【作者】 赵达强；

【导师】 王爱忠；

【作者基本信息】 苏州大学 ， 麻醉学， 2011， 硕士

【摘要】 目的:观察经皮心肺支持对猪暴发型脂肪栓塞综合征的抢救治疗效果,从而为临床将经皮心肺支持应用于抢救治疗暴发型脂肪栓塞综合征提供参考依据。研究方法:将重32.85-46.35 Kg的小型猪12只,随机分配至实验组和对照组。在实施气管插管全麻后,静脉注射致死剂量的脂肪(12ml),两组都给予大剂量激素、扩容、抗凝及升压等常规对症支持治疗。实验组除给予上述治疗外,还给予经皮穿刺股动静脉置管的心肺支持疗法。记录和测定两组在注射脂肪前、注射脂肪后即刻、1小时、2小时、3小时、4小时、5小时、6小时、7小时、8小时、9小时、10小时的平均动脉压(MAP)、中心静脉压(CVP)、呼气末二氧化碳分压(PETCO2)、氧饱和度(SpO2)、血管活性药物的用量、动脉血二氧化碳分压(PaCO2)、血中乳酸浓度、血中游离脂肪酸水平、两组实验动物的生存时间和不同时点的死亡率。研究结果:实验组注射脂肪液后5小时和10小时的死亡率显著低于对照组(0 Vs 83.3%, P<0.01;0 Vs 100%, P<0.01);对照组的小型猪平均在静脉注射脂肪后184.17±54.81分钟时死亡,各观察指标均恶化。而实验组的小型猪静脉注射致死剂量的脂肪之后,通过经皮心肺支持治疗,可以存活至体外循环10小时之后,并且各项观察指标在恶化后逐渐恢复至正常或接近正常水平。结论:经皮心肺支持可以使暴发型脂肪栓塞综合征的猪度过最初的极度右心、全心衰竭和酸中毒,可以有效地为全身脏器提供所需的氧耗,为抢救暴发型脂肪栓塞综合征,及进一步呼吸支持治疗创造条件,从而降低死亡率。更多还原

【Abstract】 Objective: To evaluate the effectiveness of percutaneous cardiopulmonary treatment for massive fat embolism and to explore the feasibility of the technology for clinical pulmonary fat embolism。Methods: Randomly assigned 12 piglets (weight between 32.85-46.35kg) into 2 groups: control group (II) and test group (I). After tracheal intubation under general anesthesia, the piglets were injected fetal dose of fat (12ml) intravenously. Both groups received supportive treatment such as large dose of steroids, fluids, anticoagulants and positive inotropic agents. But for the test group, percutaneous cardiopulmonary bypass was set up through the femoral vein. MAP ,CVP ,PETCO2 , SpO2 , PaCO2 ,lactic acid (LAC) and free fatty acid were monitored continuously and recorded in before and right after fat injection and then every hour for 10 hours. The total dosage of positive inotropic agents , the survival time and mortality rate were compared between the two groups.Results: The mortality of 5th hour,10th hour in the test group were much lower than in t -he control group. The average survival time after fetal dose of fat injection in the control g -roup was 184.17±54.807 min with all the monitored vital signs deteriorated dram -atically. While in the test group, the piglets survived more than 10 hours after the fetal fat injection. Moreover, the vital signs and the monitored data returned to or close to the base - line unde -r the percutaneous cardiopulmonary support.Conclusion: Percutaneous cardiopulmonary support can effectively provide oxygen supply sufficiently for the primary damaged right heart failure and severe acidosis caused by massive pulmonary fat embolism and then it can facilitate the further advanced life support and eventually reduce the mortality and morbidity.更多还原