沙漠干热环境猪肠管火器伤继发性肾损伤的病理学观察

Pig intestines tube firearm injuries in hot and dry desert environment:Pathological observation of secondary renal damage

目的:观察沙漠干热环境腹部肠管火器穿透伤后肾脏损害的病理学变化。方法:健康长白仔猪84头随机分为常温组及沙漠干热环境组,每组分为对照组、伤后1h、2h、4h、8h、12h和24h组。建立腹部肠管火器穿透伤模型后,分别于伤后各时间点检测各组体温、伤道局部细菌学定量、血液细菌性培养定性、血清中内毒素水平;同时,切取肾组织进行病理组织学及超微结构观察。结果:两组动物均形成肠管穿孔伤,伤后各时间点体温逐渐升高,在相同时间点,沙漠组体温明显高于常温组(P<0.01);伤道血细菌培养:沙漠组伤后4h达到感染临界值与常温组具有显著性差异(P<0.01);8h血浆内毒素水平:沙漠组为0.970±0.04EU/ml与常温组0.63±0.08EU/ml具有显著性差异(P<0.01)。肾病理变化:沙漠组较常温组病变提前且随时间的延长呈进行性加重,以12h组-24h组出现肾小球变质性炎、肾小管急性坏死等病变。结论:沙漠环境腹部肠管火器穿透伤可造成肾损害,进行性发展为急性肾小球变质性炎和急性肾小管坏死,可能导致急性肾功能不全;血液动力学障碍及肠源性内毒素血症可能是肾损害的重要因素。

Objective：To investigate the changes of Kindney injury in abdominal firearm wound pigs following intestinal perfora-tion due to abdominal firearm wound in dry-heat desert environment.Methods：84 Chang-Bai piglets were divided equally into normal temperatutr environment group and dry heat desert environment group.Each group were equally divided randomly into 7 groups：control group and wounded 1 hour group,2 hour group,4 hour group,8 hour group,12 hour group and 24 hour group.The model of penetrating abdominal firearm wound was established in wounded groups.Body temperature was measured and bacteriological quantitative qualita-tive analysis were performed in local wound tract,quantitative serum bacteria culture and serum levels of endotoxin were respectively determined in all groups.The histopathological and ultrastructural were detected in cut kidney tissue at the same time.Results：Intestinal perforations were formed in two groups.The temperature gradually increased at different time points after injury.The temperature of desert group was higher than normal temperature group at same time points（P0.01）;The blood culture in wound tract in 4-h group reached critical point of infection,the difference between two group was significant（P0.01）;plasma endotoxin in 8-h group ：The desert group was 0.970±0.04EU/ml,the normal group was 0.63±0.08 EU/ml,it was significant difference between two groups（P0.01）.The change of kidney pathology：The lesions of desert group was earlier than normal group,the progressively increased with extended.The acute tubular necrosis and glomerulonephritis were occurred in 12-h group and 24-h group.Conclusion：intestinal firearm wound in desert environment cause kidney damage.It can be developed into glomerulonephritis and acute tubular necrosis,even lead to acute renal failure.Henvodynamic impairment and intestinal endtoxemia may be the important causes lesding to injury of kidney.