伤后即行切痂对烧伤大鼠心肌损伤的防治作用

目的 探讨早期一次性切痂对烧伤后心肌损伤的防治作用。方法 建立30％ TBSAⅢ度烧伤大鼠立即切痂模型，动物随机正常对照组、未切痂组和切痂组，于伤后1，3，6，12和24h检测血浆肌钙蛋白T（TnT)和肿瘤坏死因子（TNF）等指标。结果 烧伤后3h血浆TnT即显著升高，伤后6h血浆TNF显著高于伤前，心肌组织中TNF也在伤后12h显著升高。未切痂组与切痂组比较，伤后1－3h未切且TnT、TNF略低于切痂组。TNF与TnT存在显著正相关关系。结论 TNF是引起烧伤后心肌损伤的重要因素，且与心肌损伤程度密切相关。伤后即行一次性切痂可以减少炎症介质的生成和释放，这可能是其对烧伤后并发心肌损伤具有防治作用的机理之一。

The protective effects of prompt escharectomy on myocardial injury following burn in rats]

OBJECTIVE: To investigate the protective effects of prompt escharectomy on myocardial injury following severe burns. METHODS: Rats were inflicted with 30% TBSA III degree scald. They were randomly divided into 3 groups: control group (C, n = 10), non-escharectomy group (NE, n = 50), escharectomy group (E, n = 50). In the E group, burn wounds were excised promptly after the injury. The levels of troponin T (TnT) and tumor necrosis factor (TNF) in plasma and TNF in myocardium were measured at 1, 3, 6, 12 and 24 hours postburn. RESULTS: TnT levels increased markedly at 3 hours post burn, plasma TNF levels increased markedly at 6 hours postburn, and TNF levels in myocardium also increased markedly at 12 hours postburn compared with the C group. Although the levels of TnT and TNF were a little lower in NE group than those in E group at 3 hours post burn, the levels of TnT 6 hours postburn and levels of TNF 12 hours postburn were significantly higher in NE group than those in E group. There were good positive correlations between TNF with TnT levels. CONCLUSIONS: TNF played important roles in the pathogenesis of myocardial injury following burns, its level was correlated with the severity of myocardial injury. TNF levels in E group was much lower that in NE group, suggesting that prompt escharectomy could reduce the production and release of inflammatory cytokines, and lessen the myocardial injury induced by uncontrolled inflammatory response.