挤压伤后心肌病理组织与节段旋转功能变化的临床研究

Pathology and clinical study of cardiac regional rotation function after crush injury

目的通过光镜观察家兔挤压伤后不同时间段心肌组织的病理变化情况,并应用超声斑点追踪技术评价地震所致挤压伤伤员治疗前后的心脏节段旋转功能,以评估挤压伤后心肌继发受损的情况。方法 42只新西兰家兔按标准制作挤压伤模型,随机分为对照组、解压即刻、解压后6、12、24、48、72h共7组,每组6只,光镜下观察不同时间段心肌组织的病理变化情况;地震挤压伤伤员37人,男性21人,女性16人,应用斑点追踪技术分别检测抗心衰治疗前后左室节段旋转功能。结果家兔挤压伤后心肌组织出现明显病理变化,以伤后12～24h的改变尤为显著。地震挤压伤伤员左室感兴趣区域的收缩期节段旋转功能在治疗后明显改善(P<0.01)。结论挤压伤后由于缺血再灌注等多种因素导致心肌收缩性能受损,心肌正性变力及变时效应减低,最终导致心肌节段旋转功能降低,伤后12～24h为心肌受损达峰时间段。

Objective To study the changes of rabbitff myocardium pathology by light microscope after crush inju- ry, and to assess the cardiac regional rotation function of the wounded in earthquake by echocardiography speckle tracking imaging after crush injury, so that to assess the myocardium secondary damaged after crush injury. Methods Forty-two New Zealand rabbits were divided into control group （ 6 rabbits ） and crush injury group （ 36 rabbits ）, and crush injury group were further divided into immediately, 6h, 12h, 24h, 48h and 72h after pressure relief groups with 6 rahbitts in each group. Their myoeardium structures were observed by the light microscopy. The wounded were detected the cardiac regional rotation function by eehocardiography speckle tracking imaging before and after treatment. Results The most obvious changes of rabbit＇s myocardium structures occurred at 12-24h after pressure relief, and the wounded cardiac regional rotation function of the region of interest（ROD were obvious improved after treatment （P〈0.01）. Conclusion The cardiac regional rotation function were decreased after crush injury, and after loosed pressure 12 to 24 h were its peak time.