|本期目录/Table of Contents|

[1]叶长青,邵先安,王前进,等.水下爆炸致急性心肺损伤模型中不同剂量乌司他丁的治疗效果评价[J].医学研究与战创伤救治(原医学研究生学报),2021,23(01):1-5.[doi:10.3969/j.issn.1672-271X.2021.01.001]
　YE Chang-qing,SHAO Xian-an,WANG Qian-jin,et al.Therapeutic effects of different doses of ulinastatin in models with acute injury of heart and lung induced by underwater explosion[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2021,23(01):1-5.[doi:10.3969/j.issn.1672-271X.2021.01.001]
点击复制

水下爆炸致急性心肺损伤模型中不同剂量乌司他丁的治疗效果评价()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第23卷
期数:
2021年01期
页码:
1-5
栏目:
出版日期:
2021-01-20

文章信息/Info

Title:
Therapeutic effects of different doses of ulinastatin in models with acute injury of heart and lung induced by underwater explosion
作者:
叶长青; 邵先安; 王前进; 王静; 马宏昊; 齐晓林; 尹纯
作者单位：233015蚌埠,解放军联勤保障部队第九○二医院心内科（叶长青、邵先安、王前进、王静、尹纯）；230027合肥，中国科学技术大学近代力学系（马宏昊）；210002 南京，东部战区总医院（原南京军区南京总医院）院部（齐晓林）
Author(s):
YE Chang-qing1;  SHAO Xian-an1;  WANG Qian-jin1;  WANG Jing1;  MA Hong-hao2;  QI Xiao-lin3;  YIN Chun1
(1.Department of Cardiovascular Medicine, the 902nd Hospital of PLA Joint Service Support Force, Bengbu 233015, Anhui, China；2.Department of Modern Mechanics, University of Science and Technology of China, Hefei 230027, Anhui, China；3.Department of Management, General Hospital of Eastern Theater Command, PLA, Nanjing 210002, Jiangsu, China）
关键词:
水下爆炸伤; 乌司他丁; 肿瘤坏死因子α; 白细胞介素8; 中性粒细胞弹性蛋白酶
Keywords:
underwater explosion;  ulinastatin;  tumor necrosis factor-alpha;  tinterleukin 8;  neutrophil elastase
分类号:
R823
DOI:
10.3969/j.issn.1672-271X.2021.01.001
文献标志码:
A
摘要:
目的构建水下爆炸致兔急性心肺损伤模型，通过观察各组模型动脉血氧分压及心肺组织湿干重比值的差异，评估乌司他丁的治疗效果。通过分析乌司他丁治疗下模型血清中的炎性细胞因子水平的变化，初步探讨乌司他丁治疗水下爆炸急性心肺损伤的可能机制。方法将40只新西兰雄兔随机分为正常对照组、爆炸损伤组、低剂量乌司他丁组和高剂量乌司他丁组。利用水下爆炸装置对爆炸损伤组、低剂量乌司他丁组和高剂量乌司他丁组造成急性心肺损伤，并在致伤后即刻对低剂量乌司他丁组和高剂量乌司他丁组分别进行2.5万U/kg和10万U/kg的乌司他丁治疗。检测实验兔在爆炸后4 h、12 h、24 h的动脉血氧分压（PaO2）及血清肿瘤坏死因子α (TNF-α)、白细胞介素8 (IL-8)和中性粒细胞弹性蛋白酶 (NE)的水平。爆炸24 h后测量家兔的心肺组织湿干重比值。结果动脉血氧分压检测结果提示：爆炸损伤组实验兔在致伤后4 h、12 h、24 h的PaO2分别为(84.97±6.41)、(79.13±9.92)、(78.24±3.53)mmHg，与正常对照组4 h（92.15±4.13）、12 h（89.39±7.54）、24 h（90.24±9.33）相比均明显下降（P=0.042，P=0.018，P=0.002），而低剂量和高剂量乌司他丁组并未观测到PaO2下降。与对照组相比，爆炸损伤组动物的心肌组织和肺组织的湿干重比值均显著升高（P=0.037，P=0.028）。高剂量乌司他丁组的心肌组织湿干重比值明显低于爆炸损伤组（P=0.047）。炎性细胞因子检测结果提示：与爆炸损伤组相比，低剂量乌司他丁组的血清TNF-α含量在爆炸后12 h和24 h均明显降低（P=0.018，P=0.013）；高剂量乌司他丁组的血清TNF-α含量也在爆炸后24 h低于爆炸损伤组（P=0.004）。低剂量乌司他丁组和高剂量乌司他丁组的血清NE含量均在爆炸后24 h显著低于爆炸损伤组（P=0.007，P=0.036）。高剂量乌司他丁组的血清IL-8在爆炸后4 h、12 h、24 h均显著低于爆炸损伤组（P=0.024，P=0.007，P=0.011）。结论成功建立了靶向致伤心肺的水下爆炸伤动物模型，初步证明了乌司他丁对水下爆炸致急性心肺损伤的治疗价值，为未来海上战伤救治提供决策依据。
Abstract:
ObjectiveThe model with acute injury of heart and lung induced by underwater explosion was constructed. Ther-apeutic effect wasassessed by observing difference in arterial oxygen partial pressure and the ratio of wet and dry weight in cardiopulmonary tissue. The change of three inflammatory cytokines was investigated after treatment with low-dose and high-dose ulinastatin therapy to explore possible the mechanism.Methods40 male New-Zealand rabbits were randomly divided into four groups, Normal group, Injury group, Low-dose ulinastatin therapy group and High-dose ulinastatin therapy group. An underwater explosion device was used to cause acute injury of heart and lung to experimental rabbits in Injury group, Low-dose ulinastatin therapy group and High-dose ulinastatin therapy group. Immediately after the injury, 25 000 U/kg and 100 000 U/kg ulinastatin were administered to Low-dose ulinastatin therapy group and High-dose ulinastatin therapy group, respectively. The arterial partial oxygen pressure (PaO2) and levels of TNF-α, IL-8, and NE in serum were detected at 4 h, 12 h, and 24 h after the explosion. The wet-dry weight ratio of heart and lung tissue was measured 24 hours after the explosion.ResultsThe results showed that PaO2 of rabbits in group I were 84.97±6.41, 79.13±9.92, 78.24±3.53 mmHg at 4 h, 12 h and 24 h after injury, which were significantly lower than group N at 4 h (92.15±4.13)，12 h (89.39±7.54)，24 h (90.24±9.33) (P=0.042, P=0.018, P=0.002). But, this was not observed in group A and B. Compared with group N, the wet-dry weight ratio of heart and lung tissue in group I were significantly increased (P=0.037, P=0.028). In addition, the wet-dry weight ratio of heart tissue in group B was significantly lower than that in group I (P=0.047).Moreover, compared with the group I, the serum TNF-α level in the low-dose treatment group was significantly lower at 12 h and 24 h after the explosion (P=0.018, P=0.013); Similarly, the serum TNF-α level in high-dose treatment group was also lower than that in group I at 24 hours after the explosion (P=0.004). In addition, serum NE levels in low-dose treatment group and high-dose treatment group were both lower than that of group I at 24 hours after the explosion (P=0.007, P=0.036). It is worth noting that the serum IL-8 level in the high-dose treatment group was significantly lower than that in group I at 4 hours, 12 hours, and 24 hours after the explosion (P=0.024, P=0.007, P=0.011).ConclusionIn this study, an animal model of an underwater explosion injury is established. Therapeutic value of ulinastatin for acute cardiopulmonary injury caused by an underwater explosion is preliminaries proved. Moreover, it had basis for decision-making in the future treatment of war injuries at sea.

参考文献/References:

