中华损伤与修复杂志（电子版）
中華損傷與脩複雜誌（電子版）
중화손상여수복잡지（전자판）
Chinese Journal of Injury Repair and Wound Healing
2014年
6期
607-613
,共7页
刘锐%曹卫红%王树明%胡森%李宗瑜%苏海涛%吕艺%张慧萍%赵增凯%郑金光%盛志勇
劉銳%曹衛紅%王樹明%鬍森%李宗瑜%囌海濤%呂藝%張慧萍%趙增凱%鄭金光%盛誌勇
류예%조위홍%왕수명%호삼%리종유%소해도%려예%장혜평%조증개%정금광%성지용
烧冲复合伤%模型,动物%多器官功能衰竭%大鼠
燒遲複閤傷%模型,動物%多器官功能衰竭%大鼠
소충복합상%모형,동물%다기관공능쇠갈%대서
Burn-blast combined injury%Model,animal%Multiple organ failure%Rats
目的：建立理想的开放爆炸环境下烧冲复合伤动物模型。方法以Wistar雌性清洁级成年大鼠460只为研究对象。随机选取90只大鼠设为预实验组，其余370只大鼠随机选取360只大鼠设为实验组，剩余10只大鼠设为正常对照组。预实验组90只大鼠随机分为预单纯烧伤组（n＝30），预烧冲复合伤组（n＝30），预烧冲复合伤组（n＝30）；预单纯烧伤组采用凝固汽油涂抹背部点燃25 s造成深Ⅱ度烧伤，烧伤面积分别为10％总体表面积（TBSA）（轻度，n＝10）、25％TBSA（中度，n＝10）、40％TBSA（重度，n＝10）；预单纯冲击伤组采用柱形黑索金炸药在不同距离（70、50、30 cm）造成轻度、中度、重度冲击伤（每组n＝10）；按照预单纯烧伤组及预单纯冲击伤组动物死亡率及器官功能障碍等，确定轻度、中度、重度的预烧冲复合伤模型：预轻度烧冲复合伤（轻度烧伤＋轻度冲击伤），预中度烧冲复合伤（中度烧伤＋中度冲击伤），预重度烧冲复合伤（重度烧伤＋重度冲击伤）；观察伤后24 h大鼠宏观变化及死亡率。实验组370只大鼠随机分为单纯烧伤组（n＝120，其中轻、中、重3组，每组n＝40），单纯冲击伤组（n＝120，其中轻、中、重3组，每组n＝40），烧冲复合伤组（n＝120，其中轻、中、重3组，每组n＝40），正常对照组（n＝10），模型的建立同预实验，伤后6 h、1 d、2 d、3 d用自动生化仪检测实验组大鼠血清肌酸激酶同工酶（CK-MB）、谷丙转氨酶（GPT）、血肌酐（Scr），并同时观察实验组大鼠死亡率及用光学显微镜观察各脏器病理变化。结果预轻、中、重度冲击伤组大鼠伤后24 h死亡率分别为10％、30％、100％；预轻、中、重度烧伤组大鼠伤后24 h死亡率分别为10％、20％、40％；预轻、中、重度烧冲复合伤组大鼠伤后24 h死亡率分别为20％、30％、100％；预冲击伤组：预重度冲击伤组大鼠均可见骨膜穿孔，均有球结膜出血，9例可见口腔黏膜破溃出血。预中度冲击伤组大鼠仅1例出现可见骨膜穿孔，9例出现球结膜出血，5例可见口腔黏膜破溃出血。预轻度冲击伤组大鼠未见骨膜穿孔及球结膜出血，未见口腔黏膜破溃出血。预单纯烧伤组：创面渗出较少，未见明显分泌物形成。预烧冲复合伤组：各器官表现基本同预单纯冲击伤组，创面变化基本同预单纯烧伤组。实验组大鼠伤后6h、1 d、2 d、3d的死亡率：单纯冲击伤组：轻度冲击伤组各时相点的死亡率分别为2．5％、10％、10％、10％，中度冲击伤组各时相点的死亡率分别为5％、20％、30％、40％，重度冲击伤组各时相点的死亡率分别为15％、50％、65％、75％，单纯烧伤组：轻度烧伤组各时相点的死亡率分别为5％、10％、20％、20％，中度烧伤组各时相点的死亡率分别为5％、20％、30％、30％，重度烧伤组各时相点的死亡率分别为10％、40％、65％、75％；烧冲复合伤组：轻度烧冲复合伤组各时相点的死亡率分别为7．5％、20％、20％、20％，中度烧冲复合伤组各时相点的死亡率分别为10％、30％、40％、40％，重度烧冲复合伤组大鼠伤后6、24 h的死亡率分别为25％、100％。轻度烧冲复合伤组CK-MB在伤后1 d增加明显，伤后2 d迅速下降，伤后3 d接近正常水平。GPT、Scr未见明显变化。中度烧冲复合伤组伤后6 h至伤后3 d均伴有不同程度器官功能障碍，CK-MB、GPT、Scr测定出现持续性异常增高。心脏：CK-MB在伤后6h即开始增加，伤后1d增加明显，至伤后2d逐步下降，伤后3d仍高于正常水平；肝：GPT在伤后6h即开始异常，伤后1d进一步增加，至伤后2d达峰值，伤后3d仍高于正常水平；肾：Scr在伤后6h变化不明显，伤后1d略有增加，至伤后2d增加明显，伤后3d略有下降仍高于正常水平，伤后2 d 中度烧冲复合伤组大鼠CK-MB （241．42±33．31）HU／L、GPT（127．71±11．54）U／L、Scr（95．37±13．02）μmol／L 与正常对照组（84．12±12．64）HU／L、（42．28±10．44）U／L、（53．53±12．71）μmol／L比较，差异有统计学意义（t＝3．327、4．081、2．508，P＜0．05）；重度烧冲复合伤组CK-MB、GPT、Scr均在伤后6 h即开始异常明显增加。心、肝、肾、肺脏、小肠均有不同程度出血、充血、炎症反应等病理学改变。结论根据实验组动物死亡率，以及存活动物脏器功能及病理形态学变化情况进行判断，中度烧冲复合伤组是较理想的烧冲复合伤动物模型。
