CHANGES OF IMMUNE FUNCTIONS AFTER RADIATION，BURNS AND COMBINED RADIATION－BURN INJURY IN RATS

ＣＨＡＮＧＥＳＯＦＩＭＭＵＮＥＦＵＮＣＴＩＯＮＳＡＦＴＥＲＲＡＤＩＡＴＩＯ，ＢＵＲＮＳＡＮＤＣＯＭＢＩＮＥＤＲＡＤＩＡＴＩＯＮ－ＢＵＲＮＩＮＪＵＲＹＩＮ　ＲＡＴＳＹａｎＹｏｎｇｔａｎｇ（阎永堂）；ＲａｎＸｉｎｚｅ（冉新泽）ａｎｄＷｅｉＳｈｕｑｉｎｇ（...     

THE EFFECT OF SKIN GRAFTING AT DIFFERENT TIME POST BLOOD TRANSFUSION AND BONE MARROW TRANSPLANTATION ON RATS COMBINED RADIATION——BURN INJURY

After the rats were iufficted with 8Gy total body gamma ray irradiation and 15% total body surface area (TBSA) full thickness burn injury, they were treated with blood transfusion (BT) and bone marrow transplantation (BMT). Then the survival of allografts grafted on the eschareetomized burn wounds in the 24, 48 and 72 h postinjury was observed. It was found that when the burn wounds were closed with allografts in the 24h postinjury, there were an early elevation of leucocytes, the appearance of the donor‘‘s cells and a significantly higher survival rate of the rats on the 30 day postinjury. The allogaafts could survive longer and wounds showed no signs of infection and healed quicker. When the allografts were grafted in the 48 h or 72 h postinjury, only harmful effects to hasten the death of rats were observed.     

轻度肠型放-烧复合伤救治的实验研究

目的探讨颈交感阻滞、壳聚糖包裹的pVITRO3-HD5-GLP2纳米粒联合L203对轻度肠型放-烧复合伤小鼠的治疗作用,探索救治肠型放-烧复合伤的综合措施.方法 TBSA15%Ⅲ度烧伤合并10 Gy放射损伤小鼠分为综合救治组及复合伤对照组,观察两组动物的平均存活时间以及小肠湿重、小肠隐窝细胞早期凋亡、恢复期增殖和肠道细菌移位等相关指标.结果综合救治可以使放-烧复合伤后动物平均存活时间延长;减轻小肠湿重的降低程度,减少肠隐窝细胞凋亡,促进恢复期肠上皮的增殖以及减少肠道细菌移位的发生.结论综合救治措施可以改善肠型放-烧复合伤肠道的损伤,延迟小鼠的死亡时间.     

Experimental studies on the treatment and pathological basis of combined radiation and burn injury

Objective To investigate therapeutics for and the pathological basis of combined radiation and burn injuriesMethods Combined radiation and burn injuries on mice and rats were inflicted by γ ray irradiation from a (60)Co source and thermal radiation from a 5 kW bromotungsten lampResults The dysfunction of myocardium played an important role in the development of early stage shock. Transfusion of irradiated (in vitro, 20 Gy) or stored (4℃, 7 days) blood after irradiation was done to promote the success of allo-transplantation of bone marrow. Decrease of IL-4 mRNA expression was the molecular basis of depression of intestinal mucosa immune and intervention of IL-4 showed an antagonistic effect on enterogenic infection. A new lipid component extracted from burn eschar was documented for the first time and its toxic effects were elucidated. The survival rate of alloskin grafts after removal of burn eschar from the recipient animals was obviously increased in combined injury due to reduction of immune rejection activity by the radiation effect. In contrast, in animal models with simple burn, the alloskin grafts were all rejected within ten days after the procedure. A successful therapeutic result (survival rate: 92% for 30 days and 67% for 100 days) was obtained by comprehensive management of treated animals, while the untreated control animals all died within 3-7 days after injury. Conclusion The pathogenesis of injury caused by simultaneous radiation and burn is extremely complicated and the treatment is very difficult. A comprehensive management program consisting of several therapeutic measures aimed at key links of the pathogenesis may achieve significantly improved results.     

