大鼠胸部创伤的实验研究
摘要
目的:创伤是外科领域最重要的基本问题之一。建立符合临床发病过程的动物模型及影响动物致伤程度的研究是研究创伤相关课题的基本条件。通过本组实验建立胸部动物模型及探讨影响胸部外伤的因素,为创伤的临床诊断及治疗研究提供理论依据。探讨不同致伤条件,对致伤严重程度的影响。
方法:(1)取30只6个月龄350-450g之间的SD大鼠,雌雄不限,分别编号为1-30号,随机分为6组,每组5只,分别设为对照组、1、2、3、4、5组。麻醉后,取右侧卧位,固定于动物固定架上,左股动脉插管接HP四导联生理记录仪,把接触面积为9.62cm2,质量分别为200g,250g,300g,350g,400g的圆柱状物体,从高为1.0米处自由落体撞击1、2、3、4、5组实验大鼠的左侧胸部第3-6肋骨。观察大鼠的一般表现。四道生理记录仪记录大鼠的伤前,伤后0.5小时、1小时、4小时、8小时、12小时、24小时心率、血压、呼吸。第3组大鼠于伤前、伤后1小时、伤后4小时行血气分析。大鼠致死后行胸腹部解剖,伤后24小时内未死亡的大鼠拉颈处死后行相应解剖观察。对损伤的肺组织行甲醛固定,行HE染色,了解肺组织的病理变化情况。
(2)取10只6个月龄350-450g之间的SD大鼠,雌雄不限,分别编号为1-10号,随机分为2组,每组5只,分别设为A、B组。麻醉后,取右侧卧位,固定于动物固定架上,左股动脉插管接HP四导联生理记录仪,把接触面积为9.62cm2,质量为300g的圆柱状物体,从高为1.0米处自由落体撞击A组实验大鼠的左侧胸第3-6肋骨。把接触面积为9.62cm2,质量为150g的圆柱状物体,从高为4.0米处自由落体撞击B组实验大鼠的左侧胸第3-6肋骨,观察项目同上。
(3)取10只6个月龄350-450g之间的SD大鼠,雌雄不限,分别编号为1-10号,随机分为2组,每组5只,分别设为A、B组。麻醉后,取右侧卧位,固定于动物固定架上,左股动脉插管接HP四导联生理记录仪,把接触面积为9.62cm2,质量为300g的圆柱状物体,从高为1.0米处自由落体撞击A组实验大鼠的左侧胸第3-6肋骨,把接触面积3.14cm2,质量为300g的圆柱状物体,从高为1.0米处自由落体撞击B组实验大鼠的左侧胸第3-6肋骨。观察项目同上。
结果:(1)部分大鼠出现口腔及鼻腔血性泡沫痰,所有大鼠撞击致伤后均出现呼吸频率加快,随着撞击重量的增加,呼吸急剧加重情况明显增加,并出现呼吸窘迫及呼吸矛盾运动。受伤较轻动物伤后4-8小时基本恢复至撞击前水平。受伤后大鼠心率加快、股动脉搏动有力。极重致伤大鼠随即出现心率缓慢,呼吸减少很快死亡。严重受伤动物心脏听诊可及受缩期杂音及明显的肺部湿罗音。重伤后随着时间的延长,呼吸、心率逐渐减慢,血压降低,降至基础生命体征的60%时,大鼠很快死亡。濒死前动物瞳孔散大,呼吸变为浅慢,张口呼吸,抽泣样呼吸,口唇发绀,股动脉搏动细弱,不久呼吸、心跳停止死亡。随着致伤重量的增加,大鼠伤后生命体征变化更为明显,与伤前相比有明显差异(P<0.05),生命体征曲线峰值明显提前,下降趋势更为明显。第3组大鼠伤后血气分析血氧、PH值明显减小(P<0.05)。随着致伤重量的增加,致伤大鼠24小时存活数明显减少。解剖结果及病理结果示大鼠致伤程度随着致伤重量的增加致伤程度明显增加。
(2)相同动量致伤A、B两组大鼠,两组大鼠伤后生命体征变化显著,与伤前相比有明显差异(P<0.05),与A组相比伤后B组生命体征曲线变化更为明显,生命体征曲线峰值明显提前,下降趋势更为明显。伤后4小时血气示B组血氧,及PH下降明显(P<0.05)。B组24小时存活数明显少于A组,解剖结果及病理结果示伤情明显较A组重。
(3)不同接触面积致伤A、B两组大鼠,两组大鼠伤后生命体征变化显著,与伤前相比有明显差异(P<0.05),伤后A、B组生命体征曲线变化基本相同,24小时存活数无明显差异,解剖结果及病理结果示A、B两组伤情判断基本相似。
结论:(1)随着撞击重量的增加,致伤程度明显增加,成功复制出大鼠胸部创伤模型,本方法具有设备要求简单、操作方便,重复性好,成功率高等特点。
(2)相同动量下,速度与质量相比,速度对胸部撞击致伤程度起更重要作用。
(3)在撞击重量及速度相同条件下,撞击面积对胸部撞击伤的程度影响较小。
Objective:
Surgical trauma is the most important areas of basic problems. And establishing an animal model of clinical disease processes and impact of animal research is to study the injury degree of the basic conditions for trauma-related issues. Through this set of experiments to establish the chest animal model and study the factors affecting the chest trauma, the trauma of the diagnosis and treatment provide a theoretical basis. Different conditions of injury, the severity of the impact of the injury.
