犬下肢创伤应激后肺脏组织的功能及病理学变化(英文)

Functional and pathological changes of lung tissues after bullet wound of dog's hind legs

背景:了解枪伤后冲击力对犬肺脏病理学的改变,有助于改进对其处置的方法或手段,或许可减轻伤后对肺功能的损害。目的:探讨枪伤后犬肺脏组织的功能和病理学的改变。设计:以实验动物为研究对象的开放性实验研究。单位:武装警察部队总医院中西医结合科。材料:实验于2003-06/12在武装警察部队总医院完成,选取成年健康杂种犬6只,雌雄各半,体质量(16.33±0.58)kg,犬龄8～12个月,由解放军军事科学院实验动物中心提供,动物中心许可证号:SCXK(军)2002-001,在温度22～23℃,湿度74%～80%下自由饮水,取食。方法:给成年健康家犬采用81式自动步枪,口径7.62mm,560式子弹,选取家犬左后肢肌肉丰厚处,避开大血管和骨组织,射击距离5m,射击后立即止血包扎,6h后进行肺脏的病理学检查。主要观察指标:观察肺脏的病理学改变。结果:肢体枪伤后肺组织主要表现为肺泡萎陷,含气量减少伴炎细胞浸润,肺水肿,小血管充血等。结论:肢体枪伤后肺部损伤明显,其作用机制与应激、局部周围组织炎性反应和远达效应有关。伤后血液流变性的变化是影响脑、肺微循环改变的重要因素之一。在伤后早期血液流变性发生明显改变,主要表现为低切变率时全血黏度及红细胞聚集指数增加,其变化均在伤后早期6h达高峰。由于全血黏度及红细胞聚集指数增加。

BACKGROUND:Knowing the pathological changes of the lungs after the wallop from the bullet wound helps to improve the method or mean of dealing with the wound or to reduce the damage to lung functions after the wound. OBJECTIVE:To probe into the functional and pathological changes of the lung tissues after bullet wound. DESIGN:Open experimental study of the animals. SETTING:Department of the Integrated Traditional Chinese and Western Medicine,General Hospital of the Chinese People's Armed Police Forces. MATERIALS:The experiment was completed from June 2003 to December 2003 at the General Hospital of the Armed Police Forces.Six healthy grown up cross bred dogs,half male and half female,weighing(16.3± 0.58) kg,aged (8- 12) months old, were provided by the Experimental Animal Center of the Military Academy of Sciences of Chinese PLA.Animal Center's license No.was SCXK(army)2002 001.The animals were fed with water and food with no restrictions in an environment in which the temperature was 22 to 23 ℃ and the humidity was 74% - 80% . METHODS:Grown up healthy domestic dogs were shot at the thick muscular part of their left hind legs with a size 81 automatic rifles, 7.62 mm in caliber and bullet of type 560.Caution was taken to avoid damage to the major vessels and the bone tissues.The shooting distance was 5 meters.Immediate hemostasis and bandaging were performed after shooting.And 6 hours later,pathological examination of the lungs was carried out. MAIN OUTCOME MEASURES:Pathological changes of the lungs. RESULTS:After the bullet wound,the main pathological manifestations of the lungs were detelectasis of the pulmonary alveoli and the decrease of air volume complicated with inflammatory alveoli infiltration,lung edema,obscure structure of pulmonary alveoli,passive congestion of the small blood vessels,etc. CONCLUSION:The lung wound was obvious after bullet wound and its mechanism was associated with stress,inflammatory reaction of the adjacent tissues and far domino effect.Blood rheological changes after the wound were one of the most important factors to affect the microcirculation of the cerebral and lung tissues.It was found that clear blood rheological changes occurred at the earlier stage after the wound,and the chief manifestations included the increase of the whole blood viscosity and the index of the erythrocyte aggregation at the time of low sheering rate.The changes reached their peaks 6 hours after the wound.On the one hand,because of the increase of whole blood viscosity and the index of erythrocyte aggregation,stasis of red blood cells might happen.And embolism of micro blood vessels in the brain and lungs would change the microcirculation of the brain and lungs. On the other hand,when serious injury of local tissues happens,the body's stress reaction would be strong and secretion and the release of stress hormones and certain active biological small molecular substances would increase,such as nitrogen monoxide( NO) ,tumor necrosis factor(TNF),endothelin( ET) ,etc.Their increase would stimulate the micro blood vessels of the brain and lungs and disturb their diastole and constriction functions.After the wound by high speed projectile,blood flow volume in the animal's cerebral and lung tissues reduced sharply.The micrangium of the brain and lung dilated, and its diameter increased,which resulted in ischemia and hypoxia of the brain and lung tissues,and therefore edema of the brain and lung tissues and hypofunction of the lungs.Therefore, for the bullet wound of the limbs,in addition to dealing with local damage,the brain,the lungs and other important organs should be protected.This provides a theoretical basis for improving the brain and lung function after the bullet wound.