骨內(nèi)輸液在戰(zhàn)創(chuàng)傷救治中應(yīng)用的可行性研究
發(fā)布時(shí)間：2018-10-04 18:24
【摘要】： 20世紀(jì)20年代早期Drinker等人提出可利用骨髓腔血液循環(huán)通路輸注液體。40年代至50年代骨內(nèi)輸液技術(shù)被廣泛應(yīng)用于急癥救治,并證實(shí)血液、液體、藥物均能經(jīng)胸骨或脛骨骨髓快速、可靠地進(jìn)入血液循環(huán)。Tocantins等人證實(shí)：剛果紅染料注入兔脛骨，10秒后可到達(dá)中心血液循環(huán)。事實(shí)上，1990年的一系列文獻(xiàn)報(bào)告：任何可經(jīng)靜脈輸注的物質(zhì)注入骨髓后幾乎立即進(jìn)入外周循環(huán)。在常規(guī)戰(zhàn)爭(zhēng)中，50%的陣亡傷員是由于大出血死亡，戰(zhàn)傷傷口出血是造成傷后30%傷員死亡的主要原因。提高戰(zhàn)地救治水平，減少傷死率便顯得尤為重要。另一方面，在現(xiàn)代戰(zhàn)爭(zhēng)中，由于高技術(shù)武器的應(yīng)用可能導(dǎo)致短時(shí)間在某一區(qū)域出現(xiàn)大批量傷員，且傷情嚴(yán)重、休克發(fā)生率高、大面積燒傷患者較多等，均導(dǎo)致建立靜脈通道困難、置管耗時(shí)。尋找快速、有效、安全的靜脈替代途徑便顯得尤為重要。美軍陸軍外科研究所單位在20世紀(jì)90年代重新開(kāi)展了對(duì)骨內(nèi)輸液技術(shù)在成人救治中應(yīng)用的評(píng)價(jià)。通過(guò)檢索近30年國(guó)內(nèi)文獻(xiàn)以及專利檢索證實(shí)，目前國(guó)內(nèi)尚無(wú)開(kāi)展骨內(nèi)輸液技術(shù)的報(bào)告。因此，為做好軍事斗爭(zhēng)的衛(wèi)勤準(zhǔn)備，應(yīng)開(kāi)展骨內(nèi)輸液技術(shù)的研究。 本課題采用大白兔肢體火器傷致脛腓骨骨折模型模擬成人戰(zhàn)傷。觀察傷情特點(diǎn)及發(fā)展，經(jīng)健肢脛骨骨內(nèi)輸液復(fù)蘇效果，與靜脈復(fù)蘇對(duì)照研究骨內(nèi)輸液技術(shù)的有效性。并從三方面研究其安全性。第一方面：肢體火器傷后經(jīng)健肢黃骨髓骨內(nèi)輸液后是否會(huì)產(chǎn)生肺動(dòng)脈脂肪栓塞。并取輸液部位脛骨作病理檢查觀察骨髓腔近期組織結(jié)構(gòu)變化。第二方面：骨內(nèi)輸液是否對(duì)紅骨髓造血微環(huán)境有影響。第三方面：骨內(nèi)輸液是否會(huì)造成骨髓感染以及遠(yuǎn)期骨髓腔組織結(jié)構(gòu)變化�；谏鲜鰧�(shí)驗(yàn)研究，臨床成功應(yīng)用骨內(nèi)輸液技術(shù)救治2例嚴(yán)重創(chuàng)傷休克患者。 通過(guò)上述研究所得主要結(jié)果和結(jié)論如下：1 肢體火器傷后合并休克發(fā)生率高，肢體毀損重。2.脛骨穿刺輸液成功準(zhǔn)確率達(dá)95.8%,時(shí)間為84±22s;股靜脈插管輸液準(zhǔn)確率也為95.8%，其時(shí)間為288±34s。3.四種臨床常用的復(fù)蘇液體與藥物經(jīng)脛骨骨內(nèi)輸液與經(jīng)股靜脈插管復(fù)蘇效果對(duì)應(yīng)一致。4. 肢體創(chuàng)傷后健肢骨內(nèi)輸液不會(huì)產(chǎn)生肺動(dòng)脈脂肪栓塞疊加效應(yīng)。5. 骨內(nèi)輸液對(duì)紅骨髓造血微環(huán)境無(wú)明顯影響。6. 骨內(nèi)輸液技術(shù)在一定時(shí)間內(nèi)（24h）不會(huì)造成骨髓感染現(xiàn)象，，所以一旦容量復(fù)蘇后應(yīng)迅速建立靜脈通道，維持時(shí)間最好不要超過(guò)24h。7.近遠(yuǎn)期骨內(nèi)輸液部位脛骨病理檢查顯示：近期無(wú)異常，遠(yuǎn)期有輕度纖維化。8.臨床成功應(yīng)用證實(shí)：骨內(nèi)輸液也是成人緊急情況下快速、可靠 WP=7 建立血管通道的最佳選擇。
[Abstract]:In the early 1920s, Drinker et al proposed that the intraosseous infusion of fluid could be used through the circulation pathway of medullary cavity. From 1940s to 1950s, intraosseous infusion was widely used in emergency treatment, and proved that blood, fluid, and drugs could be transmitted quickly through sternum or tibial bone marrow. Reliable access to blood circulation. Tocantins et al. Confirmed that Congo red dye was injected into rabbit tibia and reached central blood circulation 10 seconds later. In fact, a series of literature published in 1990 reported that any substance that could be injected via vein into bone marrow entered the peripheral circulation almost immediately. In the conventional war, 50% of the casualties died as a result of massive bleeding, and the main cause of death was wound bleeding. It is particularly important to improve the level of field rescue and reduce the rate of injury and death. On the other hand, in modern warfare, because of the use of high-tech weapons, large numbers of casualties may appear in a certain area in a short period of time, and the injuries are serious, the incidence of shock is high, and there are more patients with extensive burns, etc. Both lead to the difficulty of establishing venous passage and the time consuming of catheterization. It is particularly important to find a fast, effective and safe alternative to the vein. The evaluation of intraosseous infusion technique in adult treatment was reconducted in the 1990s by the US Army Surgical Research