速冻玻璃化储存异体皮的临床应用

目的：分析和总结自1987年以来速冻玻璃化储皮临床应用情况。方法：搜集我科1987年至1999年使用速冻玻璃化储存的异体皮救治烧伤患者临床资料以及我科皮库储存异体皮国内使用情况,总结和分析速冻玻璃化储存异体皮的临床应用效果和异体皮的使用情况。结果：使用速冻玻璃化异体皮的烧伤患者平均烧伤面积为55.4%,其中平均Ⅲ度面积为30.9%,应用异体皮面积为3466～10208cm^2。采用速冻玻璃化保存的皮肤复温后其活力可达到新鲜皮肤的70%左右,该法保存的皮肤质地柔软、转红快、成活率高,存活期长,最长可在患者创面上成活2个月左右。术后异体皮成活率为95%。从1987年至1999年底我科皮库供全国各地18个省和3个自治区的48个市,8个县的108家各级医院冷冻异体皮使用,包括我科自用用,共使用皮肤面积达3604260cm^2。结论：采用速冻玻璃化储存的异体皮覆盖创面,仍是目前最有效、最方便、经济实惠的方法,使用异体皮进行烧伤的救治已经成为国内大多数医院普遍使用的一项救治措施。     

小鼠肠型放射损伤合并烧伤对小肠上皮细胞的复合效应

体重30～35g杂种健康雄性小鼠746只,分设四组:单放(~(60)Co 12 Gy)、单烧(15％Ⅲ度)、放烧(两伤复合)和正常对照组。对比研究放烧复合后的死亡效应和肠上皮损伤效应的动态变化。结果表明复合效应有明显的病程阶段性差异:伤后48小时内放烧组死亡率较单放组为高,肠上皮损伤亦较重,其原因可能与早期休克有关。而伤后49～96小时,放烧组的死亡率却较单放组为低,肠上皮恢复亦较好。由此可见,机体对复合伤的反应十分复杂,必须对其作具体分析,有针对性地进行防治。     

Bax蛋白在高能电子线大鼠皮肤辐射损伤模型中的表达及意义

目的 探讨Bax在高能电子线大鼠皮肤辐射损伤中的作用及机理，为临床的治疗提供线索。方法 运用免疫组化技术SP法检测40例高能电子线大鼠皮肤辐射损伤模型中的表达，分析它们与照射剂量之间的关系。结果 Bax在40例照射的大鼠中，5Gy、15Gy、30Gy、45Gy组阳性表达率分别为30％、30％、70％、70％；各照射剂量组同Bax蛋白阳性表达无相关性，但有趋势性（P＜0．05）。结论 电离辐射能增加大鼠皮肤组织中Bax蛋白的表达；Bax蛋白的表达可能与照射剂量有关；Bax蛋白具促细胞凋亡作用，参与放射性皮肤损伤的形成。     

放射损伤及放烧复合伤对小肠上皮损害的量效研究

用２８７只小鼠分别以变动照射剂量（８￣２６Ｇｙ，８个剂量）和固定烧伤深度（１５％Ⅲ°），变动烧伤面积（５％、１０％、２５％Ⅲ°）和固定照射剂量（１２Ｇｙ）致放烧复合伤（放烧），与同剂量单纯放射损伤（单放）相对比，以小肠隐窝计数和氚－胸腺嘧啶脱氧核甙（＾３Ｈ－ＴｄＲ）参入量为基本指标，结果说明放烧和单放时肠上皮效应与致伤因素间存在肯定而显著的量效关系，提出了系列数据和公式。照射剂量是决定效应的主要因     

A study on mitochondrial respiratory dysfunction and lipid peroxidation in the liver after radiation,burn,and combined radiation-burn injuries in mice

Male mice were subjected to 6 Gy total body irradiation,20% TBSAfull-thickness burns,or combined radiation-burn injury and lipid peroxides(LPO),vita-min E,sulfhydryl group,respiratory control ratio(RCR),ADP/O ratio,and cytochromeoxidase activity of the liver mitochondria were determined in the first 9 d postinjury.Theresults are as follows:(1)LPO level increased in the early postinjury stage after combinedradiation-burn injury,on the 5th-7th day after irradiation and on the 7th day postburn.(2)Vitamin E level decreased significantly in the two groups of radiation and burn inju-ries but showed no significant decrease after combined injury.(3)The sulfhydryl groupshowed a tendency to increase in all the 3 groups.(4)The activity of cytochrome oxidaseincreased significantly on the 7th day after radiation but decreased considerably in theburn and combined injury groups.(5)RCR and ADP/O ratio decreased more significantlyin the combined injury group than in either the radiation group or the burn group.These facts suggest that the respiratory dysfunction of the liver mitochondria results mostprobably from the damage on the mitochondrial membrane due to lipid peroxidation.     

