高原高寒战时环境猪肢体枪弹伤后全身炎症反应的特点  

Features of systemic inflammatory response in pigs after gunshot on limb in high altitude,high cold and war environment

作　　者：殷作明[1] 李素芝[1] 胡德耀[2] 叶峰[1] 杨志焕[2] 石泉贵[1] 刘良明[2] 林秀来[1] 宋俊[1] 何代平[1] 李楠[1] 陈永龙[1] 何蓉城[1] 孙克勤[1] 刘安[1] 

机构地区：[1]西藏军区总医院全军高原战创伤救治中心,西藏拉萨850003 [2]第三军医大学大坪医院野战外科研究所,重庆400042

出　　处：《创伤外科杂志》2011年第1期59-63,共5页Journal of Traumatic Surgery

基　　金：军队指令性课题资助项目(01L008)

摘　　要：目的探讨高原高寒环境下平战时猪枪弹伤后血浆中肿瘤坏死因子α(TNFα)、白介素-1b(IL-1b)、白介素-4(IL-4)、白介素-10(IL-10)、一氧化氮(NO)等炎症介质和内毒素含量变化的规律。方法将实验小型猪24头随机分为高原战时致伤组(GZ)、高原平时致伤组(GP)和平原平时致伤组(PP)。每组8头,在模拟战时和平时环境下致伤,分别于伤前、伤后10、30分钟、2、6、12小时、1、2、3、5、7和10天采集静脉血用Elisa法测定血浆TNFα、IL-1b、IL-4、IL-10浓度,用比色法测NO,用鲎试剂法测内毒素含量。结果 PP组在伤后2小时TNFα和IL-1b含量升高,NO在伤后6～12小时降低;IL-4和IL-10升高的时间较TNFα、IL-1b晚。(2)GP组TNFα、IL-1b、IL-4、IL-10和NO变化规律与PP组相似,但其升高或者降低的幅度较PP组要大,恢复到正常水平的时间较PP组延后。(3)GZ组伤前血浆中就出现TNFα、IL-1b和IL-4、IL-10轻度升高,伤后其升高的幅度较PP组和GP组大、达到高峰的时间较高原PP组提前,在高水平持续的时间较其它组长。结论高原环境条件下机体应激反应增强,当经受枪弹伤后,机体炎症反应强而持久,过度的炎症反应使机体的抵抗力下降,对感染的敏感性增加,易诱发脓毒血症的发生。Objective To investigate the change rules of inflammatory mediators such as TNFa,IL-1b,IL-4,IL-10,NO and endotoxin content in plasma of pigs after gunshot wound in high altitude and high cold environment in peace and wartime.Methods Totally 24 pigs were divided randomly into normal environment group（PP,n=8）,high altitude group（GP,n=8）,and high altitude with war environment group（GZ,n=8）.Gunshot wound were induced in different environments.The content of TNFa,IL-1b,IL-4,IL-10,NO and endotoxin in plasma were measured at different time points before and after injury.Results In PP group,the content of TNFa and IL-1b in plasma increased at 2 hours after injury,while NO decreased at 6 to 12 hours after injury,and the time of IL-4 and IL-10 in plasma increased later than TNFa and IL-1b.In GP group,the change rules of forementioned mediators were similar to PP group,but the range of increase and decrease was larger than that in PP group,and the time of reaching to normal level was longer than PP group.In GZ group,TNFa,IL-1b,IL-4,and IL-10 appeared in plasma before injury,but their ranges of increase after injury were larger than PP group and GP group,their time of reaching to peak was earlier than PP group,and their duration at high level was longer than other groups.Conclusion Some extent of inflammatory response exists in body before injury because of severe striking of wartime factors in GZ group.The inflammatory response aggravates and persists,the resistance of body decreases,the susceptibility to infection increases and the body is susceptive to sepsis.

关 键 词：枪弹伤 炎症反应 高原 寒冷 战争 

分 类 号：R827[医药卫生—临床医学]