胸部开放伤后海水浸泡致急性肺损伤的实验研究  

Experimental Study or Acute Lung Injury after Open Chest Wound and Seawater Immersion

作　　者：李辉[1] 鹿尔驯[1] 虞积耀[1] 王育红[1] 孙笑非[1] 王大鹏[1] 周正谋[1] 关淑珍[2] 马聪[2] 

机构地区：[1]海军总医院胸外科 [2]海军总医院检验科

出　　处：《海军总医院学报》2000年第2期67-70,共4页Journal of Naval General Hospital of PLA

基　　金：本课题为解放军总后勤部卫生部"九五"指令性课题(96-L004)

摘　　要：目的:探讨海水浸泡胸部开放伤致急性肺损伤的特点,为研究救治方案提供依据.方法:实验动物致伤后随机分为单纯胸外伤组(n=10)和海水浸泡组(n=10).海水浸泡组动物于伤后置入人工配制的海水中,于伤前及入水后0.5、1、2、3和4h取血测定TNFa和IL-Iβ变化,同时监测血液动力学、呼吸系统和动脉血气变化.活杀或死后立即取肺标本行光镜和电镜检查.单纯胸外伤组除不浸泡海水外处理同海水浸泡组.结果:海水浸泡组死亡率明显高于单纯胸外伤组,并且生存时间明显短于单纯胸外伤组,平均生存时间为45min.海水浸泡组的急性肺损伤明显重于单纯胸外伤组,表现在严重的低氧血症和高碳酸血症、肺含水量明显增加、血浆TNFa和IL-Iβ伤后明显升高并且高峰时间明显提前.结论:海水浸泡加剧胸外伤致急性肺损伤的程度,导致呼吸及循环系统进行性衰竭,加速实验动物死亡.Objective: To evaluate the effect of seawater immersion on acute lung injury after chest trauma. Methods: Twenty health dogs were divided into two groups. A right open pneumothorax was induced in both simple chest trauma (SCT) group (n=10) and seawater immersion (SI) group (n=10). After induction of chest trauma animals in SI group were immersed in artificial seawater. Blood samples were taken at seven different time intervals for assessing blood gas. plasma level of TNF. and IL-1β. The hemodynamic and repiratory changes were recorded. At the end of study lung was harvested for assessing lung water content and ratio of wet weight and dry weight. Results: Post-trauma mortality was much higher in SI group than that in SCT group. The main cause of death were acute lung injury and secondary circulatory failure. The mean survival time in SI group was 45 minutes and in SCT group was more than 4 hours (p<0. 01). The plasma levels of TNF. and IL-1β significantly increased at 30 minutes and reached the highest level at 60 minutes after seawater immersion. The time of peak level appeared earlier in SI group than that in SCT group. Conclusion: Seawater immersion is closely related to severity of acute lung injury after open chest trauma. It could results in high mortality rate and rapid death due to progressive dysfunction of respiratory and circulatory system.

关 键 词：海水浸泡 开放性胸部伤 急性肺损伤 动物模型 

分 类 号：R655.06[医药卫生—外科学] R655.3[医药卫生—临床医学]