本文關(guān)鍵詞： 微量元素 重度創(chuàng)傷 氧化應(yīng)激 急性肺損傷 多器官功能障礙綜合征　出處：《汕頭大學(xué)》2006年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景 嚴(yán)重創(chuàng)傷不但造成局部組織破壞，還可引發(fā)一系列全身性病理生理反應(yīng)，導(dǎo)致休克、全身炎癥反應(yīng)綜合征(systemic inflammatory response syndrome，SIRS)和多器官功能不全綜合征(multiple organ dysfunction syndrome，MODS)等，甚至死亡。其中MODS是嚴(yán)重創(chuàng)傷后最嚴(yán)重的并發(fā)癥，在其發(fā)生發(fā)展過程中，肺臟是最常見或最先受累的器官。創(chuàng)傷后急性肺損傷(acute lung injury，ALI)在MODS的進(jìn)展中起著重要作用，作為ALI晚期的急性呼吸窘迫綜合征(acute respiratory distress syndrome，ARDS)是MODS的重要組成部分和啟動(dòng)環(huán)節(jié)。研究表明，嚴(yán)重創(chuàng)傷可引起血清Se、Fe、Zn等多種微量元素(trace element，TE)急劇下降及體內(nèi)再分布，，創(chuàng)傷程度與血TE下降程度明顯相關(guān)，一定量的補(bǔ)充能降低重傷者M(jìn)OF、感染發(fā)生率。目前，人們對(duì)創(chuàng)傷后ALI／ARDS進(jìn)行了大量細(xì)胞因子等方面的基礎(chǔ)研究，但尚未涉及創(chuàng)傷后急性TE缺乏與繼發(fā)ALI／ARDS之間關(guān)系的研究報(bào)道。我們的前期工作，也證實(shí)嚴(yán)重創(chuàng)傷后引發(fā)急性TE缺乏與MODS，特別與死亡密切相關(guān)。因此，本實(shí)驗(yàn)通過建立家兔重度創(chuàng)傷模型及補(bǔ)充TE，觀察血清及肺組織TE、氧化應(yīng)激、細(xì)胞間粘附分子-1(ICAM-1)以及MODS等指標(biāo)，探討重度創(chuàng)傷引發(fā)的急性TE缺乏與繼發(fā)ALI之間的關(guān)系，為臨床救治及法醫(yī)死因分析和死亡機(jī)理提供理論基礎(chǔ)。 材料和方法 雄性純種新西蘭白兔70只，隨機(jī)分：①正常對(duì)照組5只；②重傷組37只，其中12只于傷后2-14d死亡，25只處死；③補(bǔ)充組28只，其中3只于傷后2-7d死亡，25只處死。④死亡組，重傷組中12只死亡家兔歸為死亡組。建立ISS=27肢體重度創(chuàng)傷模型。傷后6小時(shí)，補(bǔ)充組耳緣靜脈滴注10％GS 50ml／kg+0.1ml安達(dá)美；傷后1～5天，腹腔給予0.025ml安達(dá)美+10％GS 5ml／kg，早晚各1次。重傷組只單純給予10％GS。重傷組及補(bǔ)充組按傷前和傷后6h、1d、3d、6d、9d、14d定時(shí)頸靜脈采血，同時(shí)隨機(jī)于傷后1d、3d、6d、9d、14d各處死5只。檢測(cè)血清及肺Zn、Se、Cu、Mn、MDA含量、Cu／Zn-SOD、Mn-SOD、GSH-PX活性、ICAM-1等，觀察肺臟及其他臟器組織形態(tài)學(xué)變化。 結(jié)果 1 一般情況 重傷后家兔體重明顯下降，呼吸加快，重傷組家兔多集中在傷后2-9天死亡，
[Abstract]:Research background. Severe trauma not only causes local tissue damage, but also leads to a series of systemic pathophysiological reactions, such as shock, systemic inflammatory response syndrome (SIRs) and multiple organ dysfunction syndrome (mods). Among them, MODS is the most serious complication after severe trauma, and the lung is the most common or the first organ involved in the development of MODS. Acute lung injuryALI plays an important role in the progression of MODS. Acute respiratory distress syndrome (ARDS), which is the late stage of ALI, is an important part of MODS. The degree of trauma is significantly related to the decrease of blood te, and a certain amount of supplementation can reduce the incidence of MOF and infection in severely injured patients. At present, people have done a lot of basic research on cytokines and other aspects of post-traumatic ALI/ARDS. However, there has not been a study on the relationship between post traumatic acute te deficiency and secondary ALI/ARDS. Our previous work has also confirmed that acute te deficiency after severe trauma is closely related to MODSs, especially to death. In order to investigate the relationship between acute te deficiency induced by severe trauma and secondary ALI, we established a rabbit model of severe trauma and supplemented with TE3, observed serum and lung TE3, oxidative stress, intercellular adhesion molecule-1 (ICAM-1) and MODS. To provide a theoretical basis for clinical treatment, forensic cause of death analysis and death mechanism. Materials and methods. Seventy male pure New Zealand white rabbits were randomly divided into 5 normal control group (n = 5) and 2 severe injury group (n = 37). Among them, 12 rabbits died from 2 to 14 days after injury and 25 rabbits were killed in the supplement group (n = 28). Among them, 3 rabbits died 2-7 days after injury and 25 rats were killed in 4 death group. In the severe injury group, 12 rabbits were classified as the death group. The ISS=27 limb injury model was established. 6 hours after injury, 10 GS 50ml / kg 0.1ml adamet was injected into the ear margin vein of the supplementary group, and 1 day after the injury, 5 days after the injury, 0.025ml adamet 10GS 5ml / kg was given intraperitoneally, once in the morning and evening. The severely injured group and the supplementary group received only 10GSs. The blood samples were collected from the jugular vein before and 6 days after injury and at the end of 6 days after injury. At the same time, 5 rats died at random on the third day, 6 days, 9 days and 14 days after injury. The contents of CuMnMDA in serum and lungs and the activity of Cur / Zn-SOMn-SODnGSH-PX and ICAM-1 were measured. The histomorphologic changes of lung and other organs were observed. Results. (1) in general, the weight of the rabbits decreased obviously and the respiration accelerated after serious injury. The rabbits in the serious injury group mostly died 2-9 days after injury.
【學(xué)位授予單位】：汕頭大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2006
【分類號(hào)】：R641;R563.8;D919

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