摘要
目的 探讨严重烧伤后早期大面积切痂对多器官功能障碍综合征 (MODS)的防治作用。 方法 (1)烧伤血清体外刺激内皮细胞 :选用 10例男性烧伤患者 ,随机分为早期切痂组 (A组 )和非早期切痂组 (B组 ) ,每组各 5例。两组患者均于A组首次切痂植皮术后 1、3、7d抽取静脉血 ,另取 6例健康志愿者静脉血作正常对照。采用上述各组血清 ,分别刺激体外培养的人脐静脉血管内皮细胞 ,观察细胞活力及通透性的改变。 (2 ) 60只Wistar大鼠 ,制成 3 0 %TBSAⅢ度烫伤模型 ,随机分为早期切痂组 (C组 ,3 0只 )和非切痂组 (D组 ,3 0只 ) ,每组各另设 5只大鼠为正常对照。两组动物于伤后 1、3、6、12、2 4和 48h行腹腔补液 ,C组于伤后 3h首次切痂植皮。补液后 1h放血处死大鼠 (每组每时相点 5只 ) ,检测腹腔巨噬细胞 (PM)的激活情况和血浆内毒素 (LPS)、白细胞介素 8(IL 8)、磷脂酶A2 (PLA2 )、丙二醛 (MDA)含量的变化。 结果 (1)与B组比较 ,A组患者血清与内皮细胞共同孵育后 ,内皮细胞活力和内皮单层通透性均有明显改善 ;(2 )C组大鼠PM的活化程度及血浆LPS、IL 8、PLA2 、和MDA含量均明显低于D组。 结论 严重烧伤后尽早清除机体失活组织 ,能减轻内皮细胞的损害程度 ,阻止炎性细胞进一步活化 ,对防治全身炎症反应综?
Objective To explore the role of massive escharectomy at early postburn stage in the prevention of internal organ dysfunction. Methods (1)Ten cases of severely burned patients were randomly divided into early (A) and non-early escharectomy (B) groups in equal number.Venous blood samples were harvested from the patients of the two groups in 1,3 and 7 postburn days (PBDs),And the samples from 6 healthy volunteers were taken as the control.The serum was separated from the above blood samples and was employed to stimulate cultured HUVECs in vitro. The cell viability and permeability was observed after the stimulation.(2)Seventy Wistar rats inflicted with 30% TBSA Ⅲ degree scalding were used as an animal model, and were randomized into early (C,n=30) and non-early escharectomy (D,n=30) groups, with 5 normal rats as control in each group. Intra-peritoneal fluid infusion was carried out at 1,3,6,12,24 and 48 postburn hours (PBHs) in rats in both groups. The rats were killed by blood letting at 1 hour after fluid supplementation. The changes in peritoneal macrophage (M) activation state and plasma contents of LPS,IL-8,PLA 2 and MDA were determined at 48 hours after escharectomy in the rats. Results The cell viability and permeability of the HUVECs co-cultured with the serum from burn patients in E group was much better preserved than that in B group. On the other hand, the peritoneal M activation and the plasma contents of LPS, IL-8,PLA 2 and MDA in C group were obviously decreased compared with those in D group.ConclusionEarly postburn escharectomy to remove denatured burned tissue were proved to be helpful in ameliorating endothelial injury and in inhibiting activation of inflammatory cells. Therefore,early escharectomy was assumed to be leneficial in the prevention of postburn SIRS and MODS.
出处
《中华烧伤杂志》
CAS
CSCD
2002年第6期350-353,共4页
Chinese Journal of Burns
基金
全军"九五"指令性课题资助项目 (96L0 43)
