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| 大鼠海水浸泡体温过低症水浴复温的实验研究 |
| 奂剑波1,陈丽娜2,韩志海1,代维3,袁丹凤3,周继红3,史成和4* |
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(1. 海军总医院呼吸与危重症医学科, 北京 100048;
2. 安徽医科大学研究生院, 合肥 230032;
3. 陆军军医大学(第三军医大学)大坪医院野战外科研究所第四研究室, 创伤烧伤与复合伤国家重点实验室, 重庆 400042;
4. 海军总医院海战伤救治研究中心, 北京 100048
*通信作者) |
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| 摘要: |
| 目的 观察重度海水浸泡体温过低症大鼠不同热水浴复温成功率和复温曲线特征。方法 取490只雄性SD大鼠（实验前行温度记录器腹腔置入术），随机分为浸泡组（450只）和对照组（40只），浸泡大鼠在（15.0±0.2）℃海水中分别浸泡不同时长：2 h（100只）、5 h（150只）、10 h（200只），每个浸泡时长的存活大鼠均随机分为5个亚组并给予相应的方法复温：被动复温（被动复温组）、37℃热水浴复温0.5 h（37℃主动复温0.5 h组）、37℃热水浴复温1 h（37℃主动复温1 h组）、42℃热水浴复温0.5 h（42℃主动复温0.5 h组）、42℃热水浴复温1 h（42℃主动复温1 h组）；对照组不进行海水浸泡，随机均分为4个亚组，分别给予上述4种不同方法的热水浴复温。计算各组的复温成功率；复温20 h后采集存活大鼠血清检测肌酸激酶同工酶（CK-MB）、丙氨酸转氨酶（ALT）、乳酸脱氢酶（LDH）水平；取出温度记录器读取动态腹腔温度数据，计算被动复温速度、热水浴复温迟发后降效应。结果 随着浸泡时间的延长，浸泡组大鼠低温海水浸泡存活率下降（P<0.05），被动复温组及主动复温组的复温成功率均下降（P<0.05），37℃主动复温1 h组大鼠复温成功率大于或等于其他主动复温组，且大于或等于被动复温组；对照组热水浴后均存活。存活大鼠血清CK-MB、ALT和LDH水平随着浸泡时间延长逐渐升高，主动复温组较对照组均升高（P<0.05），在浸泡时长相同时，37℃主动复温1 h组的CK-MB、ALT和LDH水平低于其他主动复温组，且低于被动复温组，部分差异有统计学意义（P<0.05）。分析复温曲线，被动复温组复温速度随浸泡时间的延长而下降（P<0.05），且死亡大鼠的复温速度低于存活大鼠（P<0.05）；热水浴复温大鼠腹腔温度可出现迟发后降效应，迟发后降总效应越大，死亡率越高；对照组37℃热水浴迟发后降效应不明显，42℃热水浴明显（P<0.05）。结论 在重度海水浸泡体温过低症的救治中，恰当的热水浴复温成功率大于被动复温。紧急情况下可以将热水浴作为一种复温选择，但不当的复温条件可降低救治成功率，其可能与迟发后降效应有关。 |
| 关键词: 海水浸泡 体温过低症 大鼠 温度记录法 复温 迟发后降效应 |
| DOI：10.16781/j.0258-879x.2018.04.0443 |
| 投稿时间：2017-11-15修订日期：2018-02-19 |
| 基金项目:全军后勤科研计划重点项目（BHJ14C009，BHJ16J011）. |
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| Experimental study on water bath rewarming in rats with hypothermia by seawater immersion |
| HUAN Jian-bo1,CHEN Li-na2,HAN Zhi-hai1,DAI Wei3,YUAN Dan-feng3,ZHOU Ji-hong3,SHI Cheng-he4* |
(1. Department of Respiratory and Critical Care Medicine, Navy General Hospital, Beijing 100048, China;
2. Graduate School, Anhui Medical University, Hefei 230032, Anhui, China;
3. The Fourth Research Room of Field Surgery Institute, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University(Third Military Medical University), Chongqing 400042, China;
4. Navy War Treatment Research Center, Navy General Hospital, Beijing 100048, China
*Corresponding author) |
| Abstract: |
| Objective To observe the success rate and rewarming curve of different water bath rewarming in rats with severe seawater immersed hypothermia. Methods A total of 490 male SD rats were intraperitoneally implanted with temperature recorder before experiment, were randomly divided into immersion group (n=450) and control group (n=40). In immersion group 100 rats were immersed in (15.0±0.2)℃ seawater for 2 h, 150 rats for 5 h, and 200 rats for 10 h. The survival rats of each group were randomly divided into five subgroups and given different rewarming treatments:passive rewarming (passive rewarming subgroup), 37℃ hot water bath rewarming for 0.5 h (37℃ active rewarming 0.5 h subgroup), 37℃ hot water bath rewarming for 1 h (37℃ active rewarming 1 h subgroup), 42℃ hot water bath rewarming for 0.5 h (42℃ active rewarming 0.5 h subgroup), 42℃ hot water bath rewarming for 1 h (42℃ active rewarming 1 h subgroup). The rats in the control group were without seawater immersion, and were randomized into four subgroups as above. The success rate of rewarming was calculated in each group. The serum levels of creatine kinase isoenzyme (CK-MB), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) were determined in the survival rats after rewarming for 20 h. Dynamic intraperitoneal temperature was recorded at the end of the experiment, and then the passive rewarming velocity, delay afterdrop effect of hot water bath rewarming were calculated. Results With the prolongation of immersing time, the survival rate of rats was significantly decreased in the immersion group (P<0.05). The rewarming success rates were significantly decreased in both the passive and active rewarming groups (both P<0.05). The rewarming success rate in the 37℃ active rewarming 1 h subgroup was greater than or equal to other active rewarming subgroups and the passive rewarming subgroup. All rats in the control group survived after hot water bath. Compared with the control group, the serum levels of CK-MB, ALT and LDH were significantly increased in the surviving rats of the active rewarming subgroups with the prolongation of immersion time (P<0.05). At the same immersing time, the levels of CK-MB, ALT and LDH were significantly lower in the 37℃ active rewarming 1 h subgroup than those in the other active rewarming subgroups (P<0.05 for some results), and were lower than those in the passive rewarming subgroup (P<0.05 for some results). Rewarming curve showed that the rewarming velocity of the passive rewarming subgroup significantly decreased with the prolongation of immersing time (P<0.05), and the rewarming velocity of the dead rats was significantly lower than that of the surviving rats (P<0.05). Delayed afterdrop effect was found in abdominal temperature of hot water rewarming rats, and the greater the effect was, the higher the mortality rate was. The delayed afterdrop effect of 37℃ hot water bath was not obvious in the control group, but it was significantly obvious in 42℃ hot water bath subgroups (P<0.05). Conclusion The success rate of proper hot water bath rewarming is greater than that of passive rewarming in the treatment of severe seawater immersed hypothermia. Hot water bath can be used as a rewarming option in emergency situations, while improper rewarming conditions can decrease the treatment success rate, which may be related to the delayed afterdrop effect. |
| Key words: seawater immersion hypothermia rats thermography rewarming delayed afterdrop effect |
