高原胸部火器伤与肺水肿关系的实验研究

Study on relationship between thoracic firearm injury and pulmonary edema at high altitude

目的 探讨高原胸部火器伤与肺水肿的关系。 方法 30只体重相近 ( 10～ 15kg)的杂种犬 ,随机分成平原对照组、高原移居组和高原世居组 (每组 10只 ,高原世居组选自高原杂种犬 ) ,用 0 .44g钢珠 ,通过滑膛枪以 ( 40 0± 5 0 )m/s的初速度造成犬右胸贯通伤 ,在不同时间测定血浆前列环素的代谢产物 ( 6 -keto -PGFα)和血栓素B2 (TXB2 ) ,伤后 8h取双侧肺组织 ,测定肺含水量并行光镜、电镜检查。 结果 ( 1)伤后各组 6 -keto -PGFα均升高 ,伤后 4～ 8h各组TXB2 升高显著。高原移居组于伤后 6～ 8hTXB2 / 6 -keto -PGFα升高明显 ,而平原对照组和高原世居组则变化不明显。 ( 2 )高原移居组伤侧肺含水量比平原组和高原世居组高 ,健侧无明显差异。 ( 3)光镜及电镜检查发现伤侧肺泡及间质水肿、出血 ,局部肺泡及毛细血管结构破坏 ,呼吸膜增厚。 结论 高原胸部火器伤早期 ,高原移居组发生肺水肿的概率较高原世居组及平原组大。早期在注重抗休克和处理血气胸的同时 ,要注重肺水肿的预防。

Objective To detect relationship between thoracic firearm injury and pulmonary edema at high altitude. Methods Thirty Mongrel dogs (weight for 10 to 15 kg) were equally divided into 3 groups, high altitude immigrants group (group A), high altitude native group (group B) and control group. Anesthetized dogs were shot in the right chest with steel balls at high altitude (3 700 m above sea level). Blood samples were collected 0.5, 2, 4, 6, 8 hours after injury. Blood was analyzed for thromboxane B 2 (TXB 2), 6-keto prostaglandin Fα (6-keto-PDFα). The right lung and the left lung were taken out for pulmonary water volume measurement and light microscopic and electronic observations 8 hours after injury. Results The level increase of blood plasma 6-keto-PGFα and TXB 2 was observed in each group after injury. The level of TXB 2/6-keto-PGFα of group A was increased 6 and 8 hours after injury; but no changes were observed in other 2 groups. Pulmonary water volume in group A was more than that in other 2 groups. Under transmission electronic microscopic observation, the main changes in each group were hemorrhage and edema of alveolus and interstitialis, edema of capillary endotheliocytes and thickening of respiratory membrane. Conclusions In the early period of chest fire-arm injury at high altitude, the risk of pulmonary edema is higher in group A than that in the other 2 groups. Although it is necessary to prevent injury from lung edema, the most important thing we should do is to deal with hemopneumothorax and shock.