不同复温速率对肢体爆炸伤合并海水吸入兔脏器损伤的作用  

The effect of different rewarming velocity on organ damages after explosive injury with seawater inhalation in rabbits

作　　者：梁杰[1] 赖西南 莫立稳[1] 甯交琳[1] 王丽丽[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所六室,创伤、烧伤与复合伤国家重点实验室,重庆400042

出　　处：《中国急救医学》2008年第4期328-331,385,共5页Chinese Journal of Critical Care Medicine

基　　金：全军“十一五”指令性课题(No.06D004)

摘　　要：目的观察不同复温速率对肢体爆炸伤合并海水吸入兔脏器损伤的作用,为海战伤低体温伤员救治提供理论基础。方法采用肢体爆炸伤合并海水吸入低体温(31.0±0.5)℃致伤模型,成年家兔18只,随机等分为快速复温组〔1℃/10 min复温至(38.0±0.5)℃〕、缓慢复温组〔0.5℃/10 min复温至(38.0±0.5)℃〕和维持低温组〔0.5℃/10 min复温至(34.0±0.5)℃〕。复温结束后观察6 h收集血标本和肺肝肾组织标本。检测血浆MDA、T-SOD、AST、ALT、Cr水平和肺湿/干比值。结果快速复温组有2只兔于复温后死亡(2/6),其余伤兔均存活至实验结束;在复温后6 h,缓慢复温组MDA浓度、AST/ALT活力、Cr浓度和肺湿/干比值均显著低于快速复温组(P<0.05),T-SOD活力则显著高于快速复温组(P<0.05);肺脏和肝脏病理损伤以快速复温组最为显著;三组肾脏病理学变化不明显。结论针对肢体爆炸伤合并海水吸入导致低体温的动物采用早期缓慢复温处理可能更有利于减轻动物的全身创伤反应和脏器损伤程度。Objective To investigate the effect of different rewarming velocity on organ injury after explosive injury with seawater inhalation in rabbits. Methods The low - body - temperature model induced with explosion injury of limbs with seawater inhalation[ （ 31.0±0.5 ） ℃ ]. Adult rabbits were randomly divided into rapid rewarming group [ 1℃/10 min rewarming to （38.0 ±0.5 ） ℃, n =6] , slow rewarrning group [ 0.5 ℃/10 min rewarming to （38.0±0.5）℃, n = 6 ] and the keeping -hypothermia group[0.5 ℃/10 min rewarming to （34.0± 0.5）℃, n = 6]. 6 h after rewarrning, blood samples, lung, liver and kidney tissue samples were collected. MDA, T - SOD, AST, ALT, Cr levels in plasma and lung wet- to-dry ratios were detected. Furthermore, pathobiological changes of lung, liver and kidney were observed. Results Two rabbits in rapid rewarming group died after rewarming （2/6） , and others survived to the end of experiment; 6 h after rewarming, slow rewarming group MDA, Cr concentrations, AST/ALT activity in plasma and lung wet - to - dry ratios were significantly lower compared with that rapid rewarrning group （ P 〈 0.05 ） , T - SOD activity was significantly higher than that rapid rewarming group （ P 〈 0.05 ） , pathological injuries of lung and liver in rapid rewarming group were most severe, followed by that of rewarming group. Conclusion The rewarming treatment maybe more conducive to reducing traumatic reaction and secondary organ damage after low - body - temperature induced with explosive injury with seawater inhalation in rabbits.

关 键 词：爆炸伤 海水吸入 复温 

分 类 号：R82[医药卫生—临床医学]