胸部爆炸伤后原发和继发性肺损伤机制研究  

Mechanism of primary and secondary injury in lung injury of chest explosive wounds

作　　者：张金洲[1] 王文[2] 段维勋[1] 侯晓彬[1] 顾春虎[1] 陈涛[1] 易定华[1] 

机构地区：[1]第四军医大学西京医院心血管外科,陕西西安710032 [2]第四军医大学西京医院中医科,陕西西安710032

出　　处：《创伤外科杂志》2007年第4期347-350,共4页Journal of Traumatic Surgery

基　　金：全军"十五"指令性课题分题资助(01L060)

摘　　要：目的研究原发损伤和继发因素在胸部爆炸伤后肺损伤中的作用。方法运用已建立的家兔胸部爆炸伤模型,检测伤后肺功能改变,观察肺损伤伤情,检测支气管肺泡灌洗液IL-6、IL-8和TNF-α含量。应用原位杂交方法检测肺组织NFκBP65和P38MAPK mRNA的表达,并与伤后肺损伤程度、细胞因子改变进行相关性分析。结果胸部爆炸伤后,100%家兔发生肺冲击伤,60.0%为极重度/重度伤,56.7%出现肺脏破片伤,周围肺组织可见明显撕裂、出血,胸部X线表现为两肺纹理增粗、模糊,伤后早期即出现呼吸频率明显增加,PaO2、P(A-a)O2、SaO2均明显下降,肺含水量增加。随伤后时间的延长,PaO2和SaO2进行性降低,P(A-a)O2及肺含水量进行性升高。伤后IL-6、IL-8和TNF-α含量均有不同程度的升高(P<0.05或P<0.01),各时相点组肺组织NFκBP65、P38MAPK mRNA均有阳性表达,NFκBP65、P38MAPK mRNA表达情况与PaO2、P(A-a)O2、IL-6和TNFα水平呈正相关(P<0.05)。结论胸部爆炸伤时的冲击波和高能破片可致肺原发损伤,同时增加肺组织内P38MAPK和NFκBP65的表达,促进炎性介质IL-6、IL8和TNFα的生成,加重胸部爆炸伤后继发肺功能损害。Objective To explore the role of primary injury and secondary neurohormonal factor in lung inju-ry of chest explosive wounds. Methods Rabbit model for chest explosive wounds was employed. Changes of pul-monary function were monitored,and the condition of lung injury was observed. Content of IL-6,IL-8 and TNF-α in bronchoalveolar lavage fluid was evaluated. The expression of NFκB P65 and P38MAPK mRNA in lung was detected by hybridization in situ ,of which ,the grade of lung injury and the correlation of the changes of cytokine were ana- lyzed. Results Pulmonary blast injury occurred in all the rabbits, of which severe and very severe cases accounted for 60%. Most of the animals（56.7%） suffered from pulmonary fragment injury. Obvious laceration and bleeding were seen in the lung tissue surrounding the wound tract. Chest radiology demonstrated increased bronchovascular shadows. Breathing frequency and lung water content elevated notably early after injury. As time prolonged, PaO2 and SaO2 progressively decreased,P（A-a） 02 and lung water content increased progressively. At the same rime,the content of IL-6,IL-8 and TNF-ct increased by different degrees（ P 〈0.05 or P 〈0.01 ） after injury. On all the time points positive expression of NFKBP65 and p38MAPK mRNA were observed in the lung tissue. Moreover,positive correlation between the expressions and PaO2 ,P（A-a） 02 ,IL-6 and TNFct were analyzed （ P 〈 0.05 ）. Conclusion Blast and fragment contribute to the primary lung injury after chest explosive injury, simultaneously, which promote the expression of NFκBP65 and p38MAPK mRNA in lung,the productions of IL6,IL-8 and TNFct were increased, and secondary lung injury were aggrated after chest explosive wounds.

关 键 词：胸部损伤 爆炸伤 肺损伤 白介素 核转录因子 丝裂原活化蛋白激酶 

分 类 号：R655.3[医药卫生—外科学]