Methods:
(1) Take 30 6 months old between 350-450g SD rats of either gender, werenumbered 1-30 numbers, were randomly divided into 6 groups, n = 5, namely, control group , 1、2、3、4、5 group. After anesthesia, take the right lateral, fixed on the animal fixation, the left femoral artery access HP four-lead physiological recorder, the contact area 9.62cm2, weight were 200g, 250g, 300g, 350g, 400g of cylindrical objects, from a high of 1.0 meters Feeney 1、2、3、4、5 group rats the left chest, rib 3-6. The general performance of the rats. 4 polygraph record before injury in rats, 0.5 hours after injury, 1 hour, 4 hours, 8 hours, 12 hours, 24 hours heart rate, blood pressure, breathing. Group 3 rats in the injury front, 1 hour after injury, 4 hours after injury, blood gas analysis. Rats underwent thoracic and abdominal anatomy of death, injury did not die within 24 hours after the rats were sacrificed underwent neck pull the corresponding anatomical structure. On lung tissue damage fixed in formalin, HE staining, to understand the pathological changes of lung tissue.
(2) Take 10 6 months old between 350-450g SD rats of either gender, were numbered 1-10, were randomly divided into 2 groups, n = 5 were set to A, B group . After anesthesia, take the right lateral, fixed on the animal fixation, the left femoral artery access H P four-lead physiological recorder, the contact area 9.62cm2, cylindrical mass of 300g of objects, from the height of 1.0 m Department Feeney A group of rats the left thoracic ribs 3-6. The contact area 9.62cm2, cylindrical mass of 150g of objects, from a high of 4.0 meters Feeney Group B rats the left thoracic ribs 3-6 to observe the project ibid.
(3) Take 10 6 months old between 350-450g SD rats of either gender, were numbered 1-10, were randomly divided into 2 groups, n = 5 were set to A, B group . After anesthesia, take the right lateral, fixed on the animals, fixation on the left femoral artery access HP four-lead physiological recorder, the contact area 9.62cm2, cylindrical mass of 300g of objects, from the height of 1.0 m Department Feeney A group of rats the left thoracic ribs 3-6, the contact area of 3.14 cm2, the quality of 300g of cylindrical objects, from 1.0 meters high impact free-falling to the left of B group rats thoracic ribs 3-6. Observation items Ibid.
