亚低温治疗创伤性凝血病合并肺损伤的实验研究方志成郑翔陈黎盛.doc

亚低温治疗创伤性凝血病合并肺损伤的实验研究　　 方志成 郑翔 陈黎 盛春风 黄云飞　　 【摘要】 目的 观察亚低温对创伤性凝血病并肺损伤的临床治疗效果， 寻找创伤性凝血病治疗方法。方法 30 只日本大耳白兔行剖胸探查术， 制作创伤性凝血病动物模型， 选择合并呼吸道出血的创伤性凝血病动物，随机分为对照组、 亚低温组， 观察动物呼吸机应用时间、 呼吸机参数， 评估呼吸机支持力度， 测定血气分析，评估氧代谢， 监测凝血功能、 ELISA 法测定肺组织局部 TNF-α 水平， 评估亚低温对创伤性凝血病治疗效果。结果 与对照组相比，亚低温治疗组呼吸机平均机械通气时间短， 脱机早， 呼吸机辅助呼吸力度低( P 　　0. 05) ，血气分析结果显示氧分压( PaO2 ) ，动脉血氧饱和度( SPO2 ) 明显升高( P 0. 05) ， 肺泡 - 动脉氧分压差( P( A - a) O2 ) 明显下降( P 0. 05) ，肺组织局部 TNF-α 水平明显下降( P 0. 05) 。结论 亚低温可有效治疗创伤性凝血病，机制与改善氧合、 抑制肺组织局部炎症等因索有关 【关键词】 亚低温; 创伤性凝血病; 肺损伤　　 Study of mild hypothermia in the treatment of traumatic coagulopathy complicated with lung injury FANG 　　 Zhi-cheng， ZHENG Xiang， CHEN Li， SHENG Chun-fen， HUANG Yun-fei Department of Intensive Care Unit， Taihe Hospital Affiliated to Hubei University of Medicine， Shiyan， Hubei 442000， China 　　 【Abstract】 Objective To observe the curative effect of mild hypothermia in the treatment of traumatic coagulopathy complicated with lung injury. Methods 30 Japanese big-ear rabbit were given thoracic surgical exploration to set up the rat model of traumatic coagulopathy. The models complicated with respiratory tract bleeding were chosen. They were randomly divided into the control group and the mild hypothermia group. Ventilator application time and the parameters of breathing machine were observed. The ventilator support was assessed. Their blood gas analysis， oxygen metabolism， and blood coagulation function were evaluated. The level of TNF-α was detected by ELISA. Results Compared with the control group， the low temperature treatment group had shorter duration of mechanical 　　ventilation， earlier weaning， lower breath strength of breathing machine ( P 0. 05 ) . Blood gas analysis results showed that oxygen partial and pressure ( PaO2 ) and arterial blood oxygen saturation ( SPO2 ) increased significantly ( P 0. 05) ， the level of P( A - a) O2 decreased obviously ( P 0. 05) . Conclusion Mild hypothermia can be effective in the treatment of traumatic coagulopathy， which m