一线救治中,限制性复苏的应用价值值得探讨。
      目的  通过建立一种新型的烧伤复合失血性休克猪模型,观察限制性复苏对该伤情猪伤后6 h内体循环和微循环的影响,探讨限制性复苏在烧创复合伤上的应用价值。
      方法  采用健康4月龄长白猪20只随机分为对照组(CON)和林格液限制性复苏组(RIN)两组,通过稠化汽油火焰和股动脉慢失血建立烧伤合并失血性休克猪模型,建模后,利用脉搏轮廓心排血量(Pulse indicated Continuous Cardiac Output,PICCO)和侧流暗视野成像显微镜系统(Side stream dark field,SDF)及血气分析比较两组在伤前和致伤后 30 min、1 h、2 h、4 h、6 h的体循环和微循环的各项指标和脏器湿干重结果。
      结果  限制性复苏可在实验终点时恢复实验猪的舌下微循环,微血管流动性指数(Microvascular flow index,MFI)评分对比CON组升高明显,差异有统计学意义(P<0.05),并可部分恢复肠系膜循环。与CON组相比,RIN组的HR、ITBVI、Lac、BE可得到显著改善(P<0.05),RIN组的肺、肠、肾组织湿干重比较CON组显著提高(P<0.05),而心、肝、脑组织的湿干重差异未出现统计学意义(P>0.05),提示肺、肠、肾组织的毛细血管通透性在合并伤后显著升高。
      结论  限制性复苏可在烧伤合并失血性休克猪伤后6h内有效恢复舌下微循环的灌注,并能改善猪合并伤后的缺血缺氧状况,一定程度稳定体循环和微循环。烧伤合并失血性休克后血管通透性的持续升高是突出的情况,这可能是未来提高此合并伤情早期治疗效果的重要突破点。

     

    Abstract:
      Background  With the increased use of improvised explosive devices (IEDs) in modern warfare, burn-hemorrhagic shock combined injury has become one of the important forms of combat injury. The value of the application of restrictive resuscitation in resource-limited first-line treatment is worth exploring.
      Objective  To explore the application value of restrictive resuscitation on burn combined hemorrhagic shock by establishing a novel burn-hemorrhagic shock combined injury pig model and to observe the effect of restrictive resuscitation on macrocirculation and microcirculation in this model within 6 h.
      Methods  Twenty 4-month-old healthy landrace pigs were randomly divided into two groups: control (CON) group and restricted resuscitation (RIN) group. A burn-hemorrhagic shock combined injury pig model was established by solid gasoline flame and slow blood loss from femoral artery. After modeling, pulse indicated continuous cardiac output (PICCO), side stream dark field (SDF) and blood gas analysis were used to compare the macrocirculation and microcirculatory parameters and organ wet to dry ratio of the two groups at the timepoints before and at 30 min, 1 h, 2 h, 4 h and 6 h after the injury.
      Results  Restrictive resuscitation can restore sublingual microcirculation in the experimental pigs at the end of the experiment, with a significant increase in microvascular flow index (MFI) scores compared to the CON group (P < 0.05), and can partially restored mesenteric circulation. Compared with the CON group, HR, ITBVI, Lac, and BE could be significantly improved in the RIN group (P < 0.05), along with the wet to dry ratio of lung, intestinal, and renal tissues (P < 0.05), However, there was no statistically significant difference in wet dry weight between heart, liver and brain tissues (P>0.05), indicating that capillary permeability of lung, intestinal and renal tissues increased significantly after injury.
      Conclusion  Restrictive resuscitation can effectively restore perfusion of the sublingual microcirculation within 6 h after injury in pigs with burn-hemorrhagic shock combined injury, and can improve ischemia and hypoxia, and can stabilize the macrocirculation and microcirculation in pigs with combined injury. The persistent elevation of vascular permeability after burn-hemorrhagic shock combined injury is a prominent situation, which may be an important breakthrough point to improve the early treatment effect of this combined injury in the future.

     

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