创伤脓毒症早期病理生理过程的探讨

目的：探讨创伤脓毒症早期病理生理变化。方法：Wistar大鼠造成低血容量性休克（血压维持在4．0－4．7kPa,1kPa=7.5mmHg）,持续2小时,休克末快速经颈静脉回输（15分钟内））失血和等量的林氏液,复苏后6小时,以蠕动泵经尾静脉输入大肠菌内毒素2mg/kg。实验分成5组,分别观察致伤前、创伤低血容量性休克末、复苏后及输注内毒素后2和24小时各器官功能的变化。结果：动物在创伤休克末和缺血－再灌注后即有全身炎症的应综合征（SIRS）出现,心、肝、肾、肺、肠等器官功能指标出现变化,创伤休克末丙氨酸转氨酶（ALT）和天冬氨酸转酶（AST）较伤前增加1倍,心肌酶谱在输内毒素2小时后大于正常值的3倍以上;病理学观察显示各器官组织有不同程度的实质性损伤;动物总死亡率为39．6％,单个器官功能障碍发生率为64．7％,2个或2个以上器官功能不全为23．5％。结论：本实验较好地重视了创伤后脓毒症发生的诱因和临床特点;SIRS发生率较高,符合多脏器功能障碍综合征（MODS）标准的仅为23．5％,是较好的创伤脓毒症模型。

Study on pathophysiological changes during early stage of sepsis after trauma

Objective:To investigate the pathophysiological changes during early stage of sepsis after trauma in rats.Methods:A rat model of hemorrhagic shock was established by bleeding and maintaining the blood pressure within 4.04.7 kPa (1 kPa=7.5 mmHg) for 2 hours,followed by rapid resuscitation with Ringer's lactate and shed blood.Endotoxin (E.coli O55B5) was infused at a dose of 2 mg/kg through tail vein at 6 hours after resuscitation.Wistar rats were divided into 5 groups according to following time intervals:prior to bleeding(n=10),end of hemorrhage (n=8),end of resuscitation (n=10),2 hours as well as 24 hours after resuscitation combined with endotoxin challenge(n=8 and 9).Results:It was revealed that inflammatory response occurred in animals during early stage after hemorrhage / resuscitation,and organ function parameters including the heart,liver,kidneys,lungs and intestine were abnormal,alanine aminotransferase (ALT) and aspartate transferase (AST) rose 2fold compared to baseline values.Meanwhile,isoenzyme of creatine kinase (CKMB) increased by 3fold at 2 hours after endotoxin challenge.The pathological examination showed vital organ damage to certain extent.The total mortality rate of experimental animals was 39.6% and the incidence of single and two or more organ dysfunction was 64.7% and 23.5% respectively.Conclusions:These data indicated that this model appears to replicate the clinical characteristics of trauma associated with sepsis.The incidence of systemic inflammatory response syndrome(SIRS) in rats is high and that of multiple organ dysfunction syndrome (MODS) is 23.5%.