猪下肢软组织枪弹伤致肺远达效应的防护研究  

The protection of anti-injury drugs to the far-reaching effects in lung of pig induced by gunshot wounds of lower limb soft tissue

作　　者：赵欣[1] 王小平[2] 姚力农 李玮[1] 李强[1] 王亚蓉[1] 郭国祯[4] 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胸外科,陕西西安710038 [3]第四军医大学唐都医院麻醉科,陕西西安710038 [4]第四军医大学军事预防医学系

出　　处：《实用放射学杂志》2014年第1期151-155,163,共6页Journal of Practical Radiology

基　　金：全军医药卫生科研基金课题（06MA207）.

摘　　要：目的观察抗损伤药物防护对猪下肢软组织枪弹贯通伤所致肺远达效应的影响。方法24只实验猪随机分为实验组（药物防护组）与对照组，每组12只。实验组于枪击前3d给予抗损伤药物防护（每天给予静脉滴注0．9％氯化钠注射液100mL．维生素c2．0g、地塞米松2．0mg、安络血10mg）。对照组给予相同量的生理盐水注射液。使用81式步枪、7．62mm子弹，复制猪下肢枪弹软组织贳通伤动物模型。分别于致伤前及敛伤后不矧时间点行胸部CT扫描并取病理标本，分析实验VCT图像特点及其病理改变。同时，在枪击前后相应时间点抽取静脉血，检测血浆内皮素（ET）及皮质醇（COR）的浓度。结果（1）实验组枪占后VCT屁示：一侧或双侧肺可见小片状高密度影，支气管管壁毛糙，可见轻度渗出性病变，未见明显肺段实变。对照组枪击后VCT显爪：双肺均出现大小程度不同的斑片状高密度影，边缘模糊，密度欠均匀，呈磨玻璃样改变．部分肺段实变。所有动物均无气胸及肺不张表现。（2）实验组枪击后肺脏大体标本肉眼仅见散在的斑点状出血灶，镜下可见肺泡腔内少量红细胞、纤维素样物质及炎性渗m。对照组枪击后肺脏大体标术肉眼可见肺表面大小程度不同的片状出血表现，未见脏层胸膜和肺实质破裂。镜下可见肺微血管扩张出血，毛细血管破裂，肺间质和肺泡腔内出血、水肿。肺泡隔变厚增粗、充血水肿，呈蜂窝状改变。肺泡腔内充满大量红细胞、纤维素样物质及白细胞。（3）实验组枪击后血浆COR水平较枪击前增高（P〈0．05），但与对照纰比较明硅减低。实验组枪击后血浆ET水平较枪击前无统计学差异（P〉0．05）。对照组枪击后血浆ET及COR水平较枪击前显著增高，以枪击后10min最为镀著（P〈0．05）。结论猪下肢软组织枪弹贯通伤可致肺远达效应损伤，�Objective To investigate the protection of anti-injury drug on pulmonary far-reaching effect induced by gtmshot wounds of lower limb soft tissue. Methods 24 pigs were randomly divided into experimental and control group, 12 pigs each group. In experiment group, anti-injury drugs [intravenous drip and 0.9% sodium chloride injection 100 ml.,vitamin C 2.0 g, dexametha- sone 2.0 mg, earbazochromc 10 rag） were given 3 days before gunshot, and the same amount of sodium chloride injection was given in control group. After anesthesia,the domestical 81-1 type semi-automatic rifle with 7.62 mm bullet was used to make the pig low- er limb soft-tissue gunshot model. Before and after injury, chest VCT scan was performed, and the characteristics of VCT images and pathological results were ;malyzed. At the same time, blood plasma endothelin （ET} and cortisol （C（）R） concentrations were checked before and after shooting at different time. Results （Din experimental group, VCT scan of lung showed very small size and extent of sheet or cord-like high density shadow with the obscure edge and nonuniform density. Pulmonary vascular and bronchial di- anaeter had no significant changes. In control group, VCT scan of lung showed different size and extent of sheet or cord-like high- density shadow with the obscure edge and nonuniform density. The reduction in light transmission and ground-glass change were found in the surrounding lung. All animals had no atelectasis and hemopneumothorax. （2）In experimental group, very small scattered dark red or bright red patchy and small areas of hemorrhagic manifestations were found in lung specimens by naked eye. I.ittle alveo lar hemorrhage, cellulose-like substances and inflammatory exudate could he found under microscope. In control group, dark red or bright red patchy and large areas of hemorrhagic manifestations were found in lung specimens by naked eye ;no visceral pleura and lung rupture were observed. I.obular pathological bleeding and ground-glass change could be seen in lar

关 键 词：肺 远达效应 枪弹伤 应激反应 猪 

分 类 号：R-332[医药卫生] R685