胸部爆炸伤致肺损伤的机制研究  

The pathogenesis of lung injury caused by chest explosive wounds

作　　者：张金洲[1] 王文[2] 段维勋[1] 陈涛[1] 顾春虎[1] 侯晓彬[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：《西北国防医学杂志》2007年第4期241-243,共3页Medical Journal of National Defending Forces in Northwest China

基　　金：全军"十五"指令性课题资助项目(01L060)

摘　　要：目的:研究原发和继发因素在胸部爆炸伤后肺损伤中的作用。方法:应用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BALF中IL-6、IL-8、TNF-α和肺组织NFκBP65和p38MAPKmRNA表达,并进行相关分析。结果:100%的家兔发生肺冲击伤,56.7%碎片伤;胸片示两肺纹理增粗、模糊;伤后PaO2、Pa(A-a)O2、SaO2明显下降,肺含水量增加;IL-6、IL-8和TNF-α含量明显升高(P<0.05或P<0.01);肺组织NFκBP65、p38MAPKmRNA表达阳性。NFκBP65、p38MAPKmRNA表达与PaO2、Pa(A-a)O2、IL-6、TNFα水平正相关(P<0.05)。结论:胸部爆炸伤时冲击波和高能碎片引起肺原发损伤,继发因素肺组织p38 MAPK、NFκB P65和IL-6、IL-8和TNFα加重肺功能损害。Objective：To explore the roles of the primary and secondary factors in lung injury caused by chest explosive wounds. Methods： The model for chest explosive wounds was made in rabbits. The pulmonary function and lung injuries were observed. The content of IL - 6, IL - 8 and TNF -α in bronchoalveolar lavage fluid and the expression of NFKBP65, P38MAPK mRNA in lung were evaluated. The correlation of lung injury grade and changes of cytokine was analyzed. Results： The pulmonary blast injuries occurred in all rabbits, 56.7% animals suffered from pulmonary fragment injury. The obvious laceration and bleeding were seen in the wound tract and surrounding tissue. Chest radiology demonstrated lung marking increase. Breathing frequency and lung water content notably elevated. As time prolonged, PaO2 and SaO2 progressively decreased, Pa （ A - a） O2 and lung water content progressively increased. The content of IL - 6, IL - 8 and TNF -α increased at different degree （ P 〈 0.05 or P 〈 0.01 ）. Positive expression of NFKBP65 and p38MAPK mRNA were observed in lung tissue. Moreover, the positive correlation between their expressions and PaO2, P （ A - a） O2, IL6 and TNFα were found （ P 〈 0.05 ）. Conclusions： Blast and fragment contribute to the primary lung injury. The secondary factors such as the expression of NFKBP65, p38MAPK mRNA in lung and the production of IL - 6, IL - 8 and TNFα aggravate the lung injuries.

关 键 词：胸部爆炸伤 肺损伤 原发因素 继发因素 

分 类 号：R655[医药卫生—外科学]