中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2009年
11期
672-675
,共4页
周飞虎%岳慧%纪筠%宋青
週飛虎%嶽慧%紀筠%宋青
주비호%악혜%기균%송청
脂肪栓塞%血液净化%细胞因子%肺%血流动力学%氧合
脂肪栓塞%血液淨化%細胞因子%肺%血流動力學%氧閤
지방전새%혈액정화%세포인자%폐%혈류동역학%양합
fat embolism%blood purification%cytokine%lung%hemodynamics%oxygenation
目的 探讨早期血液净化对创伤性肺脂肪栓塞的影响,为临床早期防治提供理论基础.方法 健康雄性杂种犬12只,随机分为两组,每组6只.A组行双侧股骨手术扩髓+骨水泥注入;B组在与A组同样实施扩髓手术的同时行血液净化治疗,直至手术结束共120 min.监测两组动物血流动力学、动脉血气和血中炎症因子变化;术后观察120 min并处死动物,取肺组织行油红O染色检查,并计算脂肪栓子数.结果 A组动物在单侧股骨髓腔操作后出现平均肺动脉压 (MPAP)、肺毛细血管楔压(PCWP)、血管外肺水(EVLW)升高,至双侧手术结束后各指标仍显著高于髓腔操作前(P均<0.05);同时在双侧手术结束时pH值、动脉血氧分压(PaO_2)下降,动脉血二氧化碳分压(PaCO_2)和血中肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、IL-6升高,与髓腔操作前相比差异均有统计学意义(P均<0.05).B组动物在手术过程中血流动力学保持稳定,动脉血气及相关炎症因子无明显变化.B组各肺叶肺脂肪栓子数较A组明显减少[(4.17±1.99)个比(18.13±6.25)个,P<0.05].结论 血液净化能有效清除血中TNF-α、IL-1β与IL-6,降低EVLW、MPAP和PCWP,改善气体交换和氧合,使肺脂肪栓子数明显减少,可有效降低髓内操作引起肺脂肪栓塞的可能性.
目的 探討早期血液淨化對創傷性肺脂肪栓塞的影響,為臨床早期防治提供理論基礎.方法 健康雄性雜種犬12隻,隨機分為兩組,每組6隻.A組行雙側股骨手術擴髓+骨水泥註入;B組在與A組同樣實施擴髓手術的同時行血液淨化治療,直至手術結束共120 min.鑑測兩組動物血流動力學、動脈血氣和血中炎癥因子變化;術後觀察120 min併處死動物,取肺組織行油紅O染色檢查,併計算脂肪栓子數.結果 A組動物在單側股骨髓腔操作後齣現平均肺動脈壓 (MPAP)、肺毛細血管楔壓(PCWP)、血管外肺水(EVLW)升高,至雙側手術結束後各指標仍顯著高于髓腔操作前(P均<0.05);同時在雙側手術結束時pH值、動脈血氧分壓(PaO_2)下降,動脈血二氧化碳分壓(PaCO_2)和血中腫瘤壞死因子-α(TNF-α)、白細胞介素-1β(IL-1β)、IL-6升高,與髓腔操作前相比差異均有統計學意義(P均<0.05).B組動物在手術過程中血流動力學保持穩定,動脈血氣及相關炎癥因子無明顯變化.B組各肺葉肺脂肪栓子數較A組明顯減少[(4.17±1.99)箇比(18.13±6.25)箇,P<0.05].結論 血液淨化能有效清除血中TNF-α、IL-1β與IL-6,降低EVLW、MPAP和PCWP,改善氣體交換和氧閤,使肺脂肪栓子數明顯減少,可有效降低髓內操作引起肺脂肪栓塞的可能性.
목적 탐토조기혈액정화대창상성폐지방전새적영향,위림상조기방치제공이론기출.방법 건강웅성잡충견12지,수궤분위량조,매조6지.A조행쌍측고골수술확수+골수니주입;B조재여A조동양실시확수수술적동시행혈액정화치료,직지수술결속공120 min.감측량조동물혈류동역학、동맥혈기화혈중염증인자변화;술후관찰120 min병처사동물,취폐조직행유홍O염색검사,병계산지방전자수.결과 A조동물재단측고골수강조작후출현평균폐동맥압 (MPAP)、폐모세혈관설압(PCWP)、혈관외폐수(EVLW)승고,지쌍측수술결속후각지표잉현저고우수강조작전(P균<0.05);동시재쌍측수술결속시pH치、동맥혈양분압(PaO_2)하강,동맥혈이양화탄분압(PaCO_2)화혈중종류배사인자-α(TNF-α)、백세포개소-1β(IL-1β)、IL-6승고,여수강조작전상비차이균유통계학의의(P균<0.05).B조동물재수술과정중혈류동역학보지은정,동맥혈기급상관염증인자무명현변화.B조각폐협폐지방전자수교A조명현감소[(4.17±1.99)개비(18.13±6.25)개,P<0.05].결론 혈액정화능유효청제혈중TNF-α、IL-1β여IL-6,강저EVLW、MPAP화PCWP,개선기체교환화양합,사폐지방전자수명현감소,가유효강저수내조작인기폐지방전새적가능성.
Objective To study the effect of early continuous blood purification (CBP) in the treatment of post-traumatic pulmonary fat embolism in dog. Methods Twelve healthy male mongrel dogs were randomly divided into two groups: group A received intramedullary reaming and bone cement injection of bilateral femurs (n=6),and group B received CBP simultaneously at the beginning of the same operation and continued until 120 minutes after the end of the operation (n=6). The changes in arterial blood gas and related cytokines were monitored at various time points. The animals were sacrificed 120 minutes after the operation,and the lungs were obtained for examination,and the amount of oil red O stained fat emboli was recorded. Results In group A,the mean pulmonary arterial pressure (MPAP),pulmonary capillary wedge pressure (PCWP) and extravascular lung water (EVLW) increased after the manipulation in single femur,and these changes persisted after the manipulation on both femurs (all P<0.05). There was a decrease in pH and arterial partial pressure of oxygen (PaO_2) and an increase in arterial partial pressure of carbon dioxide (PaCO_2),tumor necrosis factor-α (TNF-α),interleukin-1β (IL-1β) and IL-6 after the operation on both femurs,showing significant differences compared with those of pre-operation period (all P<0.05). In group B,the hemodynamics,contents of cytokines and arterial blood gases were stable. Compared with those of group A,there was a significant decrease in the number of pulmonary fat emboli in group B (4.17±1.99 vs. 18.13±6.25,P<0.05). Conclusion The therapy of CBP could decrease the level of the serum TNF-α,IL-1β,IL-6 and EVLW,MPAP,PCWP,which could ameliorate gas exchange and oxygenation of the lung. And it also could reduce the number of pulmonary fat emboli and decrease the incidence of pulmonary fat embolism caused by femoral intramedullary operation.
