海水浸泡弹烧复合伤血细菌学与内脏病理学的变化

The visceral pathological and blood bacteriological changes caused by combined projectile-burn wound jointed with seawater soak

目的探讨海水浸泡弹烧复合伤伤后血液细菌学变化与内脏病理学变化之间的关系。方法建立海水浸泡弹烧复合伤模型后,依模型将15只成年杂种犬随机分为单纯弹烧复合伤组(简称非浸泡组,7只)和海水浸泡弹烧复合伤组(简称浸泡组,8只),于伤后即刻和4、7、10、20、28h共6个时相点抽取静脉血进行血细菌培养。另于伤后28h和濒死期将动物活杀,取心、肝、肺、肾行病理学观察。结果浸泡组动物菌血症出现较早且严重。导致菌血症的细菌来源复杂,不仅有肠道菌群,还有海水特有菌群和皮肤常驻菌群。在内脏器官组织病理学上,不仅有不同程度的血液循环障碍及退行性变,还有严重的炎症反应。结论在海水浸泡弹烧复合伤中,伤后出现的严重菌血症进一步加重了内脏器官损伤。

Objective To approach the relationship between visceral histopathology and blood bacteriology changes of projectile-burn combined wound jointed with seawater soak. Methods After model creation in dogs of projectile-burn combined wound jointed with seawater soak, fifteen dogs were randomly assigned randomized into two groups: projectile-burn-only(unsoaked group, US), projectile-burn combined wound with seawater immersion(soaked group,S). 0, 4,7,10,20,28h after injury the blood samples were taken for bacterial culture. Tissue samples of heart, liver, kidneys were taken for pathological examination with light microscope (LM) 28h after injury or in the moribund stage. Results Bacteriemia was found in soaked group earlier and severer.The bacteriemia has a multiple sources. There were not only intestinal bacteria, but also surface bacteria and seawater bacteria found in soaked group. Different degrees of circulation disturbance, degeneration changes and severe inflammation reaction were found in viscera. Conclusion After seawater soak, bacteriemia aggravated the injury of animals′ viscera, and thus led to a higher mortality.