發(fā)布時間：2018-03-11 00:07

  本文選題：高原高寒　切入點：治療　出處：《蘭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討高原高寒地區(qū)腹腔嚴(yán)重感染特點及腹部外加壓治療腹腔創(chuàng)傷性大出血的可能性及其作用機制,為臨床治療高原高寒地區(qū)腹腔嚴(yán)重感染和腹部外加壓治療腹腔創(chuàng)傷性大出血提供理論依據(jù)。方法實驗一:通過手術(shù)選取實驗用家兔腸系膜上動脈,據(jù)腸系膜上動脈與腹主動脈分叉15cm處切斷腸系膜上動脈,遠端結(jié)扎,近端置管并引出體外,完成后關(guān)腹,制作實驗兔腹腔創(chuàng)傷性大出血的動物模型,將動物模型隨機分成2組,單純出血(P)組和腹部外加壓(T)組。單純出血(P)組:通過腸系膜上動脈內(nèi)導(dǎo)管進行放血,記錄失血量、出血速度、觀察動物的生命體征及記錄存活時間。腹部外加壓(T)組:用醫(yī)用血壓計腹部外加壓,使血壓計壓力顯示7mmHg后與單純出血(P)組做相同的處理。實驗在模擬高原環(huán)境動物實驗艙中進行,模擬環(huán)境為海拔5500米,溫度-25℃。實驗二:將實驗兔隨機分成5組(A、B、C、D、E組)。通過手術(shù)造模,取腹部正中切口,在實驗家兔肝臟右外葉中部距邊緣2.0厘米處縫一針4號絲線,使線環(huán)繞的肝臟組織厚度相當(dāng)于預(yù)期的肝臟破裂口大小,將縫線的末端標(biāo)記后引出體外,操作完成后關(guān)腹。繼續(xù)飼養(yǎng)家兔,對實驗家兔血液分析,待血液分析恢復(fù)與手術(shù)前一致時進行以后實驗。實驗時將縫線向上拉出,拉出的縫線可在實驗家兔肝臟上形成切割傷。對5組實驗兔分別腹部外施加0mm Hg、3mmHg、7mmHg、11mmHg、15mmHg的壓力。分別于實驗前、腹部外加壓后1、2、4、6h通過耳緣靜脈取血檢測血液中的炎癥因子變化,比較各組血液中炎癥水平。腹部加壓6.5h后處死家兔取肝臟、腎臟、小腸標(biāo)本,進行病理學(xué)觀察,比較各組標(biāo)本病理學(xué)變化。實驗在模擬高原環(huán)境動物實驗艙中進行,模擬環(huán)境為海拔5500米,溫度-25℃。實驗三:將實驗兔隨機分成2組,經(jīng)手術(shù)制作實驗家兔腹腔嚴(yán)重感染的動物模型。對實驗兔術(shù)前禁食8 h,麻醉成功后備皮、消毒,以上腹部正中線依次切開皮膚、皮下、筋膜、肌肉及腹膜,距回盲部15 cm處用組織剪剪開小腸周徑1/3,清理切口附近小腸內(nèi)容物,距切緣上下各0.5 cm處用1號縫線將系膜緣腸壁懸吊于右側(cè)腹壁,1號絲線分三層關(guān)腹。分別于實驗前、術(shù)后12、18、24、36小時取血檢測血液中的白細(xì)胞計數(shù)及炎癥因子水平,36小時后處死家兔,取小腸、肝臟及腎臟進行病理學(xué)檢查。比較手術(shù)前后血液中白細(xì)胞計數(shù)及炎癥因子水平,及通過病理學(xué)檢查了解兩組實驗兔機體炎癥反應(yīng)嚴(yán)重程度,實驗在模擬高原環(huán)境動物實驗艙中進行,實驗組(T)組:高原高寒組模擬環(huán)境為海拔5500米,溫度-25℃,對照組(P)組:平原組模擬環(huán)境為海拔100米,溫度25℃。結(jié)果實驗一:腹部外加壓(T)組與單純出血(P)組比較,其平均出血量分別為50.19±10.02ml與61.81±9.12,平均出血速度為1.06±0.21ml/min與1.93±0.48ml/min,平均存活時間為47.72±4.48min與33.45±7.00min,兩組差異顯著,差異有統(tǒng)計學(xué)意義(P0.05)。實驗二:五組實驗兔血液中炎癥因子水平比較,A、B、C三組各時間段實驗兔血液中炎癥因子兩兩比較差異不明顯,差異無統(tǒng)計學(xué)意義。D、E兩組實驗兔血液中炎癥因子水平分別與C組比較,差異明顯,差異有統(tǒng)計學(xué)意義(P0.05)。實驗三:高原高寒環(huán)境下兩組白細(xì)胞水平比較,差異無統(tǒng)計學(xué)意義(P0.05),TNF-α、IL-6與平原組比較,差異明顯,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論通過以上實驗研究我們得出以下三點結(jié)論:1、在高原高寒地區(qū)實驗兔腹部創(chuàng)傷性大出血的現(xiàn)場急救中,應(yīng)用腹部外加壓能顯著減少實驗兔的出血量、出血速度,延長存活時間,值得進一步深入研究討論。2、應(yīng)用不同腹部外壓力治療高原高寒地區(qū)實驗兔腹部創(chuàng)傷性大出血,理論上壓力越高腹腔出血量越少,但過高的壓力增加了腹腔間隔室綜合征的發(fā)生,7mmHg左右的壓力既能有效減少腹腔創(chuàng)傷性大出血的出血量,又能使機體炎癥反應(yīng)降到最低,是較為理想的腹部外加壓壓力。為臨床應(yīng)用腹部外加壓治療腹腔創(chuàng)傷性大出血提供理論指導(dǎo)。3、高原高寒地區(qū)相較于平原地區(qū),腹腔感染嚴(yán)重發(fā)生較早,感染較重,炎癥因子水平較高,值得進一步研究。
[Abstract]:Objective to study the possibility of treatment of abdominal traumatic cold plateau region hemorrhage and its mechanism of serious infection and abdominal pressure, abdominal cavity for clinical treatment of plateau alpine region of serious infection and abdominal external pressure for the treatment of abdominal traumatic hemorrhage and provide a theoretical basis. Methods: the surgical selection of experimental rabbits according to the superior mesenteric artery, superior mesenteric artery with the abdominal aortic bifurcation 15cm cut the superior mesenteric artery and distal ligation, the proximal catheter and out of body, the abdomen was closed after the establishment of animal model of rabbit abdominal traumatic hemorrhage, the animal models were randomly divided into 2 groups, simple hemorrhage (P) group and external abdominal pressure (T) simple group. Hemorrhage (P) group: blood through superior mesenteric artery catheter, record the blood loss, bleeding rate, observation of animal life signs and record the survival time. External abdominal pressure (T) group: Abdominal medical sphygmomanometer with external pressure, the blood pressure pressure after 7mmHg and simple hemorrhage (P) group received the same treatment. Experiments were carried out in a simulated high altitude animal experiment module, the simulation environment is 5500 meters above sea level, temperature -25. Experiment two: the experimental rabbits were randomly divided into 5 groups (A, B, C D, E group). The operation model, take the middle abdominal incision, in experimental rabbit liver right lateral lobe at 2 cm from the edge of the central No. 4 sewing thread, the line around the liver tissue thickness is equivalent to the expected size of liver rupture, will end labeling suture after leading body, after the completion of the operation the abdomen was closed. Continue feeding rabbits, analysis of experimental rabbit blood, to be resumed after the experiment and analysis of blood before operation. The experiment will be favorable to pull out suture, the suture can be formed