腹部火器伤肠管穿透后内毒素血症与肝细胞损伤  

Endotoxemia and hepatocyte injury after intestinal perforations due to abdominal firearm wound

作　　者：李泽信[1] 李荣[2] 薛会朝[1] 刘江伟[3] 张永久[3] 冯德元[3] 

机构地区：[1]新乡医学院第一附属医院普外科,河南卫辉453100 [2]新乡医学院 [3]兰州军区乌鲁木齐总医院普外科

出　　处：《医学信息（内.外科版）》2009年第12期1077-1079,共3页Medical Information Operations Sciences Fascicule

基　　金：兰州军区医药卫生科研基金资助项目(LXH-2005019)

摘　　要：目的探讨腹部火器伤肠管穿透后内毒素血症的发生及其与肝细胞损伤性变化的关系。方法健康长白仔猪42头随机等分为对照组和伤后1h、2h、4h、8h、12h和24h组,实验组建立腹部火器伤肠管穿透模型后,用显色基质鲎试剂法检测各组血浆内毒素水平,同时测定肝细胞凋亡指数和血清中ALT、AST水平变化情况。在光镜下观察各组肝细胞形态学变化,电镜下观察肝细胞超微结构改变。结果伤后各组血浆内毒素水平、肝细胞凋亡指数及血清ALT、AST水平均明显高于对照组(P<0.05)。血浆内毒素水平于伤后8h出现高峰,伤后12h仍维持在高峰值水平;肝细胞凋亡指数及血清ALT、AST水平均于伤后2h和12h出现2个高峰。伤后各组出现逐渐加重的肝细胞水肿、变性、坏死和肝细胞超微结构损伤。伤后血浆内毒素水平与肝细胞凋亡指数及血清ALT、AST水平均存在正相关(r值分别为0.736、0.534、0.352,P<0.05)。结论腹部火器伤肠穿孔后内毒素血症发生早,其可能导致了多种形式的肝细胞损伤。Objective To investigate the development of endotoxemia and its correlation with hepatocyte injury after intestinal perforations due to abdominal firearm wound in pigs. Methods A total of 42 Chang - Bai piglets were randomized into 7 groups：control group and wounded 1 hour group,2 hour group,4 hour group, 8 hour group, 12 hour group,24 hour group. The model of intestinal perforations due to abdominal firearm wound was established in wounded groups. Levels of plasma endotoxin was measured by using ehromogenie limulus amehoeyte lysate test. Hepatocyte apop- tosis indexes and serum ALT, AST levels were also determined. The alterations of hepatocyte morphology were observed under light microscope and the ultrastruetural changes of hepatoeyte under electron microscope in all groups. Results Levels of plasma endotoxin, hepatocyte apoptosis indexes and serum ALT, AST in wounded groups were all significantly elevated compared to control group （P 〈 0.05）. Plasma endotoxin reached the peak in 8h group, and it was still at the peak level in 12 h group. Hepatocyte apoptosis indexes and serum ALT,AST levels appeared two peaks in 2 h group and 12 h group. Hepatoeyte edema, metamorphosis, necrosis were gradually aggravated from 1 h group to 24 h group and at the same time hepatocyte uhrastructural injuries were found. Plasma endotoxin levels were positive correlation with both hepatocyte apoptosis indexes and serum ALT, AST levels （ P 〈 0.05 ）. Conclusions After intestinal firearm wound, en- dotoxemia happens early,which induces varied hepatocyte injuries.

关 键 词：内毒素 腹部火器伤 肝细胞损伤 

分 类 号：R657.5[医药卫生—外科学]