[1]Lance RM, Capehart B, Kadro O, et al. Human Injury Criteria for Underwater Blasts[J]. PLoS One，2015,10(11):e143485.
[2]Fetherston T, Turner S, Mitchell G，et al. Marine Mammal Lung Dynamics when Exposed to Underwater Explosion Impulse [J]. Anat Rec (Hoboken), 2019,302(5):718-734.
[3]杨志焕，朱佩芳，蒋建新，等. 水下冲击伤损伤特点的初步探讨[J]. 中华创伤杂志, 2003，19(2):45-48.
[4]Cheng Z, Li L. Ginsenoside Rg3 ameliorates lipopolysaccharide-induced acute lung injury in mice through inactivating the nuclear factor-κB (NF-κB) signaling pathway[J]. Int Immunopharmacol, 2016,34:53-59.
[5]Hafner S, Wagner K, Wepler M, et al.Physiological and immune-biological characterization of a long-term murine model of blunt chest trauma[J]. Shock, 2015,43(2):140-147.
[6]Guo Y,Ma L, Zhang F, et al.Neutrophil elastase ameliorates matrix metalloproteinase-9 to promote lipopolysaccharide-induced acute lung injury in mice 1[J]. Acta Cir Bras, 2016,31(6):382-388.
[7]董志君, 朱旗. 参麦注射液对内毒素诱导急性肺损伤大鼠血清TNF-α、IL-6和IL-8的影响[J]. 现代实用医学, 2013,25(6):671-673.
[8]贺盟, 董利民, 侯晓彬. 兔胸部爆炸伤后IL-6、IL-8及TNF-α的时间相关性表达[J]. 法医学杂志, 2014,30(2):85-87.
[9]张俭, 王辉. 乌司他丁对创伤后急性肺损伤患者炎症水平的影响及其临床疗效的评价[J]. 中国临床药理学杂志, 2014,30(10):886-888.
[10]管向东, 黄顺伟. 乌司他丁在急性肺损伤中应用的研究进展[J]. 中华医学杂志, 2006,86(31):2224-2226.
[11]潘建光, 赖国祥, 文文, 等. 利用简易三通管路建立大鼠肺爆震伤模型的实验方法[J]. 医学研究生学报, 2018, 31(4):412-415.
[12]乔少林, 齐晓林, 黄奕江, 等. 水下爆炸致急性脊髓损伤动物模型的构建[J]. 安徽医学, 2017,38(9):1103-1106.
[13]吴海燕, 黄勍栋, 唐婷玉, 等.乌司他丁对水下爆炸所致兔急性肺损伤的保护作用[J].浙江医学,2018,40(9):929-932.
[14]李雪萍, 齐晓林, 叶长青, 等.乌司他丁干预水下爆炸致兔急性肺损伤NF-κB、MMP-9的表达变化[J].中国实验诊断学,2017,21(11):2000-2002.
[15]王健, 陈勇兵, 丁需清, 等. 胸部撞击致家兔急性肺损伤的实验研究[J]. 临床和实验医学杂志, 2018,17(9):906-909.
[16]段小丽, 张赛, 涂悦, 等. 乌司他丁治疗创伤后急性肺损伤的临床效果分析[J]. 中国医药, 2019,14(5):693-697.
[17]丁体龙, 齐晓林, 黄奕江, 等. 血必净对水下爆炸实验兔心肺损伤的治疗作用[J].东南国防医药,2017,19(3):239-242.
[18]张金洲, 王文, 段维勋, 等. 胸部爆炸伤后原发和继发性肺损伤机制研究[J]. 创伤外科杂志, 2007,9(4):347-350.

相似文献/References:

[1]尹述旺,阳文新,王跃华,等.乌司他丁联合甲泼尼龙治疗脂肪栓塞综合征5例的体会[J].医学研究与战创伤救治(原医学研究生学报),2013,15(02):100.
[2]杨洪光,李 峰,游淑红,等.乌司他丁联合连续性血液滤过治疗 多器官功能障碍综合征53例临床观察[J].医学研究与战创伤救治(原医学研究生学报),2008,10(03):189.
　YANG Hong-guang,LI Feng,YOU Shu-hong,et al.Clinical observation of 53 cases with multiple organ dysfunction syndrome treated with ulinastatin combines with continuous veno-venous hemofiltration[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2008,10(01):189.
[3]宋景春,胡炜,杨洋,等.应用血栓弹力图评价乌司他丁的体外抗凝作用[J].医学研究与战创伤救治(原医学研究生学报),2018,20(05):480.[doi:10.3969/j.issn.1672-271X.2018.05.007]
　SONG Jing-chun,HU Wei,YANG Yang,et al.Effects of ulinastatin on coagulation in vitro in Chinese healthy volunteers[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(01):480.[doi:10.3969/j.issn.1672-271X.2018.05.007]

备注/Memo

备注/Memo:
基金项目：南京军区医学重点课题资助项目（14ZD20）
更新日期/Last Update: 2021-01-26