兔胸部撞击伤后呼吸功能的改变  

Changes of lung function after chest-impacted injuries in rabbits

作　　者：张金洲[1] 刘维永[1] 易定华[1] 徐长杰[2] 马福成[3] 

机构地区：[1]第四军医大学西京医院心脏外科,西安710032 [2]第四军医大学西京医院放射科,西安710032 [3]第四军医大学西京医院病理科,西安710032

出　　处：《中华实验外科杂志》2005年第7期784-786,共3页Chinese Journal of Experimental Surgery

摘　　要：目的建立胸部撞击伤后急性呼吸窘迫综合症(ARDS)模型。方法65只兔分为对照组(n=5)和实验组(LV组、MV组、HV组,n=20)。对照组不致伤,实验组以不同速度撞击右侧胸壁。伤前、伤后4、12、24、48、72h检测动脉血气、肺干湿重比、支气管肺泡灌洗液总蛋白含量和胸部X线检查,观察肺组织苏木精伊红染色和肿瘤坏死因子α(TNFα)表达。结果LV组死亡率10%,5%动物出现ARDS,肺病理变化较轻。MV组死亡率15%,25%动物出现ARDS,总蛋白含量和肺病理较LV组明显,但较HV组轻微。HV组死亡率40%,60%动物出现ARDS。伤后24h氧合指数降到191.3mmHg(1mmHg=0.133kPa),72h为153.81mmHg。肺干湿重比明显低于对照组,总蛋白含量明显高于对照组。肺泡结构严重破坏,大量红细胞、炎细胞渗出,肺间质肿胀增厚。左侧肺间质肿胀和大量炎细胞浸润。胸部X线双肺透光度减低。各组伤后肺组织TNFα均为阳性表达,HV组最明显。结论速度(20.29±0.03)m/s,压缩幅度20%,撞击质量5.7kg撞击面积3.14cm2致伤家兔胸部后出现急性呼吸窘迫综合症,可作为创伤性ARDS动物模型。Objective To establish animal model of ARDS after chest-impated injured in rabbits.Methods Sixty-five rabbits were assigned to control group (n=5) and experimental groups (LV,MV,HV,n=20).Rabbits in control group were not impacted.Rabbits in experimental groups were impacted on the right chest with different driving-velocity.Ratio of dry/wet lung,content of total protein in BALF and arterial blood gas were monitored before and after injury 4,12,24,48,72 h respectively.Pathological observation and Chest X-ray were performed.The expression of TNF-αwas detected.Results In LV group,10% animals died and 5% animals represented with ARDS.Only were slight pathological changes seen.In MV group,15% animals died and 25% animals represented with ARDS.Content of total protein and pathological changes were remarkably compared with LV group,but more slightly when compared with HV group.In HV group,40% animals died and 60% animals had ARDS symptoms.Oxygenation index (OI) presented a trend of reduction after injury,at 24 h OI dropped to 191.3 mm Hg(1 mm Hg=0.133 kPa),and at 72 h it was 153.81 mm Hg.Ratio of dry/wet lung after injury was much lower than that of control group.Content of total protein was higher than that of control group.Pathological observations showed the structure of pulmonary alveolar was destroyed,large amounts of red blood cells and inflammatory cells immersed.Thickened lung interstitial was seen.In left lung the interstitial also thickened and lots of inflammatory cells immersed.Chest radiography showed diffuse immersion on bilateral lungs.The expressions of TNF-αwas positive in experimental groups,particularly in HV group the result was much more significant.Conclusion With impacting-parameters [velocity (20.29± 0.03) m/s,compression 20%,weight 5.7 kg],rabbits could develop into a series of clinical representations,which was highly similar to ARDS in human beings.

关 键 词：胸部撞击伤 肿瘤坏死因子-α(TNF-α) 呼吸功能 急性呼吸窘迫综合症 支气管肺泡灌洗液 总蛋白含量 创伤性ARDS 胸部X线检查 肺病理变化 炎细胞浸润 对照组 死亡率 动脉血气 伊红染色 氧合指数 肺泡结构 阳性表达 撞击面积 

分 类 号：R655[医药卫生—外科学] R587.1[医药卫生—临床医学]