甲状腺素对胸部火器伤后心功能不全治疗作用的实验研究

Therapeutic effect of thyroid hormone on heart dysfunction caused by thoracic wall gunshot wounds

目的 观察胸部火器伤后甲状腺激素 (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 3组。A组 :正常对照组 6只 ;B组 :火器伤组 6只 ;C组 :FT3治疗组 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) ,观察心肌病理及超微结构。结果 B组伤后6小时平均动脉压 (6 1.1± 15 .4)mmHg,明显低于A组 (10 1.3± 17.5 )mmHg ,左室舒张末压 (39.6± 7.7)mmHg及中心静脉压 (2 0 .93± 1.97)cmH2 O ,显著高于A组 [(16 .3± 11.0 )mmHg ,(6 .5 4± 0 .5 2 )cmH2 O],cTnT漏出较A组增加明显 ,血FT3(1.32± 0 .37)ng/ml浓度明显低于A组 (5 .16± 1.45 )ng/ml,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后造成心肌病理损害及心功能不全 ;甲状腺激素明显减低 ,与心功能减退有一致性关系 ;纠正伤后低T3状态 ,有显著的治疗效果。

Objective To investigate the change of thyroid hormone(TH)and its therapeutic effect on heart dysfunction after trauma.Methods Eighteen rabbits were assigned randomly into three groups.The rabbits in group A were served as a control,group B was shot at left thoracic wall passing through the cardiac region with small diameter rifle,group C was treated by T 3 into veins(10ng/kg)after trauma.Results MAP in group B was much lower than that in group A after trauma(P<0.05),CVP and LVEDP were much higher than those in group A.Plasma concentration of cTnT was much higher than that in group A,but level of FT 3 decreased markely after trauma.In myocardial interstitium,many of red cells leaked out of vessel.In group C,MAP was much higher than that in group B,compared with that in group A,no significant difference was found,CVP and LVEDP were much lower than those in group B,but there was no difference between A and C,level of FT 3 was nearly normal and was much higher than that in group B.Observations of pathology were that edema of myocardial cells and hemorrhage of myocardial interstitium were alleviated markely.Conclustion Rabbits were shot at the left thoracic wall passing through cardiac region with small diameter rifle,which can establish animal model of heart dysfunction.Reduction of TH is in correspondence with heart dysfunction;?Correcting euthyroid sick syndrome after trauma can improve significantly the heart function.