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目的 探讨高原胸部火器伤与肺水肿的关系。 方法 30只体重相近 ( 10～ 15kg)的杂种犬 ,随机分成平原对照组、高原移居组和高原世居组 (每组 10只 ,高原世居组选自高原杂种犬 ) ,用 0 .44g钢珠 ,通过滑膛枪以 ( 40 0± 5 0 )m/s的初速度造成犬右胸贯通伤 ,在不同时间测定血浆前列环素的代谢产物 ( 6 -keto -PGFα)和血栓素B2 (TXB2 ) ,伤后 8h取双侧肺组织 ,测定肺含水量并行光镜、电镜检查。 结果 ( 1)伤后各组 6 -keto -PGFα均升高 ,伤后 4～ 8h各组TXB2 升高显著。高原移居组于伤后 6～ 8hTXB2 / 6 -keto -PGFα升高明显 ,而平原对照组和高原世居组则变化不明显。 ( 2 )高原移居组伤侧肺含水量比平原组和高原世居组高 ,健侧无明显差异。 ( 3)光镜及电镜检查发现伤侧肺泡及间质水肿、出血 ,局部肺泡及毛细血管结构破坏 ,呼吸膜增厚。 结论 高原胸部火器伤早期 ,高原移居组发生肺水肿的概率较高原世居组及平原组大。早期在注重抗休克和处理血气胸的同时 ,要注重肺水肿的预防。
Objective To investigate the relationship between chest firearm injuries and pulmonary edema at high altitude. Methods Thirty dogs with similar body weight (10 ~ 15kg) were randomly divided into two groups: control group, plateau group and plateau group (10 in each group, Plateau group) Right trabeculectomy was induced in the canines at the initial speed of (40 0 ± 5 0) m / s by a smoothbore gun. The plasma prostacyclin metabolites (6-keto-PGFα) and thromboxane B2 (TXB2) were measured at different times. Bilateral lung tissue was harvested 8h after injury, and lung water content was measured in parallel with light and electron microscopy. Results (1) After the injury, the 6-keto-PGFα in each group increased, and the TXB2 in each group increased significantly from 4 to 8 hours after injury. In the plateau migration group, the levels of TXB2 / 6-keto-PGFα increased significantly from 6 to 8 h after injury, while the changes in plain control group and plateau Habitat group were not obvious. (2) The water content of injured lungs in the plateau emigrant group was higher than that in the plains group and highland group, and there was no significant difference in the contralateral side. (3) Light and electron microscopy showed injury of alveoli and interstitial edema, hemorrhage, destruction of local alveoli and capillary structure, and thickening of respiratory membrane. Conclusion In the early stage of plateau chest firearm injury, the incidence of pulmonary edema in plateau migrating group is higher than that in plateau living group and plain group. Early emphasis on anti-shock and treatment of blood pneumothorax, we must pay attention to the prevention of pulmonary edema.