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Medicine
一种新的猪腋窝交界性出血混合定量评价模型
一种新的猪腋窝交界性出血混合定量评价模型
JoVE Journal
Medicine
This content is Free Access.
JoVE Journal Medicine
A New Hybrid Quantitative Evaluation Model for Axillary Junctional Hemorrhage in Swine

一种新的猪腋窝交界性出血混合定量评价模型

Full Text
714 Views
08:27 min
December 6, 2024

DOI: 10.3791/66974-v

Dongchu Zhao*1, Chang Liu*1, Yong Guo2, Huaya Zhang1, Lianyang Zhang*1, Yang Li*1

1State Key Laboratory of Trauma, Burns and Combined Injuries, Medical Center of Trauma and War Injury, Daping Hospital,Army Medical University, 2Emergency Department, Emergency and Critical Care Medicine Center,The Third Affiliated Hospital of Chongqing Medical University

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Please note that some of the translations on this page are AI generated. Click here for the English version.

Overview

This study presents a hybrid quantitative model for axillary junctional hemorrhage in swine, enhancing pre-hospital hemostatic intervention evaluation. The research investigates the effectiveness of combining controlled hemorrhage with free bleeding to improve emergency interventions in hemorrhagic shock.

Key Study Components

Area of Science

  • Hemostasis
  • Emergency medicine
  • Animal models

Background

  • The femoral artery hemorrhage model is commonly used in hemostasis research.
  • The axillary artery hemorrhage model has been largely unexplored.
  • This study aims to establish a foundation for future hemostasis research in the axillary junctional area.
  • Innovative hemostatic devices are needed for massive bleeding in junctional areas.

Purpose of Study

  • To develop a hybrid quantitative model for axillary junctional hemorrhage.
  • To evaluate pre-hospital hemostatic interventions.
  • To explore new hemostatic strategies for hemorrhagic shock.

Methods Used

  • Mechanical arms and vascular blocking bands were used in the hemorrhage model.
  • Controlled hemorrhage was combined with free bleeding and controllable pressure.
  • Ultrasonography was employed to map the axillary artery.
  • Blood loss was measured under controlled conditions during the experiments.

Main Results

  • The mean blood loss after volume-controlled hemorrhage was measured across three groups.
  • No statistically significant difference in blood loss under compression was observed among the groups.
  • The study provides data on blood loss percentages relative to total blood volume.
  • Results indicate the potential effectiveness of the hybrid model for future research.

Conclusions

  • The hybrid model enhances the understanding of hemostatic interventions.
  • Future studies can build on this foundation to develop new hemostatic devices.
  • This research contributes to the field of emergency medicine and trauma care.

Frequently Asked Questions

What is the significance of the axillary junctional hemorrhage model?
It provides a new avenue for research in hemostasis at junctional areas, which has been largely unexplored.
How does this study improve pre-hospital interventions?
By evaluating the effectiveness of combining controlled hemorrhage with free bleeding, it aims to enhance emergency response strategies.
What methods were used to measure blood loss?
Blood loss was measured using a combination of mechanical arms, vascular blocking bands, and precise monitoring techniques.
What are the future implications of this research?
The findings can guide the development of new hemostatic devices and strategies for managing massive bleeding in trauma cases.
What were the main findings regarding blood loss?
The study found no significant differences in blood loss among the experimental groups, providing baseline data for future research.

本研究提出了一种猪腋窝交界性出血的混合定量模型,加强了院前止血干预评估。

我们的研究重点是创新性地将机械臂和血管阻塞带应用于出血模型。我们正在研究控制出血与自由出血和可控压力的结合如何提高失血性休克病例院前紧急干预的有效性。在交界区止血领域,股动脉出血模型使用最多,而辅助动脉出血模型尚未探索。

我们的模型为腋窝交界区的止血研究奠定了基础。未来,我们的实验室将专注于开发用于交界区大量出血的新型止血装置和快速止血策略的研究。首先,将注射了镇静剂的动物转移到手术室,并将其肢体固定在手术台上的仰卧位置。

