模拟深埋条件下复合性挤压伤死亡大鼠的病理变化及其死亡原因

Pathological changes and death reasons of rats with combined crush injury under simulated deep burial

目的研究模拟深埋条件下持续性挤压伤复合低氧缺水缺食死亡大鼠内脏器官的病理变化特点及其死亡原因。方法 Wistar雄性死亡大鼠40只,其中复合性挤压伤组（复合组）27只（26只活存时间4.2~6.8 d,1只为挤压72 h解除致伤后0.6 d猝死）,低氧缺水缺食组（三缺组）13只（活存时间6.5-11.0 d）,挤压伤模型采用钳夹双后肢近端法[压力为（44.1±2.9）N],切取肾、心、肝、脾、肺、脑、胃肠,常规石蜡制片,苏木精-伊红（HE）染色,光镜观察,部分脏器行电镜观察和原位末端转移酶标记技术（terminal deoxynucleotidyl transferase-mediated dUTPbiotin nick end labeling,TUNEL）检测细胞凋亡。结果①复合组所有死亡大鼠的上述内脏器官均发生损伤和病变,轻者细胞变性,重者细胞坏死和凋亡,并均发生充血、血停滞为主的血循环障碍病变,其病变程度和范围均分别重于和大于三缺组,并随活存时间的延长呈加重和扩大趋势。②复合组中的14只猝死和早期死亡原因为心源性为主的多器官功能不全综合征（multiple organ dysfunction syndrome,MODS）,8只死亡原因主要为肾源性为主的MODS,5只死亡原因为全身性的恶液质和MODS;与三缺组的死亡原因明显不同。结论后肢挤压伤复合低氧缺水缺食死亡大鼠的各远隔脏器均发生明显损伤病变,具有高发性、广泛性、进行性、不同脏器差异性特点;以心脏和肾脏病变分别为主的MODS为其主要死亡原因,其中前者更易导致猝死和早期死亡。

Objective To study pathological characteristics of viscera organs and death reasons of rats suffered crush injury and deprivation of food and water under simulant condition of deep burial.Methods 40 male Wistar rats were divided into combined crush injury group（combined group,27 rats,among of which 26 rats lived 4.2- 6.8 d,one rat suddenly died at 0.6 d after release from 72 h crush） and hypoxia combined with deprivation of food and water group（three-lack group,13 rats,lived 6.5- 11.0 d）.Crush injury model was established by clamping the near ends of double hind limbs[pressure for（44.1 ±2.9）N].After paraffin section of kidney,heart,liver,spleen,lung,brain,stomach and intestine,HE staining and observation by optical microscopy were applied.Some viscera were observed by electrical microscopy and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling（TUNEL） method was used to detect cell apoptosis.Results Above viscera organs of dead rats in combined group were all injuried and pathological changes occurred.Cell denaturalization,apoptosis and necrosis occurred.Blood circulation obstacle mainly showed as engorgement and blood stagnation occurred.Both degree and scope of pathological changes in combined group were more serious than that in threelack group,and showed aggravating and extending trend along the live time.The death reason of 14 sudden death rats and early death in combined group was mainly cardiac multiple organ dysfunction syndrome（MODS）,and 8 rats died of kidney source MODS,even 5 rats died of systemic MODS and dyscrasia,which were obviously different from three-lack group.Conclusion Obviously pathological changes of remoteness viscera occur in dead rats suffered hind limbs extrusion injury and deprivation of food and water,which are characterized as high incidence,universality,progressive and viscera otherness.Cardiac and kidney source MODS is the main death reason,and the former can easily induce sudden death and early death.