目的：建立理想的開放爆炸環境下燒遲複閤傷動物模型。方法以Wistar雌性清潔級成年大鼠460隻為研究對象。隨機選取90隻大鼠設為預實驗組，其餘370隻大鼠隨機選取360隻大鼠設為實驗組，剩餘10隻大鼠設為正常對照組。預實驗組90隻大鼠隨機分為預單純燒傷組（n＝30），預燒遲複閤傷組（n＝30），預燒遲複閤傷組（n＝30）；預單純燒傷組採用凝固汽油塗抹揹部點燃25 s造成深Ⅱ度燒傷，燒傷麵積分彆為10％總體錶麵積（TBSA）（輕度，n＝10）、25％TBSA（中度，n＝10）、40％TBSA（重度，n＝10）；預單純遲擊傷組採用柱形黑索金炸藥在不同距離（70、50、30 cm）造成輕度、中度、重度遲擊傷（每組n＝10）；按照預單純燒傷組及預單純遲擊傷組動物死亡率及器官功能障礙等，確定輕度、中度、重度的預燒遲複閤傷模型：預輕度燒遲複閤傷（輕度燒傷＋輕度遲擊傷），預中度燒遲複閤傷（中度燒傷＋中度遲擊傷），預重度燒遲複閤傷（重度燒傷＋重度遲擊傷）；觀察傷後24 h大鼠宏觀變化及死亡率。實驗組370隻大鼠隨機分為單純燒傷組（n＝120，其中輕、中、重3組，每組n＝40），單純遲擊傷組（n＝120，其中輕、中、重3組，每組n＝40），燒遲複閤傷組（n＝120，其中輕、中、重3組，每組n＝40），正常對照組（n＝10），模型的建立同預實驗，傷後6 h、1 d、2 d、3 d用自動生化儀檢測實驗組大鼠血清肌痠激酶同工酶（CK-MB）、穀丙轉氨酶（GPT）、血肌酐（Scr），併同時觀察實驗組大鼠死亡率及用光學顯微鏡觀察各髒器病理變化。結果預輕、中、重度遲擊傷組大鼠傷後24 h死亡率分彆為10％、30％、100％；預輕、中、重度燒傷組大鼠傷後24 h死亡率分彆為10％、20％、40％；預輕、中、重度燒遲複閤傷組大鼠傷後24 h死亡率分彆為20％、30％、100％；預遲擊傷組：預重度遲擊傷組大鼠均可見骨膜穿孔，均有毬結膜齣血，9例可見口腔黏膜破潰齣血。預中度遲擊傷組大鼠僅1例齣現可見骨膜穿孔，9例齣現毬結膜齣血，5例可見口腔黏膜破潰齣血。預輕度遲擊傷組大鼠未見骨膜穿孔及毬結膜齣血，未見口腔黏膜破潰齣血。預單純燒傷組：創麵滲齣較少，未見明顯分泌物形成。預燒遲複閤傷組：各器官錶現基本同預單純遲擊傷組，創麵變化基本同預單純燒傷組。實驗組大鼠傷後6h、1 d、2 d、3d的死亡率：單純遲擊傷組：輕度遲擊傷組各時相點的死亡率分彆為2．5％、10％、10％、10％，中度遲擊傷組各時相點的死亡率分彆為5％、20％、30％、40％，重度遲擊傷組各時相點的死亡率分彆為15％、50％、65％、75％，單純燒傷組：輕度燒傷組各時相點的死亡率分彆為5％、10％、20％、20％，中度燒傷組各時相點的死亡率分彆為5％、20％、30％、30％，重度燒傷組各時相點的死亡率分彆為10％、40％、65％、75％；燒遲複閤傷組：輕度燒遲複閤傷組各時相點的死亡率分彆為7．5％、20％、20％、20％，中度燒遲複閤傷組各時相點的死亡率分彆為10％、30％、40％、40％，重度燒遲複閤傷組大鼠傷後6、24 h的死亡率分彆為25％、100％。輕度燒遲複閤傷組CK-MB在傷後1 d增加明顯，傷後2 d迅速下降，傷後3 d接近正常水平。GPT、Scr未見明顯變化。中度燒遲複閤傷組傷後6 h至傷後3 d均伴有不同程度器官功能障礙，CK-MB、GPT、Scr測定齣現持續性異常增高。心髒：CK-MB在傷後6h即開始增加，傷後1d增加明顯，至傷後2d逐步下降，傷後3d仍高于正常水平；肝：GPT在傷後6h即開始異常，傷後1d進一步增加，至傷後2d達峰值，傷後3d仍高于正常水平；腎：Scr在傷後6h變化不明顯，傷後1d略有增加，至傷後2d增加明顯，傷後3d略有下降仍高于正常水平，傷後2 d 中度燒遲複閤傷組大鼠CK-MB （241．42±33．31）HU／L、GPT（127．71±11．54）U／L、Scr（95．37±13．02）μmol／L 與正常對照組（84．12±12．64）HU／L、（42．28±10．44）U／L、（53．53±12．71）μmol／L比較，差異有統計學意義（t＝3．327、4．081、2．508，P＜0．05）；重度燒遲複閤傷組CK-MB、GPT、Scr均在傷後6 h即開始異常明顯增加。心、肝、腎、肺髒、小腸均有不同程度齣血、充血、炎癥反應等病理學改變。結論根據實驗組動物死亡率，以及存活動物髒器功能及病理形態學變化情況進行判斷，中度燒遲複閤傷組是較理想的燒遲複閤傷動物模型。
목적：건립이상적개방폭작배경하소충복합상동물모형。방법이Wistar자성청길급성년대서460지위연구대상。수궤선취90지대서설위예실험조，기여370지대서수궤선취360지대서설위실험조，잉여10지대서설위정상대조조。예실험조90지대서수궤분위예단순소상조（n＝30），예소충복합상조（n＝30），예소충복합상조（n＝30）；예단순소상조채용응고기유도말배부점연25 s조성심Ⅱ도소상，소상면적분별위10％총체표면적（TBSA）（경도，n＝10）、25％TBSA（중도，n＝10）、40％TBSA（중도，n＝10）；예단순충격상조채용주형흑색금작약재불동거리（70、50、30 cm）조성경도、중도、중도충격상（매조n＝10）；안조예단순소상조급예단순충격상조동물사망솔급기관공능장애등，학정경도、중도、중도적예소충복합상모형：예경도소충복합상（경도소상＋경도충격상），예중도소충복합상（중도소상＋중도충격상），예중도소충복합상（중도소상＋중도충격상）；관찰상후24 h대서굉관변화급사망솔。