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目的探讨火器多发伤时肠道屏障功能的损害是否比单发伤更为严重。方法制作火器伤模型,24只小型猪随机分为对照组(C组,不致伤)、颅骨切线伤组(H组)、双侧股骨骨折组(L组)和多发伤组(M组,颅骨切线伤加双侧股骨干粉碎性骨折,创伤严重程度评分法≥16),每组6只。伤后在不同时间点采血,用酶学分光光度法检测血浆D-乳酸水平以反映肠道通透性;用分光光度法检测血中和小肠组织中二胺氧化酶(DAO)含量以评价肠上皮细胞受损情况;用偶氮显色法鲎试验(LAL)定量测定门静脉血浆内毒素浓度。72h活杀,取小肠组织观察病理组织学变化,测定组织中DAO含量。结果对照组各项指标均无明显变化。多发伤组与单发伤组相比:(1)血浆D-乳酸水平更高,尤其比H组高,在48～72h,P<0.01;(2)血浆DAO含量持续升高,并维持72h,而此时单发伤组已经恢复正常水平;(3)小肠组织DAO含量降低;(4)血浆内毒素水平更高,在72h,P<0.05～0.01;(5)小肠病理组织学变化更显著,出现肠绒毛顶端坏死、脱落。结论火器多发伤后出现肠道通透性升高、肠上皮结构和完整性受损,并在72h内逐渐加重,发生内毒素血症。多发伤引起的肠道屏障功能损害比单发伤更为严重。
Objective To investigate whether the impairment of intestinal barrier function in multiple firearm injuries is more severe than single injury. Methods A total of 24 miniature pigs were randomly divided into control group (C group, non-injury group), tangential head injury group (H group), bilateral femoral fracture group (L group) and multiple injury group (M group, Skull tangential injury plus bilateral femoral comminuted fractures, trauma severity score ≥ 16), 6 in each group. Blood samples were collected at different time points after injury, and plasma D-lactate level was measured by enzymatic spectrophotometry to reflect intestinal permeability. Diamine oxidase (DAO) content in blood and small intestine was detected by spectrophotometry to evaluate intestinal Epithelial cells were damaged by azo colouration test (LAL) quantitative determination of portal vein plasma endotoxin concentrations. 72h live kill, take small intestine tissue histopathological changes, determination of tissue DAO content. Results There was no significant change in the indexes of the control group. (1) Plasma D-lactate level was higher, especially higher than H group, P <0.01 at 48-72h; (2) Plasma DAO level continued to increase and maintained for 72h (3) the content of DAO in the small intestine decreased; (4) the level of plasma endotoxin was higher at 72h (P <0.05-0.01); (5) The histological changes in the small intestine were even more Significantly, the top of the intestinal villus appears necrosis, shedding. CONCLUSIONS: After the injury of firearm, the intestinal permeability increased, the structure and integrity of the intestinal epithelium were impaired, and gradually increased within 72h. Endotoxemia was observed. Multiple trauma caused by intestinal barrier function damage more serious than single injury.