四氧化二氮爆炸致冲毒复合伤对家兔血流动力学及病理形态学的影响

目的　复制四氧化二氮 (N2 O4)爆炸致冲毒复合伤模型 ,并研究其对血流动力学及病理形态学的影响。方法　健康成年雄性标准壹级家兔 2 0只 ,体重 2 74± 0 5 9kg。随机分为 :①冲击伤组 (B) ;②N2 O4吸入中毒组 (N) ;③冲毒复合伤组 (BN)。复制冲毒复合伤模型连续监测血流动力学指标并进行前后对照比和同时相组间比。结果　冲击伤后早期 ,心率显著增快 ,平均动脉压 (MAP)、左心室收缩压 (LVSP)、心室内压最大上升、下降速率±dp/dtmax均一过性上升。而四氧化二氮及冲毒复合伤组动物早期心率、MAP、LVSP、dp/dtmax均呈现逐渐下降的趋势 ,伤后 3h～ 6h最低。主要病理形态学改变 :①肺冲击伤以出血明显 ,N2 O4中毒组病变稍轻 ,以肺水肿为著 ,复合伤组肺出血和水肿均加重 ;②心肌纤维断裂 ;③肝浊肿 ,肝细胞灶性及桥接坏死 ;④肾浊肿 ,肾小管坏死 ;⑤脑 :部分神经细胞 /小血管和淋巴管周围空隙增宽 ,脑膜血管扩张充血。结论　四氧化二氮及冲毒复合伤组家兔在 3h～ 6h内血流动力学状态明显恶化 ,而冲毒复合伤组家兔的血流动力学状态恶化程度更为明显。另外 ,三组家兔的主要病理形态学均有改变 ,以冲毒复合伤组的损伤最重 ,提示对冲毒复合伤进行早期救治 (在 3h～ 6h内 )的重要性。

The effect of the blast－intoxic combined injury on rabbits pathologic and hemodynamic changes following the explosion of nitrogen tetroxide

Objectve　To establish the blast－intoxic combined injury model caused　by the explosion of nitrogen tetroxide and to investigate the pathological　and hemodynamic changes of this model．Methods　20 male first class rabbits were randomized into 3 groups：1）Blast injury by the explosion of nitrogen tetroxide．2）Intoxication of nitrogen tetroxide．3）Blast－intoxic combined injury of nitrogen tetroxide． the　blast－intoxic combined injury model　was　prepared．The hemodynamic changes were recorded by the four－channel physiologic recorder before injury and 30 minutes，3，6，12，15，18 hours after injury．Results　HR，MAP，LVSP，±dp／dt max were significantly elevated on the early stage of the blast injury but decreased gradually on the early stage of the blast－intoxic combined injury and get to　the　 lowest point 3 to 6 hours after the blast－intoxic combined injury．Main changes of the Pathomorphology：lung haemorrhage was the main changes of the blast injury．Pulmonary edema，poisoning with nitrogen tetroxide，was slight than that of the blast injury．Both hemorrhage and edema of the　 brain caused　by combined injury were markedly elevated．Pathological changes of the combined injury：fragmentation of　cardiac　muscle，hepatic cloudy swelling，hepatocellular focal necrosis and bridging necrosis，kidney cloudy swelling and tubular necrosis，increased gap of the some neurocytes，lympatic vessels and blood vessels．Dilatation and hyperemia of meningeal blood vessels．Conclusion　The rabbits，poisoning with nitrogen tetroxide and following blast－intoxic combined injury by the explosion of nitrogen tetroxide，especially the latter，had significantly hemodynamic deterioration during the third to the sixth hours　after injury　．Each of the 3 groups has pathomorphologic changes and the blast－intoxic combined injury group was the worst．It emphasized the significance of early treatment of combined injury（3 to 6 hours）．