休克期切痂对大面积烧伤病人能量消耗的影响

目的观察休克期切痂植皮对烧伤病人能量消耗的影响。方法对２１例烧伤面积大于３０％的深度烧伤病人,依休克期切痂与否分为休克期切痂植皮组（１５例）和非休克期切痂植皮组（６例）,所有病人在治疗期间应用新型代谢车床旁动态监测病人静息能量消耗（ＲＥＥ）变化。结果休克期切痂植皮组和非休克期切痂植皮组病人在年龄结构、烧伤总面积、Ⅲ度烧伤面积、首次切痂面积等方面基本一致（Ｐ＞０．０５）,尽管两组病人ＲＥＥ均明显升高,２周时休克期切痂组为（３１１±１５）Ｊ·ｈ－１·ｍ－２,非休克期切痂组为（３４５±１６）Ｊ·ｈ－１·ｍ－２。但休克期切痂植皮组由于及时切痂植皮封闭创面,病人在伤后２周内ＲＥＥ明显低于非休克期切痂植皮组,且休克期切痂植皮组病人在切痂前、切痂后ＲＥＥ均显著低于非休克期切痂组。结论严重深度烧伤病人休克期切痂植皮可在一定程度上降低机体的高代谢状态。     

环孢霉素和供体脾细胞门静脉接种延长小鼠心脏移植存活

OBJECTIVE: To investigate the effect of portal venous inoculation of donor splenocytes combined with cyclosporin A (CsA) administration on cardiac allograft survival in mice. METHODS: Heterotopic cardiac transplantation between fully allogenic NIH/q and BALB/C strain mice was performed. A modified procedure of neonatal heart-in-ear transplantation, as originally described by Fulmer et al, was adopted. We prepared donor splenocytes from NIH/q or third-party C57BL/6 spleens for BALB/C recipients, which were injected preoperatively via the recipient portal vein or the systemic vein 1 week before the heart-in-ear transplantation. The recipients were subsequently treated with a short course of the immunosuppressive agent, CsA (4 mg/kg starting from 7 d before the operation till 5 d after it). RESULTS: Portal venous inoculation of donor splenocytes combined with CsA significantly prolonged cardiac graft survival (n=6, P<0.05) that reached 31.00+/-3.23 d, and 2 of the 6 allografts survived for more than 35 d. Donor splenocytes injected via the systemic vein or third-party C57BL/6 mice splenocytes injected via the portal vein did not prolong graft survival (P>0.05). CsA alone or portal venous inoculation of donor-specific splenocytes alone also prolonged graft survival (P<0.05), with mean graft survival time of 18.50+/-2.59 d and 16.11+/-1.97 d respectively. CONCLUSION: Combination of portal venous inoculation of donor-specific splenocytes and CsA can prolong murine cardiac allograft survival, which is donor antigen-specific.     

Effects of Combined Radiation-Burn Injury on Intestinal Epithelium in Mice

Seven hundred and forty-six mice,weighing 30-35g,were randomlydivided into 4 groups.The animals of the first three groups were inflicted withradiation injury(12 Gy total body irradiation from a ~(60)Co source),burn injury(15% TBSA third degree burns),and combined injury of the 2 agents ,mentionedabove respectively.The 4th group served as normal control.The mortality and the dynamic changes of the intestinal epithelium of theexperimental animals were studied.It was found that the clinical course of thecombined injury group was quite different from that of the other two.Themortality of the combined injury group was higher and the damage on theintestinal epithelium more severe than those of the radiation injury group in thefirst 48 h after infury.In the second 48 h,the mortality of the combined injurygroup became lower and recovery of the injured intestinal epithelium faster.     

