| Thoraco-abdominal injury is usual in modern life or war. It is emphasis and difficulty in treatment of thoraco-abdominal impact injury because of it's complexity and high mortality. Acute lung injury (ALI), even acute respiratoy distress syndrome (ARDS) after thoraco-abdominal impact injury is one of the main cuases of motorlity. The study on the mechanic and treatment of thoraco-abdominal injury has seldom been reported. The objectives of the present study are to establish the experimental model of thoraco-abdominal injuries model, and to evaluate the alteration of cytokine (CK) under trauma and stress condition, discuss their roles in ALI. At the same time, we investigate the influence of mucosolvan on the pulmonary function, discuss it's role in the prophylaxis and treatment of ALI after thoraco-abdominal impact injury. The part as follow is the results and conclusions of the study.1. The model of thoraco-abdominal injury has much virtue:(1) The equipment is simple, physics- paramete is easy to control, the locus of being struk is accurate, the reliability is very good. (2)The types and severity of liver trauma are similar to clinical patients. The injury grade is concentrated in a range from grade Ⅱ to grade Ⅲ. The changes of lung after traume is similar to pathologic changes of acute lung injury(ALI). It is useful to investigate the pathophysiologyic character of clinical patients who suffered from severy thoraco-abdominal injury.(3) There is cardiac injury and ribs fracture besides lung injury and hepatic injury. (4) The model can be used to evaluate the curative effect of some medicines. 2.The changes of physiological index and blood gas analysis: The respiratory rate raised significantly in group ALI after trauma(P<0.01), it reached the hight of 87±6 frequencyies/min. In earlier period after trauma, the changes of PaO2 ,SaO2 and PH isn't obviously.Then, gradual respiratory acidosis was found in group ALI. PaO2,SaO2 and PH decreased progressively after truama ,the PaCO2 increased progressively.3. The changes of cytokine: the content of TNF-а in blood reached the hight in 1 hour after trauma vs normal control group (P<0.01); the content of IL-1 in blood reached the hight in 3 hour after trauma vs normal control group (P<0.05); the content of IL-6 and IL-8 in blood reached the hight in 7 hour after trauma vs normal control group (P<0.01). Chenges of inflammatory cytokines after truama were consistent with pathologic changes of lung and the pulmonary function. 4. CD18 immunohistochemistry staining: the expression of CD18 in normal contral group is weaker than that in ALI group. In ALI group, CD18 was positive expressed in polymophonuclear leukocyte(PMN ) and alveolarmacrophage (AM). So, we draw a conclusion: TNF-α,IL-1,IL-6 ,IL-8 and CD18 play key roles in the develop of acute lung injury after trauma5. we used mucosolvan early after thoraco-abdominal impact injury, invaestigated it's treatment role on ALI from three aspects: (1) The changes of blood gas: In group ALI, PaO2 ,SaO2 and PH decreased sharply in 7 hour after trauma. But in two treatment groups, the decrease of PaO2 and SaO2 were less serious than that in group ALI(P<0.05). There isn't significance difference between group two treatment groups. (2) The content of TNF-α,IL-1,IL-6 and IL-8 in two treatment groups was less than that in group ALI(P<0.05). The content of TNF-α,IL-1,IL-6 and IL-8 in large dosage group was less than that in normal dosage group (P<0.05). In two treatment groups, pathologic changes of ALI such as pulmonary edema,focal hemorrhage,atelectasis were less serious than group ALI. The changes in large dosage group was less sriuos than normal dosage group. (3) CD18 immunohistochemistry staining: in group ALI, CD18 was more positive expressed in lung than that in two treatment groups. From the result of experiment, we think that mucosolvan inhibite the inflamatory induced by TNF-α,IL-1,IL-6 ,IL-8 and CD18. Mucosolvan have definite prophylaxis and treatment roles on ALI after thoraco-abdom... |
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