早期血液净化治疗创伤性肺脂肪栓塞的实验研究  

Experimental study of early blood purification in the treatment of post traumatic pulmonary fat embolism

作　　者：周飞虎[1] 岳慧[1] 纪筠[1] 宋青[1] 

机构地区：[1]解放军总医院外科重症医学科,北京100853

出　　处：《中国危重病急救医学》2009年第11期672-675,共4页Chinese Critical Care Medicine

基　　金：解放军总医院科技创新苗圃基金（07MP33）

摘　　要：目的探讨早期血液净化对创伤性肺脂肪栓塞的影响，为临床早期防治提供理论基础。方法健康雄性杂种犬12只，随机分为两组，每组6只。A组行双侧股骨手术扩髓＋骨水泥注入；B组在与A组同样实施扩髓手术的同时行血液净化治疗，直至手术结束共120min。监测两组动物血流动力学、动脉血气和血中炎症因子变化；术后观察120min并处死动物，取肺组织行油红O染色检查，并计算脂肪栓子数。结果A组动物在单侧股骨髓腔操作后出现平均肺动脉压（MPAP）、肺毛细血管楔压（PCWP）、血管外肺水（EVLW）升高，至双侧手术结束后各指标仍显著高于髓腔操作前（P均〈0．05）；同时在双侧手术结束时pH值、动脉血氧分压（PaO2）下降，动脉血二氧化碳分压（PaCO2）和血中肿瘤坏死因子-α（TNF—α）、白细胞介素-1β（IL-1β）、IL-6升高，与髓腔操作前相比差异均有统计学意义（P均〈0．05）。B组动物在手术过程中血流动力学保持稳定，动脉血气及相关炎症因子无明显变化。B组各肺叶肺脂肪栓子数较A组明显减少（（4．17±1．99）个比（18．13±6．25）个，P〈0．053。结论血液净化能有效清除血中TNF—α、IL-1β与IL-6，降低EVLW、MPAP和PCWP，改善气体交换和氧合，使肺脂肪栓子数明显减少，可有效降低髓内操作引起肺脂肪栓塞的可能性。Objective To study the effect of early continuous blood purification （CBP） in the treatment of post-traumatic pulmonary fat embolism in dog. Methods Twelve healthy male mongrel dogs were randomly divided into two groups： group A received intramedullary reaming and bone cement injection of bilateral femurs （n= 6）, and group B received CBP simultaneously at the beginning of the same operation and continued until 120 minutes after the end of the operation （n= 6）. The changes in arterial blood gas and related cytokines were monitored at various time points. The animals were sacrificed 120 minutes after the operation, and the lungs were obtained for examination, and the amount of oil red O stained fat emboli was recorded. Results In group A, the mean pulmonary arterial pressure （MPAP）, pulmonary capillary wedge pressure （PCWP） and extravascular lung water （EVLW） increased after the manipulation in single femur, and these changes persisted after the manipulation on both femurs （all P〈0.05）. There was a decrease in pH and arterial partial pressure of oxygen （PaO2） and an increase in arterial partial pressure of carbon dioxide （PaCO2）, tumor necrosis factor-α （TNF-α）, interleukin-1β （IL-1β） and IL-6 after the operation on both femurs, showing significant differences compared with those of pre-operation period （all P〈0.05）. In group B, the heraodynamics, contents of cytokines and arterial blood gases were stable. Compared with those of group A, there was a significant decrease in the number of pulmonary fat emboli in group B （4.17± 1.99 vs. 18.13± 6.25, P〈0. 05）. Conclusion The therapy of CBP could decrease the level of the serum TNF-α, IL-1β, IL-6 and EVLW, MPAP, PCWP, which could ameliorate gas exchange and oxygenation of the lung. And it also could reduce the number of pulmonary fat emboli and decrease the incidence of pulmonary fat embolism caused by femoral intramedullary operation.

关 键 词：脂肪栓塞 血液净化 细胞因子 肺 血流动力学 氧合 

分 类 号：R686[医药卫生—骨科学]