胸部爆炸伤后血浆及肺组织中NO、TNF-α和IL-8的变化及L-NAME的作用

Changes of NO, TNF-α and IL-8 in plasma and lungs in explosive wound of thorax before and after the administration of L-NAME

目的 研究胸部爆炸伤后细胞因子的变化规律 ,探讨L NAME的作用。方法 用雷管和钢珠同步致伤家兔胸部后 ,测定血浆、支气管肺泡灌洗液及肺组织中NO、TNF α和IL 8水平 ;光镜、电镜下观察肺组织的病理变化 ;测定肺含水量和肺通透指数 ;伤前静脉给予L NAME。结果 伤后 1h血浆NO水平显著升高 ,3h达高峰 ,TNF α和IL 8水平随NO的升高而升高 ,但TNF α出现的时间要早于IL 8;肺组织主要表现为出血、水肿、炎细胞浸润、内皮和上皮细胞变性及内皮细胞通透性增强 ;给予L NAME后 ,不仅3种细胞因子水平降低 ,肺组织病变也有所减轻。结论 NO在胸部爆炸伤后病理生理改变中处于主导地位 ,早期应用L NAME有助于胸部爆炸伤的早期救治。

Objective To study the changes of cytokines and the effects of L NAME on it in explosive wound of thorax. Methods Thorax of rabbits were traumatized with steel sphere and detonator synchronously, level of NO, TNF α and IL 8 in plasma, bronchoalveolar lavage fluid and lung tissue were determined. Pathological changes of lung were observed under light and electron microscope. Water content and pulmonary microvascular permeability index were detected too. N ω nitro L arginine methyl ester(L NAME) was given intravenously before wounding in experimental group. Results Level of NO in plasma was dramatically increased at 1 h, and reached its peak at 3 h after wounding. TNF α and IL 8 were also increased with increasing of NO, TNF α incresed earlier than that of IL 8. Bleeding, edema, inflammatory cells infiltration, degeneration of endothelial cell and epithelial cell and increased permeability of endothelial cell were observed in the lung. After L NAME treatment decreased level of three kinds of cytokines and alleviated pathological changes of lung were seen in L NAME treated grsup. Conclusion NO plays a major role in the pathophysiologyical changes of thoracic explosive wound, L NAME administration is helpful for early therapy of thoracic explosive wound.