Institute. Through the retrieval of domestic literature and patent retrieval in recent 30 years, there is no report on intraosseous infusion technology in China. Therefore, in order to prepare for military struggle, intraosseous infusion technique should be studied. The model of tibia and fibula fracture caused by firearm injury of limb of white rabbit was used to simulate adult war injury. The characteristics and development of the injury were observed, and the effect of intraosseous infusion resuscitation through tibia was studied, and the effectiveness of intraosseous infusion was compared with that of venous resuscitation. And from three aspects to study its safety. First, whether pulmonary artery fat embolism will occur after firearm injury through intraosseous infusion of yellow bone marrow. Tibia was taken from infusion site for pathological examination to observe the recent changes of tissue structure of medullary cavity. Second, whether intraosseous infusion has an effect on hematopoietic microenvironment of red bone marrow. Third, whether intraosseous infusion will cause bone marrow infection and long-term changes in bone marrow tissue structure. Based on the above experimental study, intraosseous infusion was successfully used to treat 2 patients with severe traumatic shock. The results and conclusions are as follows: (1) the incidence of shock after firearm injury is high, and the limb damage is heavy. 2. The accuracy rate of tibial puncture infusion was 95.8%, the time was 84 鹵22s, and the accuracy rate of femoral vein infusion was 95.8s.The time was 288 鹵34 s.3. Four common clinical resuscitation fluids and drugs received intraosseous infusion via tibia and femoral vein intubation respectively. There is no superposition effect of pulmonary artery fat embolism in healthy limb intraosseous infusion after limb trauma. Intraosseous infusion had no significant effect on hematopoietic microenvironment of red bone marrow. The intraosseous infusion technique will not cause bone marrow infection in a certain time (24 hours), so once volume resuscitation, vein passage should be established quickly, and the maintenance time should not exceed 24h.7. In the near and long term intraosseous infusion site tibia pathological examination showed that there was no abnormality in the near future and mild fibrosis in the long term. Clinical application has proved that intraosseous infusion is also rapid in adult emergencies. Reliable WP=7 is the best choice for establishing vascular passage.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2003
【分類號(hào)】：R826
本文編號(hào)：2251417
[Abstract]:In the early 1920s, Drinker et al proposed that the intraosseous infusion of fluid could be used through the circulation pathway of medullary cavity. From 1940s to 1950s, intraosseous infusion was widely used in emergency treatment, and proved that blood, fluid, and drugs could be transmitted quickly through sternum or tibial bone marrow. Reliable access to blood circulation. Tocantins et al. Confirmed that Congo red dye was injected into rabbit tibia and reached central blood circulation 10 seconds later. In fact, a series of literature published in 1990 reported that any substance that could be injected via vein into bone marrow entered the peripheral circulation almost immediately. In the conventional war, 50% of the casualties died as a result of massive bleeding, and