Hardaway R M, Williams C H, Marvasti M, Farias M, Tseng A, Pinon I, Yanez D, Martinez M, Navar J
Department of Surgery, Texas Tech University Health Sciences Center, El Paso 79905-1298.
Crit Care Med. 1990 Dec;18(12):1413-8. doi: 10.1097/00003246-199012000-00021.
Death from traumatic shock has been associated with loss of blood externally or internally. However, many patients die after trauma, even though blood volume restoration is adequate. Death is often due to pulmonary failure (adult respiratory distress syndrome [ARDS]). Death and ARDS have been associated with disseminated intravascular coagulation (DIC) and microclots in the lungs. Dissolution of the microclots after trauma can be achieved by activation of endogenous plasmin. Nine pigs were anesthetized for 48 h. Trauma was administered by 60 standard blows to each thigh resulting in a bruise of muscle but no skin, bone, or major vessel injury. Nutrition and respiration were maintained at normal levels. All nine pigs died with severe lung pathology and low PaO2. Ten other traumatized pigs were treated with a plasminogen activator iv 4 h after trauma. Five of these were treated with tissue plasminogen activator (tPA) and five with urokinase. All treated pigs survived 48 h and maintained a normal PaO2. Autopsy showed minimal lung pathology.
创伤性休克导致的死亡与体表或体内失血有关。然而，许多患者在创伤后死亡，即便血容量已得到充分补充。死亡往往是由于肺功能衰竭（成人呼吸窘迫综合征[ARDS]）。死亡和ARDS与弥散性血管内凝血（DIC）及肺部微血栓有关。创伤后微血栓的溶解可通过激活内源性纤溶酶来实现。九只猪麻醉48小时。对每只猪的每条大腿进行60次标准击打造成创伤，导致肌肉瘀伤，但无皮肤、骨骼或大血管损伤。营养和呼吸维持在正常水平。所有九只猪均死于严重的肺部病变和低动脉血氧分压（PaO2）。另外十只受创伤的猪在创伤后4小时静脉注射纤溶酶原激活剂进行治疗。其中五只接受组织纤溶酶原激活剂（tPA）治疗，五只接受尿激酶治疗。所有接受治疗的猪均存活48小时且维持正常的PaO2。尸检显示肺部病变轻微。
