家兔挤压伤后心脏整体功能与心肌超微结构的变化  

Changes in cardiac function and myocardial ultrastructure after crush injury in rabbits

作　　者：赖小今[1] 郭进春[2] 邓旦[1] 廖明松[1] 梁燕[1] 陶杰[1] 陈重[1] 罗克枢[3] 李昆[4] 王超[4] 熊杰[5] 胡宗海[5] 

机构地区：[1]成都军区总医院超声科,成都610083 [2]成都军区总医院干部病房,成都610083 [3]成都军区总医院病理科,成都610083 [4]成都军区总医院中心实验科,成都610083 [5]成都军区总医院检验科,成都610083

出　　处：《解放军医学杂志》2012年第7期699-701,共3页Medical Journal of Chinese People's Liberation Army

基　　金：四川省卫生厅基金课题(090009)~~

摘　　要：目的探讨家兔挤压伤后心肌组织继发受损及心功能障碍的机制。方法制作家兔挤压伤动物模型。42只新西兰家兔随机分为对照组（n=6）和挤压伤组（n=36）,后者采用20kg压力连续挤压6h,并根据解压时间再分为解压即刻组,解压后6、12、24、48h和72h组,每组6只。采用多功能复合心脏超声检测不同时间段心脏整体功能变化;采用电镜观察不同时间段心肌组织超微结构的变化。结果解除挤压后各时间点心脏整体收缩指标[左室射血分数（EF）、左室周径缩短率（FS）、室壁增厚率（ΔT）及每分钟输出量（CO）]及舒张功能指标[快速充盈期峰值血流速度（PFVE）、缓慢充盈期峰值血流速度（PFVA）、PFVE/PFVA及舒张期充盈速率（PFR）]测值均呈进行性降低（P〈0.05）,其中以EF及FS测值降低最为明显,解压后12-24h心脏整体功能测值降低达到峰值（P〈0.01）。电镜下心肌组织超微结构变化明显,以伤后24h改变尤为显著。结论挤压伤后可致心肌组织继发损伤及心功能障碍,解压后12-24h为心脏损伤峰值阶段。多功能复合心脏超声技术能够较精准、客观、快捷地评估挤压伤后心脏的继发受损情况。Objective To explore the mechanism of secondary myocardial injury and cardiac dysfunction after crush injury in rabbits.Methods Forty-two New Zealand rabbits were randomly divided into control group（6 rabbits） and crush injury group（36 rabbits that received pressure of 20kg on upper parts of bilateral hind limbs and buttocks for 6h）,and crush injury group were subdivided into instant group,6,12,24,48 and 72h group after pressure relief with 6 rabbits in each group according to pressure relief time.The cardiac function changes in different time periods were detected by the multi-functional composite echocardiography,and the changes in myocardial ultrastructural at different time periods were observed under electron microscope.Results The systolic indexes such as left ventricular ejection fraction（EF）,left ventricular circumference shortening（CS）,ventricular wall thickening and cardiac output per minute and diastolic function indexes such as peak flow velocity during rapid filling phase,peak flow velocity during slow filling phase,E/A ratio and diastolic filling rate were progressively reduced at respective time points after pressure relief,especially EF and CS.All the indexes for cardiac function were reduced to negative peak level 12-24h after pressure relief（P〈0.01）;the myocardial ultrastructural changes were obvious,particularly 24h after injury.Conclusions Crush injury may result in secondary injury to the myocardium and cardiac dysfunction,reaching the peak phase of cardiac injury during 12-24h after pressure relief.Multi-functional composite cardiac echocardiography can accurately,objectively and rapidly assess the myocardial damage after crush injury.

关 键 词：挤压综合征 心肌 超声心动描计术 

分 类 号：R541[医药卫生—心血管疾病]