本文選題：膽道灌注 + 低溫治療��； 參考：《第二軍醫(yī)大學(xué)》2014年碩士論文

【摘要】：研究背景和目的： 盡管肝臟位于肋骨弓下這個(gè)相對(duì)于受保護(hù)的位置，但它卻是腹部損傷中較為常見的器官，僅次于脾和小腸。對(duì)于右腹部外傷來說，肝大多會(huì)受累。而當(dāng)今交通事故的屢見不鮮以及各種反社會(huì)、反人類的暴力行為的頻頻發(fā)生，成為肝臟損傷的主要原因。肝臟損傷會(huì)造成大量的失血以及炎癥因子的大量釋放，使得機(jī)體產(chǎn)生嚴(yán)重的低血壓性休克和炎癥反應(yīng)。因此，當(dāng)肝臟損傷發(fā)生時(shí)，迅速的轉(zhuǎn)運(yùn)以及爭(zhēng)分奪秒的搶救措施就成為了關(guān)系到傷員生死的決定性因素。 低溫治療作為一種新型的治療方法，在近年來由于其被廣泛應(yīng)用于臨床而持續(xù)受到關(guān)注，在心臟驟停、神經(jīng)損傷以及新生兒缺血缺氧性腦病等領(lǐng)域，該方法已經(jīng)取得了公認(rèn)的效果。在臨床前期試驗(yàn)中的數(shù)據(jù)和結(jié)果顯示，低溫具有降低細(xì)胞代謝，抑制細(xì)胞凋亡等作用，使得一些專家提出低溫治療可以在創(chuàng)傷領(lǐng)域得到應(yīng)用，但低溫治療在腹部創(chuàng)傷尤其是肝膽外科的應(yīng)用還鮮有報(bào)道，就像對(duì)心臟、神經(jīng)等創(chuàng)傷的保護(hù)作用一樣，，我們考慮低溫對(duì)于機(jī)體的保護(hù)作用一定也適用于肝臟。 我們進(jìn)行這項(xiàng)研究，通過做一個(gè)前瞻性、隨機(jī)對(duì)照的動(dòng)物肝損傷失血性休克的模型，觀察創(chuàng)傷后的生理反應(yīng)及其各項(xiàng)檢測(cè)指標(biāo)，來探索膽道灌注4°C低溫液體對(duì)于創(chuàng)傷肝臟的實(shí)際降溫效果及其保護(hù)作用。 研究方法： 實(shí)驗(yàn)方案設(shè)計(jì)是用來模擬實(shí)際肝創(chuàng)傷失血性休克緊急救治的，為了實(shí)驗(yàn)的統(tǒng)一性與可靠性，我們用兩片手術(shù)刀片尾端重合來對(duì)13頭麻醉后的年齡體重相仿的雄性巴馬小型豬進(jìn)行一個(gè)標(biāo)準(zhǔn)的肝損傷的處理。在15分鐘的非控制性出血后進(jìn)行像紗布按壓及補(bǔ)液等簡(jiǎn)單的臨時(shí)救治，1小時(shí)后，13只動(dòng)物按照先前用隨機(jī)數(shù)表所分好的那樣隨機(jī)入組。對(duì)照（Control）組7頭，進(jìn)行標(biāo)準(zhǔn)的外科肝傷救治方法；低溫(Hypothermia)組6只，同樣進(jìn)行標(biāo)準(zhǔn)的肝傷救治方法，但額外進(jìn)行4°C乳酸鈉林格注射液的膽道灌注。每頭動(dòng)物都在同樣的環(huán)境下飼養(yǎng)7天來對(duì)膽道灌注低溫液體誘導(dǎo)低溫治療的效果進(jìn)行一個(gè)評(píng)估。手術(shù)期間，所有的血壓、心率、肝溫、體溫都全程記錄，手術(shù)中4次由豬前腔靜脈采血，術(shù)后1、3、5、7天同樣各一次采血，來檢測(cè)血常規(guī)及肝腎功能。實(shí)驗(yàn)結(jié)束時(shí)將動(dòng)物處死，取右前葉肝組織做病理切片，H-E染色，觀察炎性細(xì)胞侵潤情況。 研究結(jié)果： 對(duì)照組和低溫組各有一頭豬由于傷勢(shì)過重，失血過多，于術(shù)后第二天死亡，排除這兩頭豬，其余所有動(dòng)物均生存到了術(shù)后第7天。實(shí)驗(yàn)過程中，對(duì)照組和低溫組初期失血量、各檢測(cè)時(shí)間點(diǎn)心率和平均動(dòng)脈壓均無明顯差異，經(jīng)不同干預(yù)方法2h后，C組和H組肝溫分別下降1.17±0.68℃和2.08±0.21℃，兩組間差異有統(tǒng)計(jì)學(xué)意義（P=0.020）；同一時(shí)段兩組體溫分別下降0.93±0.83℃和0.48±0.75℃，差異無統(tǒng)計(jì)學(xué)意義（P=0.40）。由于轉(zhuǎn)氨酶指標(biāo)是呈偏態(tài)分布的，所以要取相應(yīng)的對(duì)數(shù)值來對(duì)其進(jìn)行描述，log(AST)在第5天時(shí)，P=0.016，差異有顯著性；log（AST）在術(shù)后灌注2小時(shí)后，P=0.026，差異有顯著性。病理切片示低溫組肝臟炎性細(xì)胞侵潤程度明顯輕于對(duì)照組。 研究結(jié)論： 膽道灌注4°C低溫液體，能夠減少創(chuàng)傷肝臟的炎癥反應(yīng)，有利于肝功能的恢復(fù)，從而對(duì)肝臟具有保護(hù)作用。
[Abstract]:Research background and purpose:
Although the liver is located under the protected position of the rib arch, it is the most common organ in the abdominal injury, second only to the spleen and the small intestine. For the right abdominal trauma, most of the liver is involved. The frequent occurrence of traffic accidents and the frequent occurrence of anti human violence and the liver injury are common in today's traffic accidents. The main reason is that liver damage can cause a large amount of blood loss and the release of inflammatory factors, causing the body to produce severe hypotensive shock and inflammation. Therefore, when the liver injury occurs, rapid transit and second rescue measures have become a decisive factor in the life and death of the wounded.
As a new method of treatment, cryogenic therapy has been paid more and more attention in recent years because of its widespread application in clinical practice. This method has been recognized in the fields of cardiac arrest, nerve injury and neonatal ischemic hypoxic encephalopathy. Some experts suggest that cryogenic treatment can be used in the field of trauma, but the application of cryogenic treatment in abdominal trauma, especially in the Department of hepatobiliary surgery, is rarely reported, like the protection of heart and nerve injuries. We consider that the protective effect of low temperature on the body must also be applied. In the liver.
