Experimental Research On Balloon Tamponade In Severe Hepatic Trauma Hemostatic

Background In some modern local wars, the wounders have been widely used in the damage control surgery (Damage control surgery, DCS) concept. Severe trauma victims only do simple processing at first, such as the maintenance of stable hemodynamics and respiratory tract, wound dressing, packing hemorrhage, external rupture of the intestine. Complex deterministic repair operation will becompleted at rear qualified hospitals.The rapid development of fast maneuveringability of our army provides a reliable way for the application of DCS.The liver is one of the most common damaged organs in abdominal trauma, the main performance of severe liver trauma is the rapid development of hemorrhagic shock. How to use the simple and effective bleeding control technology limited liver hemorrhage in the most short time,to delay in the process of the rapid deterioration of the hemodynamic, to transfer the wounded back to hospital fortreatment is our topic in the first place.The traditional method is gauze packing hemostasis for the uncontrolled bleeding of severe liver injury. But the gauze tamponade effect often rely on theoperator’s experience, at the same time, gauze packing will cause the liver tissue necrosis, bleeding again after removal of gauze and so on.Based on the above background, this study established liver injury animal model of controllable.Try using the "pressure adjustable balloon"packing,Combined with the rapid implementation of control liver hemorrhage with the intermittent Pringle technique outside the peritoneal cavity to treat the severe liver trauma injury of animal model. To provide a theoretical basis for the clinical application of the method.To evaluate and discuss the method feasibility as field surgical treatment.Objective To establish explosive injury of liver model.Using the self-developed "pressure adjustable air bag" for peripheral hepatic oppression, at the same time, rapid implementation of control liver hemorrhage with the intermittent Pringle technique outside the peritoneal cavity. Monitor hemodynamics indexes, liver function damage and free radicals, lipid peroxidation damage level after implementation of the above method. To provide a theoretical basis for the application of quick and easy liver hemorrhage control technology.Methods After the animal abdominal incision, place the explosives on the lobe of the liver surface, implement protective measures to the adjacent organs, thenfire. Using the formerly established approach to make experimental canine AASTⅢ、Ⅳ hepatic trauma (n=18). The animal were randomly divided into control group and treatment group, the treatment group include A, B, C, D four subgroups. A groups of air pressure is10mmHg, sustained compression time is2h(P=10mmHg, T=2h);B group gasbag pressure is10mmHg,sustained compressiontime of4h(P=20mmHg, T=2h); C balloon pressure20mmHg, sustained compression time of2h(P=20mmHg, T=4h); D balloon pressure is20mmHg, time4h,blocking(P=20mmHg, T=4h).After injury6minutes, establish intravenous accessto fluid resuscitation then immediately the10mmHg,20mmHg pressure adjustable air bag is arranged in the liver wound, fast control liver hemorrhage and external abdominal implementation of intermittent Pringle technique. Intermittent Pringle, blocking time is20min, the opening time is2min.The values of infrahepatic inferior vena cava pressure (IHIVCP),central venous pressure(CVP), mean aortlc pressure(MAP) were recorded,liver lesion area (cm2) and the amount of blood loss were measured, liver tissue malondialdehyde (MDA) content, alanineaninotransferase(ALT) and aspartateaminotransferase(AST) were tested also after injury. Comparison of indexes in different hepatic peripheral pressure of oppression,to determine a reasonable and effective pressure to liver and optimum balloon compression time.Results1.Each group of experimental animal preoperative mean arterial pressure based mean value fluctuates between94.75and11.42mmHg. The liver lesionarea of the control group and treatment group after injury was10.88±1.21cm2, the blood loss was94.61±9.02ml after injury. Each group of mean arterial pressure, liver damage area after injury and blood loss has no significant difference (P=0.526, P=0.946) before balloon tamponade.2.After the injury, the operation group compared with the control group, the experimental animal has more survival time, mean arterial pressure decreased slower, less blood loss, the treatment group and control group were significantly different (P<0.05).3.After explosive injury, at the same time after operation, the total of blood loss of group balloon tamponade with10mmHg pressure was significantly more than that of group in20mmHg pressure (P<0.05), what more, the experimental animal had hemorrhagic shock at4hours after injury, AST, ALT, MDA increased in different degrees; Balloon tamponade after20mmHg blood loss was significantly less than for10mmHg, but under the pressure of20mmHg compression, the inferior vena cava pressure and central venous pressure of the experimental group animal were increased, also,the AST, ALT, MDA were significantly increased. Compared to10mmHg and20mmHg pressure of the balloon tamponade, the degree of liver damage has obvious differences (P<0.05).Conclusions1.Successfully establish in accordance with AAST III, IV injury animal model with the simple explosive device, which is controllable and repeatability.2. The adjustable pressure balloon compression combined with in vitro implementation of intermittent Pringle technique can be convenient and fast to control liver hemorrhage, the method can play a similar role of hemostatic gauze packing, and What’s more, operating experience of this method is low dependence. The pressure generated by the air bag to the liver can conveniently adjust according to the changes of physiological indexes of patients and hemostatic effect.3. The results show:the appropriate pressure to the liver can produce certain hemostatic effect, the excessive pressure to the liver better hemostatic effect, but also had severe liver damage, the canine hepatic wound can bear limited pressure and pressing time, the more pressure generated by the air bag to the liver,hemostatic effect is more obvious,but the liver damage caused by liver compression is more serious. We should as far as possible reduce the liver wound bleeding by optimizing the air bag pressure and pressing time to avoid serious liver damage.