海水淹溺肺水肿大鼠肺血管通透性变化的观察

目的研究海水淹溺肺水肿大鼠的肺血管通透性变化与超氧化物歧化酶(SOD)、丙二醛 (MDA),髓过氧化物酶(MPO)的关系。方法 16只雄性SD大鼠按随机表法随机分为对照组和淹溺组,均以伊文思蓝(EB)20 mg／kg静脉注射,淹溺组气管内注射海水4 ml／kg,建立海水淹溺性肺水肿大鼠模型,于注射4 h后处死大鼠,计算肺组织湿重／干重比(W／D),取肺组织做病理切片HE染色,高倍镜下中性粒细胞(PMN)计数,测定肺组织中的EB浸出量(每100 mg湿肺用1 ml甲酰胺浸泡),测定肺组织匀浆中的SOD、MDA、MPO含量,以及血浆的SOD、MDA含量。结果对照组和淹溺组结果分别为: W／D 4．45 ±0．18、8．61±0．42,P<0．05;PMN(13．6±3．4)、(120．2±21．2)个／高倍视野,P<0．05;肺组织EB浸出量(18．4 ±1．8)、(30．9±4．1)μg/ml,P<0．05;肺匀浆MPO(0．64±0．08)、(1．14 ±0．16)活力单位／g湿片,P<0．05;SOD(75．6±11．7)、(67．6±10．3)U／mg protein,P>0．05;MDA(1．32±0．21)、 2．21±0．33 nmol／mg protein,P<0．05;血浆中的SOD(96．6±29．3)、(92．3±33．9)U／mg protein,P> 0．05;MDA(8．24±1．79)、(15．21±2．93)nmol／ml,P<0．05。结论海水淹溺后4 h肺血管通透性明显增加,组织湿重／干重比、中性粒细胞计数、MPO含量、血浆和肺组织匀浆中的MDA含量均增加。血浆和肺组织匀浆中的SOD未见明显变化。     

Radiographic diagnosis of cardiogenic pulmonary edema]

Development of pulmonary edema (increased extravascular lung water) is a common and sometimes life-threatening clinical problem in critical-care unit patients. There are three principal causes: cardiac failure, overhydration, and increased pulmonary capillary permeability. Among these, cardiogenic edema consists of left heart failure and overhydration. Determining the specific cause of any given case of pulmonary edema is important and leads to more rapid and definitive treatment. A plain chest film can often explicate the cause of edema with a high degree of accuracy if careful attention is given to certain radiographic features. The principal features useful for correctly determining the cause of edema in a high percentage of cases are the distribution of pulmonary blood flow, distribution of pulmonary edema, and vascular pedicle width. Ancillary features are pulmonary blood volume, bronchial cuffing, septal lines, pleural effusion, and air bronchograms. Cardiac size and shape as well as specific intracardiac calcifications could also help distinguish cardiogenic from noncardiogenic pulmonary edema.     

Noncardiogenic pulmonary edema caused by decompression sickness: rapid resolution following hyperbaric therapy

Noncardiogenic pulmonary edema is a recognized but uncommon manifestation of type 2 decompression sickness. It typically occurs within 6 hours of a dive. Because the adult respiratory distress syndrome in this setting is believed to be due to microbubbles in the pulmonary vasculature, recompression in a hyperbaric chamber has been recommended as a form of therapy. A patient developed noncardiogenic pulmonary edema following a seawater dive to 75 feet. There was complete radiologic and clinical resolution within 5 hours of hyperbaric therapy.     

Emphysema of the neck caused by a blast injury of the anterior oral cavity]

Parapharyngeal emphysema after blast injury of the oral cavity is very rare. It occurs as a consequence of sudden increase in the air pressure in the oropharynx which lacerates the buccogingival mucosa and enables entering of the air into the neck spaces. A possible mechanism of development and the way of penetration of the air into the parapharynx are explained.     

Pathophysiologic reactions in sheep to blast waves from detonation of aerosol explosives]

In the controlled field experiments 18 sheep were exposed to the detonation of the aerosol explosive generating the blast wave necessary to produce death in 50% of cases. The time of death and characteristic damages on the predilection sites of some organs are interpreted as blast type injuries. General response of the body to blast wave was similar to the one produced by other etiological factors. A special characteristic of the experiment was the frequency and severity of pathologic changes on the internal organs of the chest and abdomen. According to the authors' opinion the severity and type of pathologic changes could be explained by effects of the complex blast wave generated by detonation of the aerosol explosives.     

