基于动物模型的院前临时VV-ECMO治疗高原重度肺冲击伤的研究OACSTPCD
Study of pre-hospital temporary VV-ECMO for the treatment of high-altitude severe blast lung injury based on animal models
目的 通过在高海拔地区进行自由场化爆实验,建立山羊重度肺冲击伤动物模型,探讨临时静脉-静脉体外膜肺氧合(VV-ECMO)技术在现场早期救治中的可行性.方法 选择成年山羊16只,按照随机数字表法分为对照组和救治组,每组8只,在海拔4 600 m高原环境下建立重度肺冲击伤模型,随后对照组山羊给予呼吸机支持,救治组山羊给予临时VV-ECMO救治.记录伤后15 min山羊存活情况,比较2组山羊伤前和伤后1 h、2 h、3 h生命体征[体温、呼吸频率、心率、平均动脉压(MAP)]及动脉血气分析指标[pH、动脉血氧分压(PO2)、动脉血二氧化碳分压(PCO2)、动脉血氧饱和度(SaO2)、乳酸(LAC)、血钙离子(Ca2+)、红细胞压积(HCT)、血红蛋白(Hb)].对所有死亡和救治结束后处死的山羊进行尸检,采用器官损伤分级(OIS)评估肺损伤严重程度,依据简明损伤评分(AIS)进行肺损伤评分.计算肺组织湿重与干重比值(W/D)和肺系数.结果 爆炸后15 min内对照组山羊死亡4只,存活4只;救治组山羊死亡5只,存活3只.2组山羊受伤前后体温、呼吸频率、心率、MAP组间比较,差异均无统计学意义(P>0.05).救治组山羊伤后1 h、2 h、3 h PO2、SaO2均优于对照组(P<0.05),伤后2 h Ca2+显著高于对照组(P<0.05);2组山羊伤后不同时间点pH、PCO2、LAC、HCT、Hb比较差异均无统计学意义(P>0.05).2组山羊伤后OIS、AIS、肺系数比较,差异无统计学意义(P>0.05),但对照组肺组织W/D较救治组低(P<0.05).结论 在高海拔地区,我们首次建立了一种新型、可行性强、救治效果稳定的临时VV-ECMO动物救治策略,可以为高原地区重度肺冲击伤现场早期的VV-ECMO救治提供动物实验依据.
Objectives To explore the feasibility of temporary veno-venous extracorporeal membrane oxygenation(VV-ECMO)technology for early on-site treatment,through establishing an animal model of severe blast lung injury in goats by free-field chemical explosion experiments in high-altitude regions.Methods A total of 16 adult goats were selected,and divided into the control group and the treatment group according to the random number table method,with 8 goats in each group.A model of severe blast lung injury was established at an altitude of 4 600 meters above sea level,then the goats in the control group were given respiratory support and the goats in the treatment group were given temporary VV-ECMO treatment.The survival status of the goats 15 minutes after injury was recorded,the vital signs[including body temperature,respiration rate,heart rate,and mean arterial pressure(MAP)]and arterial blood gas analysis indicators[including pH,arterial partial pressure of oxygen(PO2),arterial partial pressure of carbon dioxide(PCO2),oxygen saturation(SaO2),lactate(LAC),calcium(Ca2+),hematocrit(HCT),and hemoglobin(Hb)]before injury and 1 hour,2 hours,3 hours after injury were compared in the two groups.The post-mortem examination was performed on all dead goats and sacrificed goats after treatment,the severity of lung injury was assessed by organ injury scaling(OIS),and the lung injury score was evaluated by abbreviated injury scale(AIS).The wet-to-dry weight ratio(W/D)and lung coefficient were calculated.Results Within 15 minutes after the explosion,4 goats in the control group died and 4 goats survived;and 5 goats in the treatment group died and 3 goats survived.There was no statistically significant difference in the body temperature,respiration rate,heart rate,or MAP before and after injury between the two groups(P>0.05).The PaO2 and SaO2 1 hour,2 hours,and 3 hours after injury in the treatment group were superior than those in the control group(P<0.05),the Ca2+ 2 hours after injury was significantly higher than that in the control group(P<0.05),and there was no statistically significant difference in the pH,PCO2,LAC,HCT or Hb at different time points after injury between the two groups(P>0.05).There was no statistically significant difference in the OIS,AIS or lung coefficient between the two groups(P>0.05),but the W/D of the lung tissue in the control group was lower than that in the treatment group(P<0.05).Conclusion We have established a novel,feasible,and stable treatment effect temporary VV-ECMO animal treatment strategy for the first time in the high-altitude regions,which can provide animal experiment evidence for the early on-site VV-ECMO treatment of severe blast lung injury in high-altitude regions.
伍正彬;邵世锋;张良潮;段朝霞;王耀丽;梁宗安;王建民
陆军军医大学大坪医院重症医学科,重庆 400042||四川大学华西医院呼吸与危重症医学科,四川 成都 610041陆军军医大学大坪医院重症医学科,重庆 400042四川大学华西医院呼吸与危重症医学科,四川 成都 610041
临床医学
爆震伤山羊体外膜肺氧合高原院前急救肺冲击伤
blast injurygoatextracorporeal membrane oxygenationplateaupre-hospital treatmentblast lung injury
《局解手术学杂志》 2024 (005)
373-378 / 6
重庆市医学重点学科建设(zdxk202102);重庆市技术创新与应用发展专项重点项目(318-084063)
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