舱内腹部闭合性爆炸伤大鼠血浆内毒素的变化及意义

Dynamic changes of plasma endotoxin concentration in rats exploded in relative closed spaces

目的观察舱内腹部爆炸伤大鼠血浆内毒素、TNF-α和IL-6水平的动态变化。方法100只成年SD大鼠随机分为舱内组和舱外组,每组50只,在模拟战斗舱室和舱外开阔地爆炸复制腹部爆炸伤模型,爆炸后3、8、24、48h和72h采集外周血检测内毒素、TNF-α和IL-6浓度,同时采集门静脉血检测内毒素水平。结果大鼠腹部爆炸伤后血浆内毒素水平在外周血和门静脉血的变化趋势基本一致,伤后3h开始升高(P<0.05);舱内组48h达高峰,舱外组24h达峰值;舱内组血浆内毒素水平较舱外组升高快,且持续时间长(P<0.05)。相同时间点门静脉血内毒素水平较外周血升高明显,但24h后组间比较差异无统计学意义(P>0.05)。外周血血浆TNF-α和IL-6水平变化趋势与内毒素水平变化基本一致,但TNF-α水平较IL-6升高早、上升速度快,而且维持在较高水平。相关分析表明,门静脉血内毒素浓度与外周血内毒素(r=0.646)I、L-6(r=0.631)、TNF-α(r=0.724)水平呈正相关(P<0.01)。结论舱内爆炸致大鼠肠道内毒素移位较舱外早且发生率高,在早期救治战斗舱室内爆炸伤伤员时需采取有效措施预防肠源性内毒素血症,检测外周血TNF-α和IL-6水平可间接判断肠道内毒素移位。

Objective To investigate the effect of blast injury on plasma endotoxin level in rats with abdominal wound subjected to explosion in relative enclosed spaces. Methods A total of 100 male rats were distributed randomly into 2 groups：enclosure and free-field groups subjected to explosion with instantaneous electric detonator. Circulating plasma endotoxin, tumor necrosis factoralpha （TNF-α）,and interleukin-6 （IL-6） concentrations were also measured at 3h, 8h, 24h, 48h and 72h after explosion. Results Changes of plasma endotoxin levels both blood samples of peripheral and portal veins were similar. The plasma endotoxin level was significantly increased since 3 h after explosion in both groups,but peaked at 48 h post-injury, then declined at 72 h in enclosure group while peaked at 24h after trauma,then recovered gradually at 48 h but was still lower in free-field group than that of enclosure group （P〈0.01）. Additionally, plasma TNF-α and IL-6 concentrations were extraordinary elevated earlier, sustained longer and stronger in relative enclosed space than that in open air. Correlation analysis showed a strong positive correlation between endtoxin concentration in blood of portal vein and endtoxin（r= 0. 646）, IL-6 （r=0. 724）, TNF-α（r= 0. 631） levels of peripheral blood （P〈0.01）. Conclusion The findings of a earlier and higher incidence of intestinal endotoxin translocation in rats with abdominal wound exploded in relative enclosed spaces suggest that it is necessary to take effective measures to prevent enterogenic endotoxemia when we treat the wounded soldier with blast injury in relative battle defence works. Detecting TNF-α and IL-6 levels of pe ripheral blood maybe indirectly identify intestinal endotoxin translocation.