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目的 探讨急诊体外循环 ( ECC)对于心脏火器贯穿伤的支持治疗 .方法 杂种犬 2 1只 ,随机分为对照组、ECC组和 ECC+手术治疗组 .麻醉后用小口径步枪射击犬心前区 ,对照组仅行伤口封闭 ,输液及胸腔闭式引流 .其余两组于伤后 5~ 7min内开始急诊 ECC. ECC组持续 ECC 3 h;ECC+手术治疗组于 ECC支持 0 .5 h后行受伤肺叶切除、心脏修补术 ,术后停 ECC,观察 3 h.实验结束后处死动物取标本 .测量血流动力学指标 ,行血气分析 .检测血浆 AL T,BUN,Cr,CK含量 .结果 各组动物心脏伤均以右室贯穿伤为主 ,伤后 2 min时胸引量为 ( 388± 6 5 ) m L .右室贯穿伤的动物平均动脉压均在 1min内降至 4k Pa以下 .应用体外循环支持可以维持动脉压为8~ 12 k Pa,循环后 1h,3 h血液中游离 Hb含量分别是 0 .2 9g.L- 1 和 0 .7g.L- 1 .ECC+手术治疗组动物脱离体外后 1,3h心率、平均动脉压和中心静脉压均与术前无显著性差异 .结论 急诊体外循环可以维持心脏火器贯穿伤动物在伤后 3 h的各项生命指标 ,并能保护各重要脏器功能 .及时地进行手术修补治疗可以明显提高心脏贯穿伤后的救治效果
Objective To investigate the supportive treatment of cardiac cardiopulmonary penetrant by Emergency Cardiopulmonary Bypass (ECC) .Methods 21 dogs were randomly divided into control group, ECC group and ECC + operation group.After anesthesia, The control group received only wound closure, infusion and closed thoracic drainage.The remaining two groups began emergency ECC within 5 ~ 7min after injury.The ECC group kept ECC 3h and the ECC + operation group received 0.5h after ECC support And the heart was repaired, ECC was stopped after operation, and observed for 3 hours.After the experiment, the animals were sacrificed to take the samples.Hydrodynamic indexes were measured and blood gas analysis was performed to detect the content of ALT, BUN, Cr and CK.Results The contents of ALT, The right ventricular trauma was the main cause of heart injury, and the volume of thoraco-introductions was (388 ± 6 5) m L at 2 min after injury.The mean arterial pressure of the traumatic right ventricle decreased below 4 kPa within 1 min. Cyclic support can maintain arterial pressure of 8 ~ 12k Pa, circulating Hb 1h, 3h blood free Hb levels were 0. 29g.L-1 and 0. 7g.L- 1.ECC + surgery group animals out of the body 1,3 h after heart rate, mean arterial pressure and central venous pressure were no significant difference with preoperative .Conclusion emergency bypass heart firearm can be maintained throughout the life of the animal injury indicators after 3 h of injury, and to protect important organs function. Timely surgical repair treatment can significantly improve the treatment effect through the heart after injury