실험조370지대서수궤분위단순소상조（n＝120，기중경、중、중3조，매조n＝40），단순충격상조（n＝120，기중경、중、중3조，매조n＝40），소충복합상조（n＝120，기중경、중、중3조，매조n＝40），정상대조조（n＝10），모형적건립동예실험，상후6 h、1 d、2 d、3 d용자동생화의검측실험조대서혈청기산격매동공매（CK-MB）、곡병전안매（GPT）、혈기항（Scr），병동시관찰실험조대서사망솔급용광학현미경관찰각장기병리변화。결과예경、중、중도충격상조대서상후24 h사망솔분별위10％、30％、100％；예경、중、중도소상조대서상후24 h사망솔분별위10％、20％、40％；예경、중、중도소충복합상조대서상후24 h사망솔분별위20％、30％、100％；예충격상조：예중도충격상조대서균가견골막천공，균유구결막출혈，9례가견구강점막파궤출혈。예중도충격상조대서부1례출현가견골막천공，9례출현구결막출혈，5례가견구강점막파궤출혈。예경도충격상조대서미견골막천공급구결막출혈，미견구강점막파궤출혈。예단순소상조：창면삼출교소，미견명현분비물형성。예소충복합상조：각기관표현기본동예단순충격상조，창면변화기본동예단순소상조。실험조대서상후6h、1 d、2 d、3d적사망솔：단순충격상조：경도충격상조각시상점적사망솔분별위2．5％、10％、10％、10％，중도충격상조각시상점적사망솔분별위5％、20％、30％、40％，중도충격상조각시상점적사망솔분별위15％、50％、65％、75％，단순소상조：경도소상조각시상점적사망솔분별위5％、10％、20％、20％，중도소상조각시상점적사망솔분별위5％、20％、30％、30％，중도소상조각시상점적사망솔분별위10％、40％、65％、75％；소충복합상조：경도소충복합상조각시상점적사망솔분별위7．5％、20％、20％、20％，중도소충복합상조각시상점적사망솔분별위10％、30％、40％、40％，중도소충복합상조대서상후6、24 h적사망솔분별위25％、100％。경도소충복합상조CK-MB재상후1 d증가명현，상후2 d신속하강，상후3 d접근정상수평。GPT、Scr미견명현변화。중도소충복합상조상후6 h지상후3 d균반유불동정도기관공능장애，CK-MB、GPT、Scr측정출현지속성이상증고。심장：CK-MB재상후6h즉개시증가，상후1d증가명현，지상후2d축보하강，상후3d잉고우정상수평；간：GPT재상후6h즉개시이상，상후1d진일보증가，지상후2d체봉치，상후3d잉고우정상수평；신：Scr재상후6h변화불명현，상후1d략유증가，지상후2d증가명현，상후3d략유하강잉고우정상수평，상후2 d 중도소충복합상조대서CK-MB （241．42±33．31）HU／L、GPT（127．71±11．54）U／L、Scr（95．37±13．02）μmol／L 여정상대조조（84．12±12．64）HU／L、（42．28±10．44）U／L、（53．53±12．71）μmol／L비교，차이유통계학의의（t＝3．327、4．081、2．508，P＜0．05）；중도소충복합상조CK-MB、GPT、Scr균재상후6 h즉개시이상명현증가。심、간、신、폐장、소장균유불동정도출혈、충혈、염증반응등병이학개변。결론근거실험조동물사망솔，이급존활동물장기공능급병리형태학변화정황진행판단，중도소충복합상조시교이상적소충복합상동물모형。
Objective To establish an animal model of burn-blast combined injury in the open explosive environment.Methods All 460 female Wistar rats were involved in this study.Ninty rats were randomly divided into pre-experiment group,the other 370 rats were randomly selected 360 rats as the experiment group,10 rats were divided into normal control group.The rats in pre-experiment group were randomly divided into pre-burn group(n=30),pre-blast injury group(n=30),pre-burn-blast combined injury group(n=30),rats in pre-burn group were burned with napalm smear on back for 25 seconds in order to replicate deep partial thickness burn,the TBSA of burned area was 10%(n=10),25%(n=10), and 40%(n=10).The column explosives RDX was used in pre-blast injury group at different distance in order to replicate mild,moderate,severe blast injury.The models of the mild,moderate,severe pre-burn-blast combined injury were