烧伤延迟复苏后氧自由基损伤及与内毒素血症关系探讨

Oxygen Free Radical Injury and Its Relation to Endotoxin Translocation after Delayed Fluid Resuscitation in Burn Patients:A Prospective Study

将４７例总面积＞３０％的烧伤患者，按伤后开始补液时间的早晚分为延迟组（１８例）和非延迟组（２９例），对比观察了血液ＯＦＲ、ＳＯＤ、ＧＳＨＰｘ、血浆ＭＤＡ含量和内毒素水平变化及红细胞膜蛋白改变。结果发现：伤后一周内两组患者均有ＯＦＲ、ＭＤＡ含量升高及ＳＯＤ和ＧＳＨＰｘ下降，同时ＲＢＣ膜蛋白损伤加重和血浆内毒素水平升高。延迟组上述改变更明显，其血浆ＭＤＡ含量与ＲＢＣ膜蛋白异常和血浆内毒素水平呈显著正相关，提示延迟复苏加重机体氧自由基损害，鉴于伤后早期无明显创面感染发生，该机理可能造成了肠道内毒素移位。

The contents of oxygen free radical (OFR),SOD,GSHPx and MDA in blood were determined in 47 patients (TBSA>30%), 27 of whom with delayed fluid resuscitation (DFR group,receiving fluid resuscitation later than 6 hours after injury),and the others had early fluid resuscitation (EFR group,fluid resuscitation within 6 hours postburn).The results showed that there was a significant increase of blood OFR content and plasma MDA,and a significant decrease of blood SOD and GSHPx subsequent to resuscitation in DFR group as compared with EFR group.Both s/w value and てe value, which expressed the changes in the structure of membrane protein,and the changes in motion of protein on membrane respectively,were singnificantly higher in DFR group ( n =6) as compared with that in EFR group ( n =6) at 24 and 72 hours.Similar changes were also seen in plasma endotoxin level.In DFR group,plasma MDA content was well correlated with s/w value,てe value and plasma endotoxin level.The data indicated that tissue reperfusion might induce the production of OFR resulting in lipid peroxidation injury.Since there was no obvious wound infection in the early stage,the elevated endotoxin content in blood might be attributed to escape of endotoxin from the bowel.(Original article on page 158)