缺血/重灌流损伤在烧伤病理学中的地位  

The Position of Ischemia/Reperfusion Injury in Burn Pathology

作　　者：张向清[1] 

机构地区：[1]中国人民解放军139医院

出　　处：《中国烧伤创疡杂志》1994年第2期8-10,58,共3页The Chinese Journal of Burns Wounds & Surface Ulcers

摘　　要：组织缺血缺氧是严重烧伤早期主要病理变化之一，积极地实行液体复苏治疗，恢复组织氧分压早已成了公认的治疗原则。但是，根据缺血／重灌流损伤的新概念，即细胞损伤不是发生在缺血、缺氧时，而是发生在重灌之后，无形中又给临床处理增添了一个既实际又突出的问题。本文就这些问题从辩证角度进行了认真分析。认为烧伤是缺血／重灌流损伤的根源，因为在缺血、缺氧时机体已具备了产生氧自由基（ODFR）的底物（次黄嘌呤）和催化底物产生ODFR的酶（黄嘌冷氧化酶），但是，在缺氧时并无过多的ODFR产生，缺血时间愈长，这种势头发展也愈快。缺氧机体一旦得到氧供，便会加速ODFR的生成反应，并对各种细胞产生损伤作用。因此，可把氧供视为发射ODFR的“扳机”。根据以上分析，减轻或缩短缺血、缺氧时间，积极实行液体复苏治疗会减少ODFR的产生。在积极实行液体复苏的同时，添加抗氧化剂减轻ODFR的损伤作用。Ischemia and hypoxia of the tissue is an importantpathological change at the early stage of severe burn.Fluid resuscitation and normalization of tissue oxygenpartial pressure have been recognized as a principle ofthe treatment. However, according to recent conceptof ischemia/reperfusion injury, tissue injury does notoccur at the ischemic and hypoxic stage, but occursafter reperfusion. This gives rise to a practicalproblem in clinical treatment. The author considersburn as the cause of ischemia/reperfusion injury. Atthe stage of ischemia and hypoxia, the tissue hasalready had the substrate which produces oxygenderived free radical (ODFR ), and the enzyme(xanthineoxidase) which catalyzes the production ofODFR by this substrate. At the beginning of thehypoxia stage, no excessive production of ODFRoccurs , once the oxygen supply is resumed, theproduction of ODFR is accelerated. Cells of varioustissues are injured at this stage. So that oxygensupply can be considered as the 'trigger' shooting outODFR. Therefore, shortening the period andlightening the severity of ischemia and hypoxia andtimely application of fluid resuscitation can diminishthe production of ODFR. At the same time,application of antioxidant can diminish the injurycaused by ODFR.

关 键 词：重灌流 病理学 液体复苏治疗 严重烧伤早期 组织缺血缺氧 损伤作用 组织氧分压 病理变化 治疗原则 细胞损伤 临床处理 次黄嘌呤 氧自由基 缺血时间 缺氧时间 抗氧化剂 新概念 氧化酶 种细胞 机体 氧供 

分 类 号：R743.31[医药卫生—神经病学与精神病学] R657.3[医药卫生—临床医学]