摘要
目的比较不同体积腹膜前间隙球囊(PPB)填塞控制猪血流动力学不稳定型骨盆骨折血管损伤出血的效果。方法取18只雌性12个月龄巴马小型猪,建立"开书样"骨盆骨折髂外血管损伤模型,造影剂造影确定血管损伤成功后,随机分为3组(n=6):对照组(C组)、PPB 500 mL组(T1组)和PPB 1000 mL组(T2组),分别将0、500和1000 mL水注至PPB。比较3组猪的60 min生存率、球囊压力、腹膜前间隙压力、膀胱压力、70 min生存率、出血量及输液量等。结果3组猪实验前的基础血流动力学指标等比较差异均无统计学意义(P>0.05),具有可比性。T2组猪的60 min生存率为100.0%(6/6),显著高于C组和T1组猪[0.0%(0/6)、0.0%(0/6)],差异均有统计学意义(P<0.05)。注水后T2组猪的球囊压力、腹膜前间隙压力分别为(127.2±4.7)、(34.5±3.6)mmHg,显著高于T1组[(78.7±3.8)、(13.7±2.8)mmHg]和C组猪[0、(9.0±1.4)mmHg],且T1组猪显著高于C组猪,差异均有统计学意义(P<0.05)。注水后C组、T1组、和T2组猪的膀胱压力[(6.7±1.0)、(5.8±1.9)、(6.0±1.1)mmHg]、出血量[(1163.0±191.3)、(1212.0±148.4)、(975.0±133.2)mL]比较差异均无统计学意义(P≥0.05)。T1组猪的输液量[(1250.0±225.8)mL]显著高于C组猪[(951.7±177.8)mL],差异有统计学意义(P<0.05)。3组实验动物解剖均未发现结直肠和膀胱损伤。结论1000 mL PPB填塞可有效控制猪骨盆骨折模型中髂外血管损伤出血,提高其60 min生存率,且不损伤结直肠和膀胱。
Objective To determine the effects of preperitoneal balloon(PPB)tamponade with different volumes of fluid on hemodynamically unstable pelvic fracture-associated arterial and venous hemorrhage in a swine model.Methods A model of open-book pelvic fracture with injuries to external iliac vessels was established in 18 female 12-month old Bama miniature pigs.After the successful establishment of hemodynamically unstable pelvic fracture with vascular injury was confirmed by contrast agent imaging,the animals were randomized into 3 even groups(n=6):a control group(group C)subjected to PPB tamponade with 0 mL fluid injected,group T1 subjected to PPB tamponade with 500-mL fluid injected,and group T2 subjected to PPB tamponade with 1,000-mL fluid injected.The 3 groups were compared in terms of 60-min survival rate,balloon pressure,peritoneal pressure,bladder pressure,70-min survival rate,blood loss,and infusion volume.Results There was no statistically significant difference in the basic hemodynamic or other experimental indicators among the 3 groups before experiment,indicating comparability(P>0.05).The 60-min survival rate in group T2 was 100.0%(6/6),significantly higher than those in group C and group T1[0.0%(0/6),0.0%(0/6)](P<0.05).After fluid injection,the balloon pressure and preperitoneal pressure in group T2 were respectively(127.2±4.7)mmHg and(34.5±3.6)mmHg,significantly higher than those in group T1[(78.7±3.8)mmHg and(13.7±2.8)mmHg]and in group C[0 mmHg and(9.0±1.4)mmHg],and the 2 indicators in group T1 were significantly higher than those in group C(all P<0.05).After fluid injection,there was no statistically significant difference among groups C,T1,and T2 in bladder pressure[(6.7±1.0)mmHg,(5.8±1.9)mmHg,and(6.0±1.1)mmHg]or in bleeding volume[(1,163.0±191.3)mL,(1,212.0±148.4)mL,and(975.0±133.2)mL](allP≥0.05).The infusion volume in group T1[(1,250.0±225.8)mL]was significantly larger than that in group C[(951.7±177.8)mL](P<0.05).No colorectal or bladder injuries were found by the anatomy of the experimental animals in 3 groups.Conclusion sPPB tamponade with 1,000-mL fluid injected in a swine model can efficiently control pelvic fracture-associated arterial and venous hemorrhage,and increase the 60-min survival rate with no colorectal or bladder injuries.
作者
邴海龙
张晨曦
孙丽炜
李放
林琳
李留美
储勤军
金小高
连鸿凯
Bing Hailong;Zhang Chenxi;Sun Liwei;Li Fang;Lin Lin;Li Liumei;Chu Qinjun;Jin Xiaogao;Lian Hongkai(Department of Anesthesiology and Perioperative Medicine,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China;Department of Orthopaedics,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China;Trauma Research Center,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2023年第6期537-543,共7页
Chinese Journal of Orthopaedic Trauma
关键词
骨盆
骨折
出血
腹膜前间隙球囊
猪
Pelvis
Fractures,bone
Hemorrhage
Preperitoneal balloon
Swine