replicated according to the mortality and incidence of multiple organ dysfunction in pre-burn group and pre-blast injury group.Mild pre-burn-blast combined injury was combined with mild burn and mild blast injury,moderate pre-burn-blast combined injury was combined with moderate burn and moderate blast injury,severe pre-burn -blast combined injury was combined with severe burn and severe blast injury.The mortality rate and macroscopic changes were observed 24 hours after injury.Three hundred and seventy rats in experiment group were randomly divided into burn group(n=120,the mild,moderate, severe in 3 groups),blast injury group (n =120,the mild,moderate,severe in 3 groups),burn-blast combined injury group(n=120,the mild,moderate,severe in 3 groups),and control group(n=10).The establishment of the model was the same with pre-experiment. The mortality,serum creatine kinase isoenzyme (CK-MB),alanine aminotransferase(GPT),serum creatinine (Scr)and the changes pathology were observed in experiment group in 6 h,1 d,2 d,3 d after injury.Results The mortality in mild, moderate,severe pre-blast injury groups was 10%,30%,and 100%in 24 hours after injury.The mortality in mild,moderate,severe pre-burn injury groups was 10%,20%,and 40%.The mortality in mild, moderate,severe pre-burn-blast combined injury groups was 20%,30%,and 100%.The pre-blast injury group:in 30 cm to explore resource,all of the 10 rats showed periosteal perforation and conjunctival hemorrhage,9 rats showed oral mucosal ulceration hemorrhage.In 50 cm to explore resource,only 1 rat showed periosteal perforation,9 rats showed conjunctival hemorrhage,and 5 rats showed oral mucosal ulceration hemorrhage.In 70 cm to explore resource,10 rats have no change in periosteal perforation, conjunctival hemorrhage and oral mucosal ulceration hemorrhage.Pre-burn group:the wound have a little exudation.Pre-burn-blast combined injury group:the organs showed the same performance with the pre-blast injury group ,the wound also showed the same changes with the pre - burn group .The mortality of experiment group in 6 h,1,2,3 d after injury:blast injury group:the mortality of mild blast injury group at each observation point was 2.5%,10%,10%,and 10%.The mortality of moderate blast injury group was 5%,20%,30%,and 40%.The mortality of severe blast injury