We conducted a study of a prospective, randomized, controlled, randomized, controlled model of hemorrhagic shock in animal liver injury, and to observe the physiological responses and detection indexes after trauma to explore the actual cooling effect and protection of the 4 degree C cryogenic liquid for the bile duct perfusion for the traumatic liver.
Research methods:
The experimental scheme was designed to simulate the emergency treatment of hemorrhagic shock in the liver. For the purpose of testing the unity and reliability of the experiment, we used the tail end of two surgical blades to deal with a standard liver injury in male Bama miniature pigs of the same age after 13 anaesthesia. After 15 minutes of uncontrolled bleeding, we followed. 1 hours after 1 hours, 13 animals were randomly assigned to the group as well as a random number table. A standard surgical treatment of liver injury was performed in a control group (Control), and 6 in the group of low temperature (Hypothermia) were treated with the same standard for the treatment of liver injury, but an additional 4 degree C lactate ringer was carried out. In the same environment, each animal was kept in the same environment for 7 days to assess the effect of hypothermia therapy on biliary tract perfusion. During the operation, all the blood pressure, heart rate, liver temperature and body temperature were recorded, and the blood was collected from the anterior vena cava in the operation 4 times during the operation, and the same blood was collected on 1,3,5,7 days after the operation. Blood routine and liver and kidney function. At the end of the experiment, the animals were sacrificed, and the liver tissues of the right anterior lobe were taken for pathological sections, and H-E staining was used to observe the infiltration of inflammatory cells.
The results of the study:
In the control group and the low temperature group, each pig was overloaded with excessive blood loss and died second days after the operation. All the other animals were excluded. All the other animals survived to seventh days after the operation. During the experiment, the amount of blood loss in the control group and the low temperature group, the time of the detection of the heart rate and the arterial pressure were not significantly different, after the different intervention methods 2H. The liver temperature of C group and H group decreased by 1.17 + 0.68 and 2.08 + 0.21 C respectively. The difference between the two groups was statistically significant (P=0.020). The temperature of two groups in the same period was 0.93 + 0.83 and 0.48 + 0.75, respectively, and the difference was not statistically significant (P=0.40). The difference between log (AST) and P=0.016 at fifth days was significant, and the difference was significant after 2 hours of log (AST) perfusion. The pathological section showed that the degree of inflammation of liver inflammatory cells in the hypothermia group was significantly lighter than that of the control group.
The conclusions are as follows:
Biliary perfusion of 4 degrees C low temperature liquid can reduce the inflammatory reaction of the wounded liver, and is conducive to the recovery of liver function, thereby protecting the liver.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R657.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 黃志強(qiáng);腹部創(chuàng)傷的臨床救治[J];中華創(chuàng)傷雜志;1998年04期

2 Kurinchi S Gurusamy;Hector D Gonzalez;Brian R Davidson;;Current protective strategies in liver surgery[J];World Journal of Gastroenterology;2010年48期

本文編號(hào)：2004262