烧伤后早期某些炎性介质对急性胃粘膜损伤的临床研究  

The effect of certain pro-inflammatory mediators on the pathogenesis of acute gastric mucosal lesion in early burn stage

作　　者：高维谊[1] 郭振荣[1] 孙世荣[1] 孙晓庆[1] 李素芹 吴志强 贺春霞 

机构地区：[1]解放军第三○四医院烧伤研究所,北京100037 [2]解放军第三○四医院消化内科,北京100037

出　　处：《中华整形烧伤外科杂志》1998年第3期203-206,共4页

摘　　要：目的观察某些炎性介质对急性胃粘膜的损伤作用。方法选择21例烧伤面积大于30％的成人患者,按休克复苏中主要临床观察指标及血液动力学恢复情况分成A、B两组。伤后于入院立即,4,7天,分别行纤维胃镜检查及胃粘膜pH(pHi)测定并监测有关重要的炎性介质。结果伤后4,7天,B组血浆内毒素(LPS)、肿瘤坏死因子(TNF-α),白介素-8(IL-8)及内皮素(ET)明显高于A组,而胃pHi值低于A组,粘膜损伤指数与pHi呈显著负相关(r=-0.89,P<0.05)。而与ET呈正相关(r=0.91,P<0.05)。结论烧伤早期大量炎性介质及细胞因子释放直接加重了胃肠的继发性粘膜损害。pHi可作为监测粘膜损伤程度的敏感指标,对了解应激性溃疡病变的发生发展具有临床指导意义。Objective To appraise the effect of certain pro-inflammatory mediators on the patho- genesis of acute gastric mucosal lesion in early burn stage. Methods 21 patients with burn injuries of over 30% TBSA were divided into A and B groups according to the main clinical indexes during shock resuscitation and hemodynamic parameters. Fiberoptic endoscopic examination, determination of intra- mucosal pH(pHi) and measurement of some mediators were done immediately after admission to the hospital and 4 and 7 days after burn injury. Results It was demonstrated that the level of LPS in plas- ma, the content of TNF-α,IL-8 and ET in group B at 4 and 7 days postburn were significantly higher than those of group A, while the value of pHi in group B was markedly lower than that of group A. Damaging index of gastric mucosa was negatively correlated with pHi (γ=-0. 89,P<0. 05) ,but posi- tively with ET (γ=0.91 ,P=0.05). Conclusions These findings suggest that the inflammatory media- tors and cytokines promoted secondary damage to gastric mucosa during early postburn. It was believed that pHi was a sensitive index, and it played an important role in the development of stress ulceration.

关 键 词：烧伤 胃粘膜损伤 炎性介质 

分 类 号：R644.06[医药卫生—外科学] R573.02[医药卫生—临床医学]