Effect of damage control surgery in the treatment of penetrating intestinal gunshot wounds in simulated cold plateau environment-a pig model
Objective To observe the rescue effect of damage control surgery (DCS) vs.traditional surger-y in the treatment of penetrating intestinal injuries caused by abdominal gunshot wounds in pigs in simulated cold plateau environment.Methods A total of30 healthy Landrace piglets aged10-12 weeks were randomly divided in-to 3 groups(n=10):respectively high-altitude injury (HI) group,high-altitude injury+traditional surgery (HIT) group,and high-altitude injury+DCS ( HID) group.The cold plateau environment was achieved in our lab,with the altitude set at 6,000 m,air pressure of about 4.7 kPa,and temperature of 8℃±2℃.The model pigs were first lo-cated in the lab chamber for 48 h,then shot by a police standard QSZ92 pistol (9 mm bullet) at 2 cm horizontally behind the navel to create penetrating intestinal injuries.After injury,in HI group wound dressing and observation treatment were conducted;in HIT group,4 h after injury the damaged small intestine or ischemic necrosis small in-testine was resected and then traditional surgery of end-to-end intestinal anastomosis was performed;In HID group,4 h after injury DCS was conducted:a decompression tube was placed at the proximal end of the broken small intes-tine and the distal end of the small intestine was closed.Small intestine with multiple perforations or ischemic necro-sis was resected,together with proximal placement of decompression tube and distal intestinal closure.The general situation,vital signs,surgery-related indicators,white blood cell count ( WBC),neutrophil count ( NEUT),interleu-kin-6 ( IL-6 ),tumor necrosis factor-α( TNF-α),alanine aminotransferase ( ALT ),aspartate aminotransferase (AST),complications,and survival were analyzed at 0,4,12,24,48 and72 h after injury.Results Contusion and rupture of the small intestine,mesenteric injury,colon rupture,bullet hole diameter,and abdominal hematocele vol-ume showed no significant differences between HIT and HID groups (all P>0.05).From 12 h,compared with HI group,HID group showed much lower respiratory rate (breaths/min,25.2±4.0 vs.32.0±4.0),heart rate (beats/min,129.9±9.8 vs.143.6±11.4) and body temperature (℃,38.3±0.6 vs.38.8±0.6).At 48 h,the HID group also showed much lower body temperature than HIT group (℃,38.3±0.6 vs.39.6±0.6,P<0.05),and quicker stabilization of vital signs.Moreover,the HID group revealed much shorter surgery time (min,146.00±14.68 vs.46.00±9.37),respiratory recovery time (min,26.20±4.24 vs.46.10±3.84),extubation time (min,45.40±3.03 vs.95.70±3.30),free movement time (min,96.90±4.48 vs.198.20±4.80),and first defecation time (h,27.90±7.80 vs.47.88±5.14),and the intraoperative blood loss and infusion volume were also signifi-cantly less (all P<0.05) compared with HIT group.From 12 h,HID group showed much lower levels of WBC,NEUT,IL-6 and TNF-α than HI group (all P<0.05),while comparison with the HIT group showed much lower WBC and NEUT from 12 h,lower IL-6 from 24 h and lower TNF-α from 48 h (all P<0.05).ALT and AST levels were much lower in HID group than in HI group from 12 h (ALT:U/L,88.4±9.9 vs.138.1±14.4;AST:U/L,110.4±8.8 vs.210.1±11.6),but comparison with HIT group revealed significant differences from 24 h (ALT:U/L,66.6±14.0 vs.82.0±8.3;AST:U/L,96.4±8.9 vs.109.7±9.9,both P<0.05).The incidence of postoperative fever,incision bleeding,skin ecchymosis and intestinal leakage was much lower in HID group than that in HIT group (all P<0.05).The 72 h survival rate of pigs in HI,HIT and HID groups was 60％,70％ and 100％,respectively.The survival curve of HID group was better than that of HI group(P<0.05).Conclusion Compared with traditional end-to-end intestinal anastomosis,early DCS after penetrating intestinal gunshot injuries in pig mod-els can shorten operation time,reduce intraoperative bleeding,accelerate anesthesia recovery,promote early postoper-ative gastrointestinal functional recovery and activity,reduce surgical complications,improve vital signs,serum in-flammatory factor levels,and survival time.DCS is recommended for early treatment of penetrating intestinal gunshot wounds in a cold plateau environment.
Penetrating intestinal injuriesGunshot woundDamage control surgeryCold plateau environment
万方数据
维普
