摘要
目的 :探讨胸部开放伤海水浸泡致急性肺损伤的特点 ,为研究救治方案提供依据。方法 :实验动物致伤后随机分为对照组 (10只 )、海水浸泡组 (10只 )和生理盐水浸泡组 (5只 )。对照组为单纯胸外伤 ,后 2组动物于致伤后分别置入人工配制的海水或生理盐水中 ,于伤前及入水后 0 .5、1、2、3和 4小时取血测定肿瘤坏死因子α(TNFα)和白介素 1β(IL 1β)变化 ,同时监测血流动力学、呼吸系统和动脉血气变化。动物活杀或死后立即取肺标本行光镜和电镜检查。对照组除不浸泡海水 (或生理盐水 )外其它处理同海水浸泡组。结果 :海水浸泡组动物死亡率明显高于对照组和生理盐水浸泡组 ,且生存时间明显短于后 2组 ,平均生存时间为 45分钟。海水浸泡组的急性肺损伤明显重于对照组和生理盐水浸泡组 ,表现为严重的低氧血症和高碳酸血症、肺含水量明显增加、血浆 TNFα和 IL 1β伤后明显升高并且高峰时间明显提前。结论 :海水浸泡加剧胸外伤致急性肺损伤的程度 ,导致呼吸及循环系统进行性衰竭 。
Objective:To investigate the pathological and clinical characteristics of acute lung injury caused by open chest wound and seawater immersion.Methods:Twentyfive healthy dogs were randomly divided into three groups which were open chest wound injury group (control, n =10),injury plus seawater immersion group (SI group, n =10) and injury plus normal saline immersion group (NSI, n =5).A right open pneumothorax was induced in all groups.After establishment of the chest trauma model,the animals in SI group were immersed in seawater along and the animals in NSI group were immersed in normd saline alone.Blood samples were taken before the injury and at 0 5,1,2,3,4 hours after injury and water immersion.Blood gas analysis was performed and the plasma level of tumor necrosis factorα(TNFα) and interleukin1β(IL1β) were assayed in all time points.The hemodynamics and respiratory indices were monitored continuously.By the end of the study,lungs were taken for morphological study under both light and electronic microscopes and for lung water content and wetdry weight ratio determination.Results:The mortality was significantly higher in SI group than those in control group and NSI group.The main causes of death were acute lung injury and secondary circulatory failure.The mean survival time in SI group was 45 minutes and significantly shorter than those in control group and NSI group (P<0 01).The extent of lung injury was severe in SI group as compared with that in control group which was manifested by severe hypoxemia and the increase of lung water content.The plasma levels of TNFα and IL1β significantly increased at 0 5 hour and peaked at 1 hour after injury and seawater immersion.The peak time appeared earlier in SI group than that in control group.Conclusions:Seawater immersion aggravates the acute lung injury after open chest trauma.It can result in high mortality rate and rapid death due to progressive of respiratory and circulatory dysfunction.
出处
《中国危重病急救医学》
CAS
CSCD
2000年第10期598-601,共4页
Chinese Critical Care Medicine
基金
解放军总后勤部卫生部"九五"指令性课题!(96L004)
关键词
开放性胸部伤
肺损伤
急性
海水浸泡
open chest wound
acute lung injury
seawater immersion