放烧复合伤与单纯放射或烧伤对大鼠在体心室肌细胞动作电位影响的比较

本文用健康SD大鼠57只,随机分为6组,用悬浮微电极记录并比较了单纯~(50)Co照射或烧伤与二者结合的放烧复合伤对在体心室肌细胞动作电位的影响,同时观察了复合伤对心肌影响的恢复过程。结果表明:放烧复合伤与单纯放射或烧伤相似.明显地影响心室肌细胞的除极化和复极化过程。但有其特点:与对照组相比,复合伤后24h,动作电位幅度降低13.6％,最大除极速率减慢41.2％。各组的心率有所不同:烧伤组增加9.8％,放射组减少17.4％,复合伤后24h组却近于对照水平,但复合伤后3天组心率减少12％,伤后5天组才略有恢复。复合伤降低平均复极化速率(-13.2％～-26.3％)及延长动作电位持续时间(APD),尤其是APD50及APD90更为明显(分别为+22.9％～+33.7％和+6.0％～+18％)。实验结果表明,放烧复合伤对大鼠心室肌动作电位的影响并非单纯放射或烧伤两种致伤作用的简单相加,在有的方面(如最大除极速率)二者是协同作用;而在另外方面(如心率)二者又是互相抵消。本实验中复合伤的致伤作用是可逆的。一般说,损伤反应出现早的参数,恢复较快,反之较慢。     

小剂量氯胺酮减轻烧伤切痂植皮术中瑞芬太尼所致痛觉过敏的效应

目的 观察小剂量氯胺酮对烧伤切痂植皮术中瑞芬太尼所致痛觉过敏（opioid-induced hyperalgesia,OIH）的影响.方法 选取2013年6-12月在解放军总医院第一附属医院烧伤科行切痂植皮手术的患者60例,年龄18～ 60岁,ASA Ⅰ～Ⅱ级,受区面积1％～30％,所有患者均使用七氟烷吸入、4 ng/ml靶控输注瑞芬太尼维持麻醉.患者随机分为两组,氯胺酮组（n＝30）麻醉诱导开始时给予0.3 mg/kg负荷量,之后以3μg/（kg·min）持续输注至手术结束;对照组（n=30）注射等剂量的0.9％氯化钠注射液,比较两组术中生命体征、术后7h内视觉模拟评分（visual analogue scale,VAS）及通过病人自控镇痛泵（patientcontrolled analgesia pump,PCA）输注的吗啡用量.结果 氯胺酮组术后3h内VAS评分、2h内吗啡用量均低于对照组（P＜0.05）.结论 当在烧伤切痂植皮手术中以瑞芬太尼作为麻醉性镇痛药时,术中持续输注小剂量氯胺酮有助于减轻瑞芬太尼所致术后痛觉过敏,减少阿片类药物的用量.     

三度烧伤创面削痂植皮的疗效观察

目的 探讨削痴植皮术在三度烧伤创面早期祛痂手术中的应用。方法 选择1997-2004年肢体三度烧伤患者157例作为A组，1991～1996年肢体三度烧伤患者80例作为B组，排外电烧伤、热挤压伤等深三度烧伤。A组行削痂植皮术，B组行切痂植皮术，观察两组手术时问、植皮成活率、创面愈合时间、以及创面愈合后肢体外形、对称性和功能的恢复。结果A组创面愈合后肢体外观、对称性和功能较好，自身对照上下肢分别缩小5．7％和5．8％，差异无显著性；B组创面愈合后肢体明显缩小、左右明显不对称、功能较差，上下肢分别缩小21．6％和25．1％，差异具有显著性意义（P〉0．05）。而两组手术时间、植皮成活率、创面愈合时间比较差异无显著性。结论 三度烧伤创面采用削痂植皮术治疗能更好地维护肢体的美观、保护肢体的功能。     

大面积烧伤瘢痕的后期整复治疗

目的为解决大面积烧伤患者后期瘢痕整复治疗时的皮源问题提供一种有效的临床治疗方案。方法选择大面积烧伤后期进行整复治疗的患者21例,其中行瘢痕皮片移植术15例（47例次手术）,瘢痕皮瓣移植术6例。分别在患者的瘢痕部位切取断层皮片或瘢痕皮瓣,行皮片移植术或皮瓣移植术,并在供皮区行邮票皮片回植。结果在47例次瘢痕皮片移植术中,皮片全部成活42例,手术部位外观明显改善,功能恢复。6例瘢痕皮瓣移植术病例中,5例皮瓣全部成活,手术部位创面修复,功能改善;1例瘢痕皮瓣表皮坏死,经过局部换药后伤口愈合,手术部位功能基本恢复。结论临床实践证实瘢痕皮片和瘢痕皮瓣移植适用于皮源奇缺的大面积烧伤患者的后期整复治疗,能提供足够的皮源。     

