猪后肢枪弹伤所致肺远达效应CT特征与生化因子的关系

目的探讨猪后肢枪弹伤所致肺远达效应损伤的CT特征及发生机制。方法对14头猪随机采用高速弹射击,建立猪后肢枪弹伤轻等程度损伤（轻伤组,7头）和重伤动物（重伤组,7头）模型。分别在枪击前、后3、10、40min、6h,利用CT对动物模型的肺部组织结构进行观察,同时在枪击前、后3、10、25、40min、6h测定主要的血管活性物质[内皮素（ET）、皮质醇（COR）]及炎性反应指标[白细胞总数、白细胞介素-6（IL-6）]的变化。结果两组实验猪枪击后的肺部CT征象变化包括组织渗出、出血、细支气管炎、肺间质、实质渗出。肺损伤发展程度与枪弹伤伤情及ET、COR及IL-6的变化趋势相一致。IL-6在枪击后升高,ET、COR水平在枪击后各时间点均较枪击前上升。结论猪后肢枪弹伤所致肺远达效应是在致伤物动能、应激反应及神经体液因素等多种条件作用下的损伤,肺远达效应损伤伤情程度与枪弹伤伤情相一致。

CT characteristics of lung far-reaching effect in gunshot on pig lower limbs and the relationship with biochemistry factors

Objective To explore the mechanism of lung far-reaching effect in gunshot on pig lower limbs. Methods Shots were made into the pigs' lower limbs to create minor wound (minor injury group, 7 pigs) model and severe wound (serious injury group, 7 pigs) model. CT manifestations of pulmonary structure pathological changes were assessed at the time of pre-gunshot, and 3, 10, 40 min, 6 h after gunshot, meanwhile vasoactive substance (endothelin, cortisol ) and inflammatory index (white blood cells, interleukin-6 ) were measured at the time of pre-gunshot, and 3, 10, 25, 40 min, 6 h after gunshot, respectively. Results Indirect lung injury caused by gunshot on lower limbs included tissues effusion, hemorrhage, bronchiolitis and pulmonary interstitial, substance effusion. The development of indirect lung injury showed a trend influenced by the injury severity and ET, COR and IL-6. The blood IL-6 level increased after gunshot. The levels of ET and COR at all time points after gunshot were higher than those pre-gunshot. Conclusion Lung far-reaching effect influenced by many factors, such as vulnerant kinetic energy, stress, inflammatory, neural humoral factors, and so on. The severity injury of far-reaching effect is consistent with the severity wound by gunshot.