Re-expansion pulmonary edema

Re-expansion pulmonary edema (REPE) is an uncommon complication following re-expansion of the lung as treatment of conditions such as hemopneumothorax, large pleural effusion, and after lobectomy, pneumothorax, or even during single-lung ventilation. The majority of REPE complications are associated with treatment of spontaneous pneumothorax. The etiology of REPE remains speculative, although it is thought to be caused by increased pulmonary capillary permeability. Risk factors, including young age, a large pneumothorax, and long duration of collapse, may help predict the patients that might encounter this complication.     

创伤性脑水肿的发生机制及治疗研究进展

颅脑创伤作为一种严重的创伤类型,无论平时还是战时均有较高的发生率,严重威胁人类生命安全。颅脑创伤后,均有不同程度的脑水肿的发生和存在,对脑水肿的治疗效果直接关系到疾病的预后。本文就创伤性脑水肿的分类、发生机制及治疗进展作了全面综述。     

水下冲击波与空气冲击波对生物内脏损伤效应的对比研究

目的对比研究水下冲击波与空气冲击波对生物内脏的损伤效应，为其防治提供一定的依据。方法用1000g TNT分别进行水下和空气中爆炸，压力传感器测定冲击波的物理参数，包括峰值压力、正向持续时间和冲量。取成年杂种犬26只，其中水下爆炸20只，空气中爆炸6只，分别用1000g TNT进行水下和空气中爆炸，观察伤后6h动物存活情况和病理形态学改变。结果水下冲击波的峰值压力明显高于空气冲击波的峰值压力，尽管正向持续时间比空气冲击波短，但冲量仍明显大于空气冲击波。生物效应的测定结果表明，水下冲击波引起的死亡率高（50％），致死边界远（距爆心12．5m），肺和腹腔脏器损伤的发生率高，且伤情严重，而空气冲击波引起的损伤轻微，仅个别动物有轻微肺损伤，未见动物死亡。结论同质量TNT水下和空气中爆炸，水下冲击波的峰值压力和冲量明显高于空气冲击波，对生物的杀伤效应也明显强于空气冲击波，肺和腹腔脏器的损伤是早期救治的重要环节。     

爆炸冲击波致轻型颅脑损伤患者血脑屏障损伤机制及其与迟发性神经功能障碍的关系

爆炸冲击波导致的轻型颅脑损伤是战时最常见的损伤之一,平民在遇到恐怖爆炸袭击、意外爆炸事故等情况时也容易出现上述损伤.该损伤经常导致认知功能障碍、记忆功能障碍、情绪障碍等神经功能障碍,而这些神经功能障碍与血脑屏障损伤密切相关.本文主要探讨爆炸冲击波相关性轻型颅脑损伤时血脑屏障功能障碍与炎症反应的关系,以及早期干预氧化应激损伤、修复血脑屏障、阻断炎症反应对减轻迟发性神经功能缺损的作用.     

Morphologic changes in the tissues and organs of sheep in blast injuries caused by detonation of aerosol explosives]

The morphologic changes of the tissues and organs of sheep caused by effects of the overpressure wave due to the detonation of the aerosol explosive in the open air are analysed. The experiments were performed on 21 sheep of which 3 served as the control. All animals were autopsized and organ samples were taken for analysis. The most impressive pathologic changes were found in the upper respiratory ways and lungs in the form of massive haemorrhage, edema and emphysema as well as numerous and severe intraabdominal changes both of the air-containing and parenchymatous organs.     

胸部爆震伤致纵隔气肿的诊断与治疗

目的探讨胸部爆震伤致纵隔气肿临床特点、诊断与治疗要点,提高对其认识及处理。方法回顾性分析厦门大学附属东南医院2012年1月—2018年12月收治14例胸部爆震伤致纵隔气肿患者的临床资料,男性12例,女性2例;年龄18~65岁,平均47.0岁;炸药爆炸伤6例,煤气爆炸伤3例,烟花爆竹爆炸伤2例,高压锅爆炸伤3例;受伤至入院时间为30min^4h。全组病例入院后即明确诊断为纵隔气肿和多发伤,胸部CT示游离气体聚集于纵隔胸膜内结缔组织,患者均出现不同程度胸闷、胸痛,其中出现呼吸困难5例,咳嗽、咯血2例,恶心、呕吐1例。结果14例纵隔气肿中行纵隔引流术7例,胸腔闭式引流术5例,末行引流术2例;开胸探查止血5例,气管修补2例,食管破裂修补1例,非手术治疗6例[其中体外膜肺氧合(ECMO)支持治疗2例]。结果中未说明。死亡1例,其余病例痊愈出院,随访2个月无纵隔气肿再发。结论胸部爆震伤伤情复杂,常合并纵隔气肿,早期有效诊断并及时发现严重的张力性纵隔气肿及纵隔器官损伤,进行有效的干预治疗措施可以显著提高患者的治疗效果。