不同程度猪下肢枪弹伤所致肺间接伤的CT表现与应激性炎症的关系  

CT manifestations of indirect lung injury caused by a varying degree of gunshot wound on pig lower limb and its association with stress-induced inflammatory

作　　者：王亚蓉[1] 赵欣[1] 姚立农[2] 王炳荣[2] 杨永慧[2] 胡福光[3] 王玮[1] 

机构地区：[1]第四军医大学唐都医院放射科,陕西西安710038 [2]第四军医大学唐都医院麻醉科,陕西西安710038 [3]第四军医大学唐都医院军务科,陕西西安710038

出　　处：《实用放射学杂志》2011年第11期1752-1756,共5页Journal of Practical Radiology

基　　金：基金项目：全军医药卫生科研课题（06MA207）.

摘　　要：目的 探讨不同程度猪下肢枪弹伤所致肺间接伤的CT表现规律及机制.方法 将14头猪随机采用高速弹射击,建立猪下肢枪弹伤中等程度损伤（软组织贯通伤,M组）和重伤动物模型（骨折,S组）,每组7头,利用CT技术对动物模型致伤前、后瞬时、10 min,40 min,6 h的肺部组织结构影像学进行观察,同时测定炎症反应指标：体温、外周血白细胞总数、白介素-6（interleukin-6,IL-6）.结果 （1） 猪下肢枪弹伤不同伤情下的肺间接伤包括渗出、实变、出血、不张、细支气管炎、胸腔积液、肺间质改变;（2）肺间接伤发展程度与枪弹伤伤情程度存在一致性趋势.伤后40 min,S组细支气管炎发生率高于M组（P〈0.05）,伤后6 h S组的渗出、实变、胸腔积液、肺间质渗出发生率高于M组（P〈0.05）;（3）IL-6水平伤后上升,6 h达到高峰.伤后40 min,6 h 2组间IL-6水平有统计学差异（P〈0.05）;（4） 伤后随IL-6水平的上升,肺渗出、实变和细支气管炎发展加重.结论 不同程度猪下肢枪弹伤所致的肺间接伤伤情程度与枪弹伤伤情相一致;致伤后早期,应激性炎症参与肺部间接伤的发展和加重.Objective To explore the CT manifestations and pathological basis of indirect lung injury caused by a varying degree of gunshot wound on pig lower limb. Methods 14 pigs were divided into two groups randomly. Shots were made into the pigs＇ lower limbs to create moderate wound model （soft tissue penetration,group M） and severe wound model （femur fracture,group S）. The CT manifestations of pulmonary structure pathological changes and inflammatory index { body temperature, blood white cell count and II.-6） were assessed pre-gunshot, at the moment of gunshot wound, 10 minutes, 40 minutes and 6 hours later. Results （1）Indi- rect lung injury induced by lower limb gunshot wound included exudation, consolidation, hemorrhage, atelectasis, bronchiolitis, pleural effusion and pulmonary interstitial pathosis;（2）The development of indirect lung injury had a trend influenced severity. The incidence of bronchiolitis in groups was higher than that in group M 40 minutes after gunshot wound by the injury （P〈0.05）. More pulmonary pathosises including exudation, hemorrhage, consolidation, pleural effusion and pulmonary interstitial were found in the group S relative to the group M 6 hours after gunshot wound（P〈0.05） ;（3）The blood IL-6 level increased after gunshot wound and reached the peak 6 hours after gunshot wound. IL-6 level in groups was higher than that in group M 6 hours after gunshot wound I P〈0.05）; （4） The severity of pulmonary effusion, consolidation and bronchiolitis increased with the blood IL-6 level （P〈0.05）. Conclusion The severity of indirect lung injury caused by lower limb gunshot is consistent with the direct injury severity. Stress-induced inflammatory has a influences on the development of the indirect lung injury and aggravates it in the early injury.

关 键 词：枪弹伤 间接伤 肺 实验 体层摄影术 X线计算机 

分 类 号：R322.3[医药卫生—人体解剖和组织胚胎学] R641[医药卫生—基础医学]