Objective To reproduce an animal model of multi-intestinal injuries with "lethal triad" characterized by low body temperature, acidosis and coagulopathy. Methods Six female domestic outbred pigs were anesthetized, and the carotid artery and jugular vein were cannulated for monitoring the blood pressure and heart rate and for infusion of fluid. The animals were shot with a gun to create a severe penetrating abdominal trauma. Immediately after the shooting, 50 ％ of total blood volume (35 ml/kg) hemorrhage was drawn from the carotid artery in 20min. After a 40min shock period, 4h of pre-hospital phase was mimicked by normal saline (NS) resuscitation to maintain systolic blood pressure (SBP) ＞8OmmHg or mean arterial pressure (MAP) ＞60mmHg. When SBP ＞ 8OmmHg or MAP ＞60mmHg, no fluid infusion or additional bleeding was given. Hemodynamic parameters were recorded, and pathology of myocardium,lung, small intestine and liver was observed. Results There were multiple intestinal perforations (8- 10 site injuries/pig) leading to intra-abdominal contamination, mesenteric injury (1-2 site injuries/pig) resulted in partial intestinal ischemia and intra-abdominal hemorrhage,and no large colon and mesenteric vascular injury. One pig died before the completion of the model establishment (at the end of pre-hospital resuscitation). The typical symptoms of trauma-induced hemorrhagic shock were observed in survival animals. Low temperature (33.3±0.5 ℃), acidosis (pH=7.242±0.064), and coagulopathy (protrombin time and activated partial thromboplasting time prolonged) were observed after pre-hospital resuscitation. Pathology showed that mvocardium, lung, small intestine and liver were severely injured.Conclusions A new model, simulating three stages of "traumatic hemorrhagic shock, pre-hospital recovery and hospital treatment" and inducing the "lethal triad" accompanied with abdominal pollution, has been successfully established. This model has good stability and high reproducibility. The survival animals can be used for related experimental intervention.%目的 建立严重腹部贯通伤致多发肠管损伤合并"致死三联征"(低体温、代谢性酸中毒、凝血功能障碍)的动物模型.方法 本地雌性杂种猪6只,麻醉后行颈内动静脉置管用于监测血压、心率及补液.动物侧卧,以实验用模拟枪枪击腹部1次.枪击后经颈动脉放血20min,占总血量50%(35ml/kg).40min后,采用生理盐水行允许性低血压复苏,维持收缩压(SBP)＞80mmHg或平均动脉压(MAP)＞60mmHg,模拟4h院前救治阶段.进行MAP、中心静脉压(CVP)、心率、动脉血气、凝血参数及血常规检测.取心肌、肺、小肠、肝组织行病理学检查.结果 枪击后出现多发肠管损伤、穿孔(每只动物8～10处)导致腹腔污染,肠系膜损伤导致局部肠管缺血、腹腔出血,无结肠及肠系膜大血管的损伤.至模型建立完成时1只动物死亡;5只生存动物均表现为典型的创伤失血性休克,院前复苏后均出现明显的低体温(33.3±0.5℃)、酸中毒(pH7.242±0.064)及凝血障碍(凝血酶原时间及部分凝血活酶时间明显延长),病理检查提示心肌、肺、小肠、肝均存在明显组织损伤.结论 本模型成功模拟"创伤失血性休克、院前复苏、院内治疗"三个阶段,成功引入"致死三联征",并伴有腹腔污染,其稳定性好,可复制性高,可应用于相关研究.
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