| Background In some modern local wars, the wounders have been widely used in the damage control surgery (Damage control surgery, DCS) concept. Severe trauma victims only do simple processing at first, such as the maintenance of stable hemodynamics and respiratory tract, wound dressing, packing hemorrhage, external rupture of the intestine. Complex deterministic repair operation will be completed at rear qualified hospitals.The rapid development of fast maneuvering ability of our army provides a reliable way for the application of DCS.The liv er is one of the most common damaged organs in abdominal trauma, the main performance of severe liver trauma is the rapid development of hemorrhagic sh ock. How to use the simple and effective bleeding control technology limited1iver hemorrhage in the most short time,to delay in the process of the rapid det erioration of the hemodynamic, to transfer the wounded back to hospital for tr eatment is our topic in the first place.The traditional method is gauze packing hemostasis for the uncontrolled ble eding of severe liver injury. But the gauze tamponade effect often rely on the operator’s experience, at the same time, gauze packing will cause the liver tiss ue necrosis,bleeding again after removal of gauze and so on. Based on the abo ve background, this study established liver injury animal model of controllable. Tryusing the "pressure adjustable balloon"packing,Combined with the rapid impl ementation of control liver hemorrhage with the intermittent Pringle technique outside the peritoneal cavity to treat the severe liver trauma injury of animal model. To provide a theoretical basis for the clinical application of the method. To evaluate and discuss the method feasibility as field surgical treatment.Objective To establish explosive injury of liver model.Using the self-developed "pressure adjustable air bag" for peripheral hepatic oppression, at the same ti-me, rapid implementation of control liver hemorrhage with the intermittent Prin-gle technique outside the peritoneal cavity.assessing the injury control.To obser-ve and testi different pressure gradient and pression-blocking time for the influ-ence of intestinal mucosal barrier function and HCN-1protein expression.Acco-rding this to optimize pression-blocking time air bag pression.To provide a the oretical basis for the application of quick and easy liver hemorrhage control te-chnology.Methods The dogs were randomly divided into control group and treatment group.Control group after modeling only gave fluid resuscitation, not to stop bleeding.To record the change of all hemodynamic index from injury to death, and collect intestinal specimens after animals dead. The treatment group was di-vided Ⅰ and Ⅱ group.Ⅰgroups air pressure is10mmHg,Ⅱ group’s air pressure is20mmHg.Ⅰ group and Ⅱ group respectively include la and Ib two subgroups. The sustained compression time of a and b is respectively2h and4h. After inj-ury6minutes, establish intravenous access to fluid resuscitation, then according grouped pressure gradient,pressure adjustable air bag is arranged in the liver w ound, fast control liver hemorrhage and external abdominal implementation of intermittent Pringle technique. Intermittent Pringle, blocking time is20min, the opening time is2min.The values of infrahepatic inferior vena cava pressure(IIV-CP).central venous pressure(CVP).mean aortlc pressure(MAP) liver lesion area (cm2) and the amount of blood loss were recorded after injury according time. After all treatment groups over.to collect blood samples and apply Elisa to test D-Lactate contents.Also take the intestinal tissue samples, observing the intestin-al micro structure change and evaluating damage degree.At the same time.usin -g immunohistochemical method to detect the intestinal mucosa and the convey of HCN-1.Compare change of indexes in different hepatic peripheral air bag pressure,to determine a reasonable and effective pressure to liver and optimum balloon compression time.Results1. It is successful to establish the experimental dogs liver blast damage model. After modeling,the liver lesion area was10.88±1.21cm2.The liver trauma condition stables at AAST Ⅲ, Ⅳ.The first6minute blood loss is94.61±9.02ml. Each group has no obvious differences(P>0.05).2.Compare control group with treatment group,the two groups have obvious differences on survival time and blood loss(P<0.05).In I group,MAP、CVP、IHIVCP gradualiy decline by the time,and hemodynamic index accelerated declined nearby4h,at the same ti-me, the experimental animal had hemorrhagic shock.In II group,MAP steady,inf-erior vena cava pressure and central venous pressure have different increase.It respectively has no obvious differences and obvious differences compared with I group in2h(P>0.05) and after2h(P<0.05).3.Compared with the control group, The D-La content of experimental group increased obviously(P<0.05), Among all groups,the highest is Ⅱb subgroups. The comparison between each group had obvious difference (P<0.05).There are differences between la and Ib (P<0.05), but between Ⅱa and Ia,Ib had no difference(P>0.05).4.Observi-ng each intestinal mucosal morphology in microscopy, according Chiu’s standard to assess the intestinal damage degree,there were obvious differences between treatment group and control group.Among all groups,the damage of la is lighte-st, Ib and Ⅱa is similar,only the mucous membrane and gland have little swel-ling deformation, the local structure is still keep integrity. But Ⅱb damage more serious, intestinal mucous membrane and gland integrity is damaged, fluff fall off and local bleeding.5.Using immunohistochemical method to test convey of HCN-1, this hint HCN-1exist in normal bowel mucosa and smooth muscle clea-rance. After modeling,HCN-1expression increases rapidly. Then HCN-1expressi-on of control group decreased quickly,and treatment group decline slowly, there was obvious difference between two groups.The HCN-1expression of Ⅱb is lo -west, there was obvious difference comepared with other group (P<0.05), la and Ib has obvious difference(P<0.05),but Ⅱa and Ⅰa, Ⅰb has no difference(P>0.05).From HCN-1change trend, group decline quickly,as a "line".The cha nge trend of Ⅱ group present slow decline before2h,after2h falling slope incr e-aseing.Conclusions1.Successfully establish in accordance with AAST Ⅲ, Ⅳ injury a nimal model with the simple explosive device. which combine with liver balloo-n compression treatment to achieve fast and efficient hemorrhage control.2.Thro-ugh balloon internal pressure adjust liver pressure to observe the effect on int-estinal function under different pressure gradient and repression-blocking time. The experimental results show that combining Pringle with balloon compression to control liver rupture bleeding is efficient, and the liver hemostatic effect is better with increase of the pressure.20mmHg is more stable than10mmHg o-n hemodynamics indexes to achieve hemorrhage control,but the pressure increa-ser and repression-blocking time longer, the greater effect on intestinal micromo-rphology and physiological function.The change of intestinal congestion and hy-poxia under different pressure in2h is more consistent and the effects lighter, an-d more than2h effects on intestinal increase gradually, and high pressure to liver cause more severe effect on intestinal physiological function.So it should optimize air pressure and oppression time using this treatment disposal under the better hemorrhage control,to avoid increasing postoperative complications a-nd the treatment effect on normal physiological function,such as intestinal mu-cosal barrier and rhythmic movement. The study think the optimum pressure a-nd compression-blocking time combination is20mmHg on2h applying this met-hod. |
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