然后用静脉留置针刺穿耳静脉。使用手术刀,从甲状软骨到胚根做一个 8 厘米的纵向皮肤切口。用钝尖手术剪刀,沿着胸骨舌骨肌的内侧表面解剖,加深解剖并在气管处做一个一厘米的切口。

然后将一根 7 毫米的气管切开插管插入 6 厘米深处,并将其连接到呼吸机上。接下来,采用切开技术对左颈动脉进行插管,至少需要两名作员。使用气管切开切口,解剖胸骨舌骨肌外侧的组织,将左颈动脉与周围的筋膜隔离开来。

用一只手用丝线缝合线抬高动脉,同时用另一只手用针刺穿动脉。然后注入 5 毫升 0.9% 氯化钠溶液以验证针头位置。在缩回针头的同时将导丝推进管子。

然后使用导线引导的导引器,提取管子并插入护套。插入后,取出导引器和导线。为了隔离右颈动脉和颈静脉,在对侧的胸骨舌骨肌附近进行侧向解剖。

现在,将一根具有双端口的 7.0 French 中心静脉导管放入右颈静脉,并立即连接传感器系统进行中心静脉压测量。将乳酸林格溶液连接到中心线的一个端口,并通过另一个端口输注维持盐水以减轻导管阻塞。接下来,将配备热敏电阻的 4.0 French 动脉导管引入右颈动脉,将其连接到心脏监护仪,同时将监护仪的静脉测量单元连接到中心静脉换能器。

将静脉和动脉换能器校准到参考腋中线的零。然后使用心脏监护仪持续监测和记录心率以及收缩压和舒张压。要引发失血性休克,使用在 T 零处收集的基线数据,在 20 分钟内以特定的平均速率从左颈静脉抽血。

第 1 组、第 2 组和第 3 组分别退出 0.33 毫升/千克/分钟、0.67 毫升/千克/分钟和 1 毫升/千克/分钟。使用超声多普勒检查来绘制腋动脉图,并区分腋窝中的动脉、金星和神经结构。将探针垂直于胸肌上方的真皮层对齐,使腋动脉能够精确解剖定位。

然后根据超声成像建立的解剖标志,标记一个 10 厘米的弧形切口作为手术入口。部分切除胸浅肌和深肌,露出腋窝鞘。要暴露腋动脉,请使用微型剪刀钝化,解剖腋窝鞘,并将 6 厘米的动脉段与周围的静脉和臂丛神经隔离开来。

然后将红色带子放在腋动脉段的近端,将绿色带子放在腋动脉段的远端,以便在造成伤害之前固定血管。系好两条血管阻塞带,暂时阻断血流。使用微型剪刀,在血管周长的三分之一左右创建一个 2 毫米的水平切口。

将外部加压装置的机械臂连接到手术台的侧面。将充气止血球连接到手臂末端。然后将柔性薄膜压力传感器固定在充气止血球囊表面的中心点,以测量直接压力。

安装后,打开软件。单击 Connected device,选择 single channel 选项,然后从 sampling rate 菜单中选择 1000 data points per second。对于输入通道,请选择 Band display 对于输出通道,请选择 Output display。

在记录之前,确保压力测量系统校准为零。单击圆形红色按钮开始录制。为了模拟外部压迫,在释放两个血管阻塞带后立即瞄准腋生伤口上的机械臂,手动给止血球囊充气以实现局部压迫,直到压力达到 210 毫米汞柱。

在压缩过程中观察设备以确保没有位移。外部压缩后,单击红色方块按钮停止数据收集。取下装置后,称量纱布以计算按压下的失血量。

第 1 组、第 2 组和第 3 组容量控制出血后的平均出血量分别为 354.2 、 714.4 和 1064.0 毫升,占总血容量的 10%、20% 和 30%。三组之间在加压下失血量没有统计学意义差异。第 1 组、第 2 组和第 3 组的平均总失血量分别为 462.9 、 893.0 和 1213.0 毫升,对应于 1 、 2 和 3 类出血性休克。

观察到所有组的心率在响应诱导休克时显着增加。心率升高在体外加压期间最为明显,并在移除时降低。心率升高的程度与采血量成正比,第 3 组增加最显着,其次是第 2 组和第 1 组。

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