X线照射对同种异体移植排斥反应的影响

OBJECTIVE: To establish appropriate animal models for observing the effects of X-ray irradiation on limb allograft rejection. METHODS: Wistar rats were used as donators and SD rats as recipients, the latter divided into 2 groups, namely irradiation group and non-irradiation group according to pretransplant treatment with or without X-ray radiation (5 Gy) on the part of the donators. The donor limbs were transplanted into SD rats who had their own limbs cut off, and the sciatic nerve, femoral nerve, and femoral artery and femoral vein were anastomosed in operation. After the operation, all the recipients were given benzathine benzylpenicillin, and their vital signs, together with changes of the allografts, observed. RESULTS: A total of 16 rats received transplantation that was successful in 6 rats of non-radiation group and 7 of irradiation group. The graft survival averaged 12.0+/-2.4 d in non-irradiation group and 24.7+/-8.1 d in irradiation group, showing significant difference in the lengths of survival between the 2 groups (P<0.05). CONCLUSION: The graft survival time in rats can be significantly prolonged by pretransplant irradiation of the allograft, which also help control acute rejection of the allograft.     

急性放射性肺损伤大鼠模型建立的探讨

目的:探讨急性放射性肺损伤大鼠模型建立的研究。方法:SD大鼠40只随机分为10 Gy组、20 Gy组、30 Gy组以及对照组(不照射),每组10只。于直线加速器下行单次全胸5 Gy、10 Gy以及15 Gy照射,2次/周。于照射后第2周、第4周行CT扫描后随机处死5只,行右肺HE染色观察其病理变化。结果:4周内无大鼠死亡,于照射2周后总量20 Gy、30 Gy组均出现不同程度的皮毛倒翻、无光泽,呼吸急促,以及饮食、体重减少等情况,其中30 Gy组最为明显。病理切片、胸部CT显示20 Gy、30 Gy照射组于第2周、第4周均有不同程度的急性炎性反应,其中以30 Gy组最为显著。结论:30 Gy照射组为建立急性放射性肺损伤大鼠模型最佳照射剂量,为今后研究防治急性放射性肺损伤作用机制的筛选提供了基础。     

CD25mAb及联合供体脾细胞诱导心脏移植免疫低反应性

目的观察静脉应用CD25mAb及联合应用供体脾细胞对移植心脏生存时间的影响。方法建立大鼠异位心脏移植模型，术中应用CD25mAb及联合应用供体脾细胞。术后通过腹壁触诊判断移植心脏存活情况。结果CD25mAb组移植心脏生存时间为12．10±4．04天，与未用药组（8．5±2．42天）相比差异有显著性意义（P〈0．05）。CD25mAb＋供体脾细胞组移植心脏生存时间为12．80±3．61天，与单独应用CD25mAb组相比没有明显差异（P〉0．05），但比单独用脾细胞组（8.40±3．50天，P〈0．05）和未用药组有明显延长（P〈0．05）。结论静脉应用CD25mAb及联合应用供体脾细胞均可以延长移植心脏生存时间。     

Dynamic changes of myocardial nitric oxide formation and cGMP content in the early stage after radiation, burn and combined radiation-burn injuries in rats

Nitricchide(NO)ispresentinmanyhssuesandactSasap~crineautocoidandintracellularchemicalmessenger.NOiss}vithesizedfromL--argininebynitricoxidesynthase(NOS).TwOmaintYPesofNOShavebeenidentified:aconstitutiveCab -calmedulindependentNOS(cNOS)andaCab independentNOS(iNOS)whichareexpressedafterthestimulationofendotoxinandceTtaincytoki...[IJ.RecentstudiesdemonstratedthatNOalightplayaroleinthemaculationofmyocdriialcontractility.TheactivityofbathcNOSandiNOSisidentifiedinisolatedeardialmyocy…