重度创伤后TE变化与继发急性肺损伤的关系

发布时间：2018-02-22 18:58

本文关键词： 微量元素重度创伤氧化应激急性肺损伤多器官功能障碍综合征　出处：《汕头大学》2006年硕士论文　论文类型：学位论文

【摘要】：研究背景严重创伤不但造成局部组织破坏，还可引发一系列全身性病理生理反应，导致休克、全身炎症反应综合征(systemic inflammatory response syndrome，SIRS)和多器官功能不全综合征(multiple organ dysfunction syndrome，MODS)等，甚至死亡。其中MODS是严重创伤后最严重的并发症，在其发生发展过程中，肺脏是最常见或最先受累的器官。创伤后急性肺损伤(acute lung injury，ALI)在MODS的进展中起着重要作用，作为ALI晚期的急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS)是MODS的重要组成部分和启动环节。研究表明，严重创伤可引起血清Se、Fe、Zn等多种微量元素(trace element，TE)急剧下降及体内再分布，，创伤程度与血TE下降程度明显相关，一定量的补充能降低重伤者MOF、感染发生率。目前，人们对创伤后ALI／ARDS进行了大量细胞因子等方面的基础研究，但尚未涉及创伤后急性TE缺乏与继发ALI／ARDS之间关系的研究报道。我们的前期工作，也证实严重创伤后引发急性TE缺乏与MODS，特别与死亡密切相关。因此，本实验通过建立家兔重度创伤模型及补充TE，观察血清及肺组织TE、氧化应激、细胞间粘附分子-1(ICAM-1)以及MODS等指标，探讨重度创伤引发的急性TE缺乏与继发ALI之间的关系，为临床救治及法医死因分析和死亡机理提供理论基础。材料和方法雄性纯种新西兰白兔70只，随机分：①正常对照组5只；②重伤组37只，其中12只于伤后2-14d死亡，25只处死；③补充组28只，其中3只于伤后2-7d死亡，25只处死。④死亡组，重伤组中12只死亡家兔归为死亡组。建立ISS=27肢体重度创伤模型。伤后6小时，补充组耳缘静脉滴注10％GS 50ml／kg+0.1ml安达美；伤后1～5天，腹腔给予0.025ml安达美+10％GS 5ml／kg，早晚各1次。重伤组只单纯给予10％GS。重伤组及补充组按伤前和伤后6h、1d、3d、6d、9d、14d定时颈静脉采血，同时随机于伤后1d、3d、6d、9d、14d各处死5只。检测血清及肺Zn、Se、Cu、Mn、MDA含量、Cu／Zn-SOD、Mn-SOD、GSH-PX活性、ICAM-1等，观察肺脏及其他脏器组织形态学变化。结果 1 一般情况重伤后家兔体重明显下降，呼吸加快，重伤组家兔多集中在伤后2-9天死亡，
[Abstract]:Research background. Severe trauma not only causes local tissue damage, but also leads to a series of systemic pathophysiological reactions, such as shock, systemic inflammatory response syndrome (SIRs) and multiple organ dysfunction syndrome (mods). Among them, MODS is the most serious complication after severe trauma, and the lung is the most common or the first organ involved in the development of MODS. Acute lung injuryALI plays an important role in the progression of MODS. Acute respiratory distress syndrome (ARDS), which is the late stage of ALI, is an important part of MODS. The degree of trauma is significantly related to the decrease of blood te, and a certain amount of supplementation can reduce the incidence of MOF and infection in severely injured patients. At present, people have done a lot of basic research on cytokines and other aspects of post-traumatic ALI/ARDS. However, there has not been a study on the relationship between post traumatic acute te deficiency and secondary ALI/ARDS. Our previous work has also confirmed that acute te deficiency after severe trauma is closely related to MODSs, especially to death. In order to investigate the relationship between acute te deficiency induced by severe trauma and secondary ALI, we established a rabbit model of severe trauma and supplemented with TE3, observed serum and lung TE3, oxidative stress, intercellular adhesion molecule-1 (ICAM-1) and MODS. To provide a theoretical basis for clinical treatment, forensic cause of death analysis and death mechanism. Materials and methods. Seventy male pure New Zealand white rabbits were randomly divided into 5 normal control group (n = 5) and 2 severe injury group (n = 37). Among them, 12 rabbits died from 2 to 14 days after injury and 25 rabbits were killed in the supplement group (n = 28). Among them, 3 rabbits died 2-7 days after injury and 25 rats were killed in 4 death group. In the severe injury group, 12 rabbits were classified as the death group. The ISS=27 limb injury model was established. 6 hours after injury, 10 GS 50ml / kg 0.1ml adamet was injected into the ear margin vein of the supplementary group, and 1 day after the injury, 5 days after the injury, 0.025ml adamet 10GS 5ml / kg was given intraperitoneally, once in the morning and evening. The severely injured group and the supplementary group received only 10GSs. The blood samples were collected from the jugular vein before and 6 days after injury and at the end of 6 days after injury. At the same time, 5 rats died at random on the third day, 6 days, 9 days and 14 days after injury. The contents of CuMnMDA in serum and lungs and the activity of Cur / Zn-SOMn-SODnGSH-PX and ICAM-1 were measured. The histomorphologic changes of lung and other organs were observed. Results. (1) in general, the weight of the rabbits decreased obviously and the respiration accelerated after serious injury. The rabbits in the serious injury group mostly died 2-9 days after injury.
【学位授予单位】：汕头大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R641;R563.8;D919

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