犬冲击伤复合高速破片伤时内皮素的变化及其意义.docVIP

犬冲击伤复合高速破片伤时内皮素的变化及其意义 　　作者：严家川，杨志焕，蒋晓江，董蕻，李晓炎，冯刚 (第三军医大学大坪医院野战外科研究所，重庆 400042) 　　摘要: 目的 探讨犬高速破片伤对冲击伤伤情的影响。方法 成年杂种狗21只，依据冲击波和高速破片的物理参数，分别复制中度冲击伤、肢体高速破片伤、中度冲击伤复合高速破片伤，观察伤后肺动脉压、致伤后24小时肺形态学、肺含水率和肺体指数，同时测定血浆和肺组织内皮素含量。结果 致伤后犬肺动脉压升高，血浆和肺组织ET含量升高。高速破片可加重中度冲击伤，其效应主要发生在肺脏，伤情可加重1个等级。结论 肢体高速破片伤对中度肺冲击伤具有加重作用，其机制与致伤后血浆和肺组织ET含量升高有关。 　　关键词:冲击伤;破片伤;复合伤;内皮素 　　Changes of endothelin after blast combined fragment injuries and its significance in dogs 　　YAN Jiachuan,YANG Zhihuan,JIANG Xiajiang,et al. 　　(Research Institute of Field Surgery，Daping hospital,Third Military Medical University,Chongqing 400042,China) 　　Abstract: Objective To explore the effects of high velocity fragment on the severity of blast injuries.MethodsAccording to the physical parameters of shock waves and high velocity fragment,models of moderate blast injury,high velocity fragment injury and moderate blast injury combined high velocity fragment injury were established in 21dogs respectively.Pulmonary arterial pressure,morphological change of lung,rate of lung water and lung body weight index were observed after injury.The levels of endothelin(ET) of plasma and lung tissues were detected after injury.ResultsThe pulmonary arterial pressure was increased after injuries.The levels of ET of plasma and lung tissues were both increased after injuries.The high velocity fragment aggravated the injuries caused by moderate blast,the lung was its target organ,and the injury became worse by one grade.Conclusion The high velocity fragment can aggravate the injuries caused by moderate blast.The mechanism involves the increased levels of ET of plasma and lung tissues after injuries. 　　Key words:blast injury;fragment injury;combined injury;ET 　　高速破片伤对肺冲击伤具有加重效应,除高速投射物压力波作用外,一些细胞因子在其中也起一定的作用[1，2]。内皮素(Endothelin，ET)是一类血管活性肽，是体内最强的血管收缩物质之一，在急慢性缺氧、休克等许多病理情况下具有重要意义[3，4]。冲击伤复合高速破片伤时ET的变化特点及其意义未见文献报道。本实验观测比较犬单纯冲击伤、单纯高速破片伤和冲击伤复合高速破片伤后血浆和肺组织ET含量变化，以期阐明伤后犬ET变化的特点和意义。 　　材料与方法 　　1 实验动物及分组 　　成年杂种犬2