损伤局部低温对肢体爆炸伤后肺损伤的保护作用  

The protective effects of regional hypothermia on lung injury after limb ＇s explosion injury in closed cabin

作　　者：甯交琳[1] 赖西南 莫立稳[1] 梁杰[1] 王丽丽[1] 

机构地区：[1]解放军第三军医大学西南医院野战麻醉科,重庆400038

出　　处：《中国急救医学》2009年第9期808-811,I0001,共5页Chinese Journal of Critical Care Medicine

基　　金：全军“十一五”指令性课题（No.062034）

摘　　要：目的观察密闭舱室环境下，肢体爆炸伤后肺损伤的特点以及肢体爆炸伤后给予损伤局部低温对肺损伤程度的影响。方法24只健康雄性SD大鼠，随机分为假致伤组、单纯致伤组和损伤局部低温干预组。采用酶联免疫法测定肺组织细胞因子TNF-d和IL-6含量，比色法测定肺组织丙二醛（MDA）含量、超氧化物歧化酶（SOD）和髓过氧化物酶（MPO）活性；肺湿／干质量比代表肺含水量；石蜡切片HE染色观察肺组织病理改变。结果密闭环境中，肢体爆炸伤后肺组织发生出血、水肿，肺间隔断裂，炎症细胞浸润，肺组织TNF-d和IL-6含量显著升高、MDA含量和MPO活性显著升高、SOD活性明显下降；在肢体爆炸伤后早期实施损伤局部低温可减轻肺组织出血、水肿和炎症细胞的浸润，降低肺组织TNF-α和IL-6含量、MDA含量和MPO活性、增加SOD活性。结论密闭环境中，肢体爆炸伤后发生明显的肺冲击伤，氧化应激和炎症细胞浸润可进一步加重肺组织损伤，采用损伤局部低温可通过减轻炎症反应、氧化应激和炎症细胞浸润，减轻肺组织损伤。Objective To study the character of lung injury after explosive injuries of limb in closed canbin and effects of regional hypothermia on severity of lung injury after limb＇s explosion injuries. Methods 24 healthy male SD rats were randomly segregated into three groups, sham - vulnerate group, simple explosive injury group and regional hypothermia group. Tumor necrosis factor α （ TNF - α ） and interleukin-6（IL- 6） in lung tissue were assayed with ELISA. Malondialdehyde （MDA） content, superoxidedismutase （ SOD ） and myeloper - oxidase （ MPO ） activity of lung tissue were assayed with chromatometry. Lung water contents were represented with lung wet weight/dry weight. Lung pathological changes were observed thought light microscope. Results Lung bleeding, oedema, inflammatory cell infiltration and breakage spacer of lung alveoli were observed in paraffin section. TNF - α and IL - 6 contents in lung tissue increased significantly, MDA contents and MPO activity increased, SOD activity decreased significantly after limb＇S explosion injuries in closed cabin. Regional hypothermia could decrease TNF- α, IL- 6 and MDA contents, MPO activity, therefore increase SOD activity of lung tissue, mitigate lung bleeding, oedema and inflammatory cells infiltration. Conclusion Blast lung injury take place after limb＇s explosion injuries in closed cabin. Inflammatory cell infiltration and oxidative stress exacerbate lung injury. Therefore regional hypothermia can mitigate lung injury by inhibiting inflammatory reaction, inflammatory cell infiltration and oxidative stress.

关 键 词：损伤局部低温 密闭舱室 肢体爆炸伤 肺损伤 

分 类 号：R826.1[医药卫生—临床医学]