腹部火器伤肠管穿透后脓毒症的发生及意义  

Development of Sepsis and Its Significance after Intestinal Perforations Due to Abdominal Firearm Wound in Pigs

作　　者：李泽信[1] 王霄[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,河南新乡453003 [3]兰州军区乌鲁木齐总医院,新疆乌鲁木齐830000

出　　处：《河南职工医学院学报》2010年第1期4-7,共4页Journal of Henan Medical College For Staff and Workers

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脓毒症的发生过程及意义。方法健康长白仔猪42头,随机分为对照组和伤后1 h、2 h、4 h、8 h、12 h和24 h组(每组6头),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,进行伤道分泌物的定量和定性分析以及血液的细菌培养及菌群分析,采用双抗体夹心ELISA法测定各组动物血清TNFα-、IL-6水平,并观察各个时间点的体温变化。结果实验各组的血浆内毒素水平及血清TNF-α、IL-6水平均明显高于对照组(P<0.05),血浆内毒素于伤后8 h达到高峰,伤后12 h仍维持在高峰值水平(P<0.05);血清TNF-α、IL-6水平均于伤后12 h达到高峰并与伤后血浆内毒素水平变化一致。伤后动物体温逐渐升高,在伤后12 h、24 h实验组的平均体温达40℃以上。伤后8 h,伤道每克组织细菌数为(5.93±0.78)×105,达到感染的临界值;弹道局部渗出物中均有表面菌群,伤后4 h开始各组可检测到肠道菌群,血液细菌培养阳性,可检测到表面菌群和肠道菌群。结论腹部火器伤肠穿孔后脓毒症发生时间早,其可能参与了伤后机体的病理生理过程。Objective To investigate the development of sepsis and its significance 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 lhour group, 2hour group, 4hour group, 8hour group, 12hour group, 24hour group. The model of intestinal perforations due to abdominal firearm wound was established in wounded groups. Levels of plasma endotoxin was measured using chromogenic limulus amehoeyte lysate test. The quantitative and qualitative analysis of bacteria were performed in all groups. Serum TNF-α and IL-6 levels were determined by ELISA. Body temperature was measured. Results Levels of plasma endotoxin, serum TNF-α and IL-6 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 12h group. At the time of 12 hours, the serum concentrations of TNF-α and IL-6 were reaching their peak according to plasma endotoxin. Body temperature was gradually elevated from the control group to 24h group. It was increased to more than 40℃ in the 12h and 24h groups. The number of bacteria in wound tracts was （5.93 ±0.78 ×10^5/g） in the 8h group and reached critical point of infection. The surface bacteria were found in wound tract in all wounded groups, and the intestinal flora were found from the 4h group to 24h group. The invasion of bacterial into blood occurred after 4h of injury. Conclusion After intestinal firearm wound, sepsis happens early,which participates in the pathophysiological process after intestinal firearm wound.

关 键 词：脓毒症 TNF-Α IL-6 腹部火器伤 

分 类 号：R656.32[医药卫生—外科学]