胸部开放伤后海水浸泡致多器官功能障碍综合征

Multiple organ dysfunction syndrome after open chest wound and seawater immersion:experimental study

目的 探讨实验动物胸部开放伤后海水浸泡致多器官功能障碍 (MODS)的发生率和发生特点。 方法 成年杂种犬致伤后随机分为对照组 (单纯胸伤组 ,n =10 )和实验组 (n =10 )。实验组动物于伤后置入人工配制的海水中。实验过程中动态监测血清丙氨酸氨基转移酶 (ALT)、门冬氨酸氨基转移酶 (AST)、肌酸肌酶 (CK)、乳酸脱氢酶 (LDH)、尿素氮 (BUN)和肌酐 (Cr)以及肿瘤坏死因子α(TNFα )和白细胞介素 1β(IL 1β)的变化。 结果 实验组MODS发生率明显高于对照组 ,而且出现时间早于对照组。实验组死亡率也明显高于对照组 ,并且生存时间明显短于对照组。 结论 胸部开放伤后海水浸泡可能是引起MODS和早期死亡的最主要原因。

Objecitve[WT5”BZ] To evaluate the effect of seawater immersion on multiple organ dysfunction syndrome (MODS) after chest trauma. [WT5”HZ]Methods[WT5”BZ] Twenty health dogs were divided into two groups. Right open pneumothorax was induced in both control group ( n =10) and experimental group ( n =10). After induction of chest trauma, animals in the experimental group were immersed in artificial seawater. Blood samples were taken at seven different intervals for assessing blood gas, plasma level of TNFα, and IL 1β. Changes of serum alanine aminotransferase (ALT), aspartate amino transferase (AST), creatine kinase (CK) lactate dehydrogenase (LDH) and creatinine (Cr) were measured. At the end of study, lung was harvested for assessing lung water content and ratio of wet weight and dry weight. [WT5”HZ]Results[WT5”BZ] A significant elevation of ALT, AST, CK and LDH was observed in both groups. Organ functional parameters in the experimental group were consistent with the failure standard at 30 minutes after seawater immersion, and those in the control group at 4 hours. Post trauma mortality and incidence of MODS were much higher in the experimental group than those in the control group ( P <0 01). The plasma levels of TNFα and IL 1β significantly increased at 30 minutes and reached the highest level at 60 minutes after seawater immersion. The time of peak level appeared earlier in the experimental group than that in the control group. [WT5”HZ]Conclusion[WT5”BZ] Seawater immersion after open chest trauma results in high incidence of MODS and high mortality rate due to progressive dysfunction of multiple organs. [WT5”HZ]