the main cause of death was wound bleeding. It is particularly important to improve the level of field rescue and reduce the rate of injury and death. On the other hand, in modern warfare, because of the use of high-tech weapons, large numbers of casualties may appear in a certain area in a short period of time, and the injuries are serious, the incidence of shock is high, and there are more patients with extensive burns, etc. Both lead to the difficulty of establishing venous passage and the time consuming of catheterization. It is particularly important to find a fast, effective and safe alternative to the vein. The evaluation of intraosseous infusion technique in adult treatment was reconducted in the 1990s by the US Army Surgical Research Institute. Through the retrieval of domestic literature and patent retrieval in recent 30 years, there is no report on intraosseous infusion technology in China. Therefore, in order to prepare for military struggle, intraosseous infusion technique should be studied. The model of tibia and fibula fracture caused by firearm injury of limb of white rabbit was used to simulate adult war injury. The characteristics and development of the injury were observed, and the effect of intraosseous infusion resuscitation through tibia was studied, and the effectiveness of intraosseous infusion was compared with that of venous resuscitation. And from three aspects to study its safety. First, whether pulmonary artery fat embolism will occur after firearm injury through intraosseous infusion of yellow bone marrow. Tibia was taken from infusion site for pathological examination to observe the recent changes of tissue structure of medullary cavity. Second, whether intraosseous infusion has an effect on hematopoietic microenvironment of red bone marrow. Third, whether intraosseous infusion will cause bone marrow infection and long-term changes in bone marrow tissue structure. Based on the above experimental study, intraosseous infusion was successfully used to treat 2 patients with severe traumatic shock. The results and conclusions are as follows: (1) the incidence of shock after firearm injury is high, and the limb damage is heavy. 2. The accuracy rate of tibial puncture infusion was 95.8%, the time was 84 鹵22s, and the accuracy rate of femoral vein infusion was 95.8s.The time was 288 鹵34 s.3. Four common clinical resuscitation fluids and drugs received intraosseous infusion via tibia and femoral vein intubation respectively. There is no superposition effect of pulmonary artery fat embolism in healthy limb intraosseous infusion after limb trauma. Intraosseous infusion had no significant effect on hematopoietic microenvironment of red bone marrow. The intraosseous infusion technique will not cause bone marrow infection in a certain time (24 hours), so once volume resuscitation, vein passage should be established quickly, and the maintenance time should not exceed 24h.7. In the near and long term intraosseous infusion site tibia pathological examination showed that there was no abnormality in the near future and mild fibrosis in the long term. Clinical application has proved that intraosseous infusion is also rapid in adult emergencies. Reliable WP=7 is the best choice for establishing vascular passage.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2003
【分類號(hào)】：R826
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