摘要目的 比较炎性反应在胸部撞击和胸部撞击-失血性休克复苏“双重打击”致大鼠急性肺损伤中的作用.方法 雄性SD大鼠30只,8周龄,体重240 ～ 280 g,采用随机数字表法,将其分为3组(n=10):假手术组(S组)、胸部创伤组(T组)和胸部创伤-失血性休克复苏组(THSR组).将砝码(300g)于95 cm高处自由落体,撞击大鼠心前区,制备胸部撞击模型,5 min后经左侧股动脉放血,使MAP在15 min内降至35 ～ 45 mmHg,并维持60 min,然后进行复苏,制备胸部撞击-失血性休克复苏“双重打击”模型.于模型制备后6h时,取右侧颈动脉血样,行血气分析,采用ELISA法测定血清TNF-α、IL-6、IL-1β和IL-10的浓度.然后处死大鼠,取肺组织,光镜下观察病理学结果,电镜下观察超微结构,采用ELISA法测定肺组织TNF-α、IL-6、IL-1β和IL-10的含量.结果 与S组比较,T组和THSR组PaO2降低,血清和肺组织TNF-α、IL-6、IL-1β和IL-10的水平升高(P＜0.05);与T组比较,THSR组PaO2降低,血清和肺组织TNF-α、IL-6、IL-1β和IL-10的水平升高(P＜0.05).THSR组肺组织病理学损伤较T组加重.结论 与在胸部撞击致大鼠急性肺损伤中的作用比较,炎性反应在胸部撞击-失血性休克复苏“双重打击”致大鼠急性肺损伤中的作用明显增强.

abstractsObjective To compare the roles of inflammatory response in acute lung injury (ALI) induced by blunt chest trauma verus by blunt chest trauma-hemorrhagic shock and resuscitation (double hits) in rats.Methods Thirty male Sprague-Dawley rats,aged 8 weeks,weighing 240-280 g,were randomly assigned into 3 equal groups (n =10 each) using a random number table:sham operation group (S group),blunt chest trauma group (T group),and blunt chest trauma and hemorrhagic shock and resuscitation group (THSR group).Lung contusion was induced in anesthetized rats by dropping a 300 g weight onto a precordial protective shield to direct the impact force away from the heart and toward the lungs.Blood was withdrawn via the left femoral artery 5 min later until MAP was decreased to 35-45 mmHg within 15 min and maintained at this level for 60 min,followed by resuscitation.At 6 h after the model was established,the arterial blood samples were collected for blood gas analysis and detection of serum concentrations of tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),IL-1β and IL-10 (by ELISA).The rats were then sacrificed and pulmonary specimens were obtained for determination of contents of TNF-α,IL-6,IL-1β and IL-10 in lung tissues and for microscopic examination.Results Compared with group S,PaO2 was significantly decreased,and the levels of TNF-α,IL-6,IL-1β and IL-10 in serum and lung tissues were increased in T and THSR groups.Compared with group T,PaO2 was significantly decreased,and the levels of TNF-α,IL-6,IL-1β and IL-10 in serum and lung tissues were increased in group THSR.The histopathological damage to lung tissues was aggravated in THSR group as compared with T group.Conclusion The role of inflammatory response in ALI induced by blunt chest trauma-hemorrhagic shock and resuscitation (double hits) is significantly stronger than that in ALI induced by blunt chest trauma alone in rats.