group was 15%,50%,65%,and 75%.Burn group:the mortality of mild burn group at each observation point was 5%,10%,20%,and 20%.The mortality of moderate burn group was 5%,20%,30%,and 30%.The mortality of severe burn group was 10%,40%,65%,and 75%.Burn-blast combined injury group:the mortality of mild burn-blast combined injury group at each observation point was 7.5%,20%,20%,and 20%.The mortality of moderate burn-blast combined injury group was 10%,30%,40%,and 40%.The mortality of severe burn-blast combined injury group was 25%,100%.In mild burn-blast combined injury group ,the serum CK-MB increased significantly in 1 d after injury,decreased rapidly in 2 d after injury,and closed to the normal level in 3 d after injury.The serum GPT and Scr showed no changes.In moderate burn-blast combined injury group,the injury after 6 hours to 3 days was associated with multiple organ dysfunction (serum CK-MB,GPT, determination of Scr a persistent abnormal increasing ).Heart:CK-MB increased in 6 h after injury, significantly changes in 1 d after injury,in 2 d after injury it gradually decreased,and it was still higher than normal level in 3 d after injury;Liver:GPT increased in 6 h after injury,it increased further in 1 d after injury,and it increased a peak value in 2 d after injury,and it was still higher than normal level in 3 d after injury;Kidney:Scr showed no changes in 6 h and 1 d after injury,it increased significantly in after 2 d, and it was still higher than the normal level after 3 d,in moderate burn-blast combined injury group after 2 d combined injury in rats of CK-MB (241.42 ±33.31)HU/L,GPT (127.71 ±11.54)U/L ,Scr (95.37 ± 13.02)μmol/L,with the normal control group (84.12 ±12.64)HU/L,(42.28 ±10.44)U/L, (53.53 ±12.71)μmol/L ,the difference was statistically significant (t =3.327,4.081,2.508,P<0.05);In severe burn-blast combined injury group,the serum CK-MB,GPT,and Scr increased abnormal obviously within 6 h after injury.The pathological changes in the hearts,livers,kidney,lungs,intestine includes hemorrhage,congestion and inflammation.Conclusions According to the animal mortality rate and survival of the animals with significant organ function and pathological changes,the animal model with moderate burn-blast combined injury was satisfied as experimental burn-blast combined injury model.
