【摘要】：目的　探討急癥體外循環(huán) ( ECC)對肺門火器傷的支持作用及呼吸模式的選擇 .方法　雜種犬 18只 ,隨機均分為對照組、ECC+定容控制呼吸救治組和 ECC+呼吸末正壓通氣 ( PEEP)救治組 .麻醉后用小口徑步槍射擊犬右肺門區(qū) ,對照組僅行傷口封閉 ,輸液及胸腔閉式引流 .定容控制呼吸組和PEEP組還于傷后分別行定容控制呼吸 ,PEEP,兩組均于傷后 15 min開始急癥 ECC.ECC支持 1h后行受傷肺葉切除術(shù) ,傷后 1.5 h停 ECC,并于 4.5 h后處死取標本 .測量血流動力學指標 ,行血氣分析 .檢測血漿中 IL- 8和心 ,肺 ,肝 ,腸組織中髓過氧化物酶 ( MPO)的活性及肺含水量 .結(jié)果　對照組傷后Pa O2 ,平均動脈壓 ( MAP)均顯著降低 ,Pa CO2 顯著升高 ,傷后 2min胸引血量達 ( 2 80± 86 ) m L.動物平均存活 ( 15 .0± 9.6 )min.治療的兩組 ECC期間 MAP維持于 ( 8～ 12 ) k Pa,血漿游離血紅蛋白含量小于 0 .35 g.L- 1 .術(shù)后 3 h PEEP組與定容控制呼吸組相比 Pa O2 ,MAP顯著升高 ;Pa CO2 和心率 ( HR)顯著降低 ;血漿中 IL - 8和心 ,肺 ,肝 ,腸組織中 MPO活性及肺指數(shù)均降低 .結(jié)論　肺門火器傷犬早期即出現(xiàn)明顯的呼吸 ,循環(huán)衰竭 .應(yīng)用急癥 ECC和呼吸支持可以維持動物血流動力學指標 ,為進一步的搶救爭取了時間 ,并能改善肺臟氣體交換功能 ;
[Abstract]:Objective to investigate the supportive effect and respiratory mode of acute cardiopulmonary bypass (ECC) on hilar firearm injury. Methods Eighteen mongrel dogs were randomly divided into two groups: the control group and the (PEEP) treatment group. After anesthesia, small caliber rifle was used to shoot the right lung portal area of dogs, while the control group was treated only with wound closure, infusion and thoracic closed drainage. The patients in the PEEP group and the control breathing group were treated with CPE respectively after injury. The patients in both groups were treated with acute ECC.ECC at 15 min after injury. The patients in both groups were treated with acute pulmonary lobectomy (ECC.ECC) for 1 h after injury. ECCs were stopped at 1.5 h after injury, and the specimens were sacrificed at 4.5 h after injury. Hemodynamic indexes were measured and blood gas analysis was performed. The activity of myeloperoxidase (MPO) and lung water content in heart, lung, liver and intestine were measured. Results in the control group, Pao 2 and mean arterial pressure (MAP) were significantly decreased after injury. The 2min chest blood volume was (280 鹵86) m L.). The average survival time was (15.0 鹵9.6) min. The level of plasma free hemoglobin in the two groups maintained at (8 ~ 12) k Pa,) during ECC (< 0.35 g 路L ~ (-1). Compared with the control group, Pa O 2 O 2 map significantly increased Pa CO2 and heart rate (HR) in PEEP group at 3 h after operation, and the activity of MPO in plasma, heart, lung, liver, intestine and lung index decreased significantly. Conclusion early respiratory and circulatory failure occurred in dogs with hilar firearm injury. The application of emergency ECC and respiratory support can maintain the hemodynamic indexes of animals, which can save time for further rescue and improve the function of pulmonary gas exchange.
【作者單位】： 第四軍醫(yī)大學西京醫(yī)院心血管外科中心!陜西西安710033 第四軍醫(yī)大學西京醫(yī)院心血管外科中心!陜西西安710033 第四軍醫(yī)大學西京醫(yī)院心血管外科中心!陜西西安710033 第四軍醫(yī)大學西京醫(yī)院心血管外科中心!陜西西安710033 第四軍醫(yī)大學西京醫(yī)院心血管外科中心!陜西西安710033 ，

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