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目的探讨急进高原火器伤血流动力学、血气及血生化指标的改变及丹参(SM)、地塞米松(DEX)单用或伍用对其的疗效。方法在西藏拉萨(海拔3 658m),采用五三式滑膛枪发射1.03g钢珠致伤急进高原的四川长白山猪后肢,观察火器伤后血流动力学、血气及血生化指标的改变及SM、DEX单用和伍用的治疗作用。结果急进高原猪火器伤后,平均肺动脉压(MPAP)、肺动脉楔压(PAWP)呈上升趋势,伤后6小时达最高,心输出量(CO)伤后1小时呈升高趋势,随后呈下降趋势;平均动脉压(MAP)、心率(HR)各组致伤前后无显著变化;单纯致伤组伤后动脉血PaO2、PaCO2显著下降,6小时最低(P<0.05);24小时血肌酐(Cr)水平显著升高(P<0.05);谷丙转氨酶(ALT)活性呈上升趋势;各组伤后K+均呈升高趋势,但Na+、C l-及血氧饱和度(O2STA)致伤前后无显著变化。SM、DEX单用和伍用均可不同程度地降低MPAP、PAWP,增加CO;伤后24小时动脉血PaO2基本恢复至伤前水平;血液Cr水平降低(P<0.05),其中以DEX单用和SM、DEX合用组效果最好。结论SM、DEX能改善急进高原火器伤的血流动力学指标,减轻缺氧及创伤所致的组织损伤,改善重要脏器的功能。
Objective To investigate the changes of hemodynamics, blood gas and blood biochemical indexes and the curative effect of salvia miltiorrhiza (SM) and dexamethasone (DEX) alone or in combination on firearm in acute plateau. Methods In Lhasa, Tibet (3 658m above sea level), 1.03g steel ball was used to hit the hind limbs of Changbai Mountain pigs in the plateau. The changes of hemodynamics, blood gas and blood biochemical indexes and the changes of SM, DEX Single and multi-purpose treatment. Results The average pulmonary arterial pressure (MPAP) and pulmonary arterial wedge pressure (PAWP) showed an upward trend after acute firearm wounds on the plateau, reaching the highest level at 6 hours after injury. The output of cardiac output (CO) tended to increase at 1 hour and then decreased There were no significant changes in mean arterial pressure (MAP) and heart rate (HR) in each group before and after injury. The PaO2 and PaCO2 in arterial blood in traumatic injury group were significantly decreased (P <0.05) (P <0.05). The activity of ALT showed an upward trend. The levels of K + increased after injury in all the groups, but the levels of Na +, C l- and oxygen saturation (O2STA) Before and after no significant change. SM and DEX could reduce MPAP and PAWP to a certain degree and increase CO, respectively. PaO2 in arterial blood recovered to pre-injury level 24 hours after injury; blood Cr level decreased (P <0.05) And SM, DEX combination group the best. Conclusion SM and DEX can improve hemodynamic indexes of firearm wounds in rapid plateau, reduce tissue damage caused by hypoxia and trauma, and improve the function of vital organs.