腹部肠管火器伤后内毒素血症与肝损伤

目的：探讨腹部火器伤肠管穿透后血浆内毒素水平的动态变化及其在伤后继发性肝损伤中的作用。方法：健康长白仔猪42头随机等分为对照组和腹部火器伤肠管穿透伤后1、2、4、8、12和24h实验组。测定各组动物血浆内毒素和血清ALT、AST水平，并在光镜下观察各组肝脏组织学变化。结果：实验组各组血浆内毒素和血清ALT、AST水平均明显高于对照组，内毒素于伤后8h出现高峰，伤后12h仍维持在高峰值水平（P〉0.05），ALT、AST于伤后2h和伤后12h出现两个高峰（P〈0．01）。相关分析表明，伤后内毒素与ALT、AST水平均呈正相关（r值分别为0．534、0．352，P〈0．05）。伤后各组出现逐渐加重的肝细胞水肿、变性、坏死。结论：腹部火器伤肠管穿透后，内毒素血症在火器伤后继发性肝损伤中起重要作用。

Endotoxemia and liver injury after intestinal perforation due to abdominal firearm wound

Objective： To investigate the dynamic changes of plasma endotoxin and its roles in the secondary liver injury after intestinal perforation due to abdominal firearm wound. Methods： A total of 42 Chang-Bai piglets were randomized into 7 groups： control group, wounded 1 hour group, 2 hour group, 4 hour group, 8 hour group, 12 hour group and 24 hour group. Plasma endotoxin and serum ALT,AST levels were determined. The alterations of hepatic tissue were observed by lightmicroscope, Results： Levels of plasma endotoxin and serum ALT、AST in wounded groups were significantly elevated compared with control group. Plasma endotoxin reached the peak in 8 h, and kept it until 12 h （P〉0.05）. Serum ALT, AST appeared two peaks in 2hrs and 12hrs （P〈0.01） respectively. In addition, the level of plasma endotoxin was positively correlated with serum ALT, AST （r=0.534～0.352,all P〈0.05）. Observed by light microscope, hepatocyte edema, metamorphosis and necrosis were gradually aggravated from lh to 24hrs. Conclusion： Intestinal endotoxemia might play an important role in the secondary liver injury after intestinal perforation due to abdominal firearm wound.