in the rabbit liver injury. The abdomen respectively in 5 groups of rabbits and applying 0mm Hg, 3mmHg 7mmHg, 11mmHg, 15mmHg, pressure. Respectively before experiment, external abdominal pressure after 1,2,4,6h through the ear vein blood was collected to detect the changes of inflammatory factors in the blood levels of inflammation were compared in blood. After 6.5h abdominal pressure of rabbits liver, kidney, small intestine were collected for pathological observation, histological changes were compared pathology. Experiments were carried out in a simulated high altitude animal experiment module, the simulation environment is 5500 meters above sea level, temperature -25. Experiment three: the experimental rabbits were randomly divided into 2 groups, the animal model establishment of rabbit surgery of severe abdominal infection. The rabbits were fasted for 8 h, the success of anesthesia reserve skin disinfection, above the abdominal midline followed by skin incision, skin, fascia, muscle and peritoneum from the ileocecal valve 15 cm tissue cut the circumference of small intestine 1/3, clean up the incision near the small intestine contents, from the cut edge of the upper and lower 0.5 cm with 1 stitches will mesovarial margin The intestinal wall hanging on the right side of the abdominal wall, 1 silk three layers respectively in closed abdomen. Before the experiment, after 12,18,24,36 hours in serum were detected in blood leukocyte count and inflammatory factor levels, 36 hours after the rabbits were killed, intestine, liver and kidney pathology. Surgery before and after blood white cell count and the levels of inflammatory factors, and by pathological examination two rabbits were inflammatory reaction severity, experiments were carried out in a simulated high altitude animal experiment module, experimental group (T group): alpine plateau group simulation environment for 5500 meters above sea level, the temperature of -25 DEG C, the control group (P group): plain simulation environment for 100 meters above sea level, temperature is 25 degrees centigrade. Results: abdominal external pressure (T) group and simple hemorrhage (P) group, the average amount of bleeding was 50.19 + 10.02ml and 61.81 + 9.12, the average rate of bleeding was 1.06 + 0.21ml/ min 1.93 + 0.48ml/min, average survival Time is 47.72 + 4.48min and 33.45 + 7.00min, the significant differences between the two groups, the difference was statistically significant (P0.05). Experiment two: comparison of five groups of rabbits in the blood levels of inflammatory factors A, B, C three inflammation group each time experimental rabbit blood factor 22 is no obvious difference, the difference was statistically significant.D, E two groups of experimental rabbit blood inflammatory factor levels were compared with C group, significant difference, the difference was statistically significant (P0.05). Experiment three: To compare the levels of white blood cells of two groups of alpine environment, there was no statistically significant difference (P0.05), TNF- alpha, IL-6, and plain group differences, there are statistically significant difference (P0.05). Conclusion through the above experimental research we draw the following three conclusions: 1, first aid in cold plateau region of rabbits abdominal traumatic hemorrhage, application of abdominal external pressure can significantly reduce the amount of bleeding, the bleeding rate of rabbits, prolonged storage Live time, it is worth further study to discuss.2, application of different abdominal pressure in plateau alpine region of rabbit abdominal traumatic bleeding, the higher the pressure on the theory of abdominal bleeding is less, but the high pressure increased abdominal compartment syndrome, 7mmHg left and right pressure can effectively reduce abdominal traumatic bleeding bleeding, and can cause the inflammatory reaction to a minimum, is the ideal abdominal external pressure pressure. Pressure for the treatment of abdominal traumatic hemorrhage and provide theoretical guidance for the clinical application of abdominal.3, plateau alpine region compared to the plain area, severe abdominal infection occurred earlier, severe infection, inflammatory factor level is high, it is worth further study.

【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R656

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