游离三碘甲状腺原氨酸治疗胸部火器伤后心功能不全的实验研究

Therapeutic effect of free triiodothyronine on heart dysfunction caused by thoracic gunshot injuries

目的 观察胸部火器伤后游离三碘甲状腺原氨酸 (FT3)变化及其对伤后心功能不全的治疗作用。 方法 家兔 18只 ,随机分为正常对照组 (A组 ,6只 )、火器伤组 (B组 ,6只 )、FT3 治疗组 (C组 ,6只 )。监测平均动脉压、左室舒张末压、中心静脉压、FT3 及心肌肌钙蛋白T(cTnT)的变化 ,观察心肌病理及超微结构。 结果 B组伤后平均动脉压明显低于A组 (P <0 .0 5 ) ,左室舒张末压及中心静脉压分别显著高于A组 ,cTnT漏出较A组增加明显 ,血FT3 浓度明显低于A组 ,心肌间质大量红细胞浸润。治疗组平均动脉压明显高于B组 ,中心静脉压及左室舒张末压明显低于B组 ,FT3 浓度接近正常水平 ,明显高于B组。心肌肿胀减轻 ,间质出血、肌丝断裂和溶解减轻现象明显。 结论 胸壁心前区切线位火器伤可造成心肌病理损害及心功能不全 ;FT3 明显减低 ,与心功能减退有一致性关系 ;纠正伤后低T3

Objective To investigate the changes of free triiodothyronine (FT 3) and its therapeutic effects on heart dysfunction after thoracic trauma. Methods Eighteen rabbits were assigned randomly into 3 groups. The rabbits in Group A were served as a control, that in Group B were shot at the left thoracic wall passing through the cardiac region with small diameter rifle, that in Group C were treated by FT 3 into veins (10 ng/kg) after thoracic trauma. Results In Group B, MAP was much lower than that in Group A after trauma ( P <0.05). In Group B, LVEDP and CVP respectively was much higher than that in Group A. Plasm concentration of cTnT in Group B was much higher than that in Group A. But level of FT 3 was in Group B decreased more markedly than that in Group A after trauma. In myocardial interstitium, many red cells were leaked out of vessel. In Group C, MAP was much higher than that in Group B, no significant difference was found. CVP and LVEDP in Group C were much lower than that in Group B. Level of FT 3 was near to normal and much higher than that in Group B. Edema of myocardial cells and hemorrhage of myocardial interstitium were alleviated markedly. Conclusions Rabbits shot dead at the left thoracic wall passing through cardiac region with small diameter rifle can contribute to an animal model establishment of heart dysfunction. Reduction of FT 3 is in correspondence with heart dysfunction. Correcting thyroid sick syndrome after trauma can improve significantly the heart function.