火器多发伤时骨折早期固定减轻肠道屏障功能损害的研究  

Early fracture fixation alleviates gut barrier function damage after multiple firearm injuries in pigs

作　　者：黎沾良[1] 杨兴东[2] 陆连荣[1] 于勇[3] 杨英祥[2] 章亚东[4] 

机构地区：[1]解放军第三○四医院普通外科,北京100037 [2]海军总医院普通外科 [3]解放军第三○四医院创伤研究室,北京100037 [4]解放军第三○四医院骨科,北京100037

出　　处：《中华外科杂志》2003年第8期620-622,共3页Chinese Journal of Surgery

基　　金：全军"九五"指令性课题资助项目 (96L0 5 3 )

摘　　要：目的　探讨多发伤时骨折早期固定能否减轻肠道屏障功能的损害。　方法　 12只小型猪制作火器多发伤模型 ,即颅骨切线伤加双股骨干粉碎骨折 ,损伤严重度评分≥ 16后 ,随机分为对照组 (n =6 )和骨折内固定组 (n =6 )。伤前及伤后 6、12、2 4、4 8和 72h ,采用酶学分光光度法检测血浆D 乳酸水平 ,观察肠道通透性的变化 ;分光光度法检测血浆和小肠组织中二胺氧化酶 (DAO)含量 ;偶氮显色法鲎试验定量测定门静脉血浆内毒素浓度 ;常规方法做门静脉血细菌培养。　结果　对照组伤后血浆D 乳酸和DAO水平显著升高 ,并维持高水平到 72h ;小肠组织DAO含量明显降低 ,门静脉血浆内毒素水平明显升高 ,门静脉血细菌培养阳性率为 6 3 3%。骨折内固定组伤后 6和 12h血浆D 乳酸、DAO和内毒素水平也明显升高 ,但 2 4或 4 8h以后明显回落 ,72h与对照组相比差异有显著意义(P <0 0 5 ) ,细菌培养阳性率也低 (30 0 % ,P <0 0 5 )。　结论　多发伤后出现肠道通透性增高 ,肠黏膜完整性受损 ,有细菌、内毒素移位发生。骨折早期内固定可以减轻肠道屏障功能的损害 ,减少肠源性感染的机会。Objective To explore if early fracture fixation can alleviate gut barrier function damage caused by multiple firearm injuries in pigs. Methods Twelve healthy pigs were subjected to tangental fracture of parietal bone and comminuted fractures of bilateral femora(ISS≥16) due to 5.8 mm bullets shooting and these bigs were divided randomly into 2 groups. Control group ( n =6) were not treated at all. Fracture fixation Group ( n =6) were managed by immediate fracture fixation of bilateral femora with intramedullary nails. Plasma concentration of D lactate, DAO and endotoxin (in portal vein) were detected at different intervals before and after trauma. The portal vein blood was cultured and the percentage of positive isolation was calculated. The concentration of DAO in small bowel was also detected 72 hours later after trauma. Results In control group, the plasma concentrations of D lactate, DAO and endotoxin increased at early stage and kept high till 72 hours after trauma; the percentage of positive blood culture was 63 3%.In Group F, the levels of plasma D lactate, DAO and endotoxin were also elevated at early stage (6～12 h), but declined significantly from 24 h or 48 h after trauma compared with control group( P <0 05),and the percentage of positive blood culture was lower(30 0%, P <0 05). The concentrations of DAO in small bowel decreased in both groups, but to a less extent in Group F. Conclusion Bacterial and endotoxin translocation emerged with increasing gut permeability after multiple firearm injuries. The damage of gut barrier function could be alleviated and the chance of enterogenous infection could be by early fracture fixation after trauma.

关 键 词：火器多发伤 骨折 早期 肠道屏障功能损害 内固定 

分 类 号：R82[医药卫生—临床医学]