火器多发伤时肠屏障功能损害实验

An Experiment of Gut Barrier Function Damage Following Multiple Firearm Injuries in a Porcine Model

目的 探讨严重创伤时肠屏障功能损伤的特点。 方法 小型猪随机分为 4组（每组 n=6）：⑴对照组（ C组 )，不致伤；⑵颅骨切线伤组 (H组 )；⑶双侧股骨干骨折组 (L组 )； ⑷多发伤组（ M组 )颅骨切线伤＋双侧股骨干骨折。伤后不同时间点检测胃粘膜 pHi值、血浆内毒素和 D－乳酸水平，作门静脉细菌培养； 72 h活杀，取回肠作组织学检查及二胺氧化酶 (DAO)活性测定。结果 72 h M组 pHi值明显低于 H和 L组（ P 0.05）。 结论 在不发生失血性休克的情况下，多发伤容易引起胃肠道缺血，其导致的肠屏障功能损害比单发伤更严重，肠道细菌及内毒素移位及肠源性感染的机会增加。

Objective To study the characteristics and pathogenesis of gut barrier damage following multiple firearm injuries in porcine models. Methods 24 small pigs were divided into 4 groups (n=6 each): control group(group C),group H (gunshot-induced tangential fracture of parietal bone),group L (gunshot-induced comminuted fracture of bilateral femora) and group M ( combined group H＋ L).Gastric intramucosal pH (pHi), plasma endotoxin in portal vein ,and plasma D-lactic acid were measured and blood samples were cultured at different time intervals after trauma. The animals were sacrificed at 72 h and ileum tissues were harvested for pathological examination and DAO measurement. Result In group M at 72 h,pHi was significantly lower than that of group H and L(P