Results:
(1). Part of the nasal cavity in rats with oral and sputum bloody foam, all the rats were breathing after injury crash frequency to speed up, with the impact the increase in weight, a sharp increase of the apparent increase breathing and respiratory distress and respiratory Contradiction . Less injured animal 4-8 hours after injury recovered to pre-crash levels. Heart rate in rats after injury, strong femoral pulse. Re-injured rats appears extremely slow heart rate, breathing quickly to reduce deaths. Cardiac auscultation can be seriously injured animals and by the significant reduction of noise and lung wet rales. As the time after serious injuries, breathing, heart rate gradually slows down, blood pressure, reduced to 60% of basic vital signs, the rats soon die. Dying before the animals dilated pupils, slow breathing becomes shallow, mouth breathing, sobbing like breathing, cyanotic lips, femoral pulse, thin, long breathing, cardiac arrest deaths. With the injury to increase the weight, vital signs post injury was more obvious than before with the injury were significantly different (P<0.05), vital signs, peak curve significant advance, the downward trend becomes more apparent. Group 3 after injury on oxygen blood gas analysis, PH was significantly reduced (P <0.05). With the injury to increase the weight, the number of injured rats significantly reduced 24-hour survival. Anatomical findings and pathology showed the extent injury in rats with injury to increase the weight significantly increased degree of injur y.
(2). The same momentum injury A, B two groups of rats, two groups of rats after injury vital signs changed significantly, and there were significant differences between pre-injury (P <0.05), A compared with group B after injury, vital signs curve is more obvious signs of life curve peak significantly earlier downward trend becomes more apparent. 4 hours after injury, group B blood gas showed hypoxemia, and PH decreased significantly (P <0.05). Group B was less than 24 hours the number of A group survival, anatomical findings and pathology showed significantly higher than A group of re-injury.
(3). Different injury contact area A, B two groups of rats, two groups of rats after injury vital signs changed significantly, and there were significant differences between pre-injury (P<0.05), wound A, B group curves of vital signs same, 24 hours no significant difference in survival numbers, anatomical findings and pathology showed A, B groups were similar injury judgments.
Conclusion:
(1). With the increased weight of the impact, extent of injury increased significantly, to replicate the successful model of chest trauma in rats, with the equipment requirements of this method is simple and easily reproducible, high success rate and so on.
(2). The same momentum, the speed and quality than the rate on the extent of thoracic impact injury play a more important role.
(3). The impact weight and speed under the same conditions, the impact area of the degree of impact injury to the chest less affected.
方法:(1)取30只6个月龄350-450g之间的SD大鼠,雌雄不限,分别编号为1-30号,随机分为6组,每组5只,分别设为对照组、1、2、3、4、5组。麻醉后,取右侧卧位,固定于动物固定架上,左股动脉插管接HP四导联生理记录仪,把接触面积为9.62cm2,质量分别为200g,250g,300g,350g,400g的圆柱状物体,从高为1.0米处自由落体撞击1、2、3、4、5组实验大鼠的左侧胸部第3-6肋骨。观察大鼠的一般表现。四道生理记录仪记录大鼠的伤前,伤后0.5小时、1小时、4小时、8小时、12小时、24小时心率、血压、呼吸。第3组大鼠于伤前、伤后1小时、伤后4小时行血气分析。大鼠致死后行胸腹部解剖,伤后24小时内未死亡的大鼠拉颈处死后行相应解剖观察。对损伤的肺组织行甲醛固定,行HE染色,了解肺组织的病理变化情况。
(2)取10只6个月龄350-450g之间的SD大鼠,雌雄不限,分别编号为1-10号,随机分为2组,每组5只,分别设为A、B组。麻醉后,取右侧卧位,固定于动物固定架上,左股动脉插管接HP四导联生理记录仪,把接触面积为9.62cm2,质量为300g的圆柱状物体,从高为1.0米处自由落体撞击A组实验大鼠的左侧胸第3-6肋骨。把接触面积为9.62cm2,质量为150g的圆柱状物体,从高为4.0米处自由落体撞击B组实验大鼠的左侧胸第3-6肋骨,观察项目同上。
(3)取10只6个月龄350-450g之间的SD大鼠,雌雄不限,分别编号为1-10号,随机分为2组,每组5只,分别设为A、B组。麻醉后,取右侧卧位,固定于动物固定架上,左股动脉插管接HP四导联生理记录仪,把接触面积为9.62cm2,质量为300g的圆柱状物体,从高为1.0米处自由落体撞击A组实验大鼠的左侧胸第3-6肋骨,把接触面积3.14cm2,质量为300g的圆柱状物体,从高为1.0米处自由落体撞击B组实验大鼠的左侧胸第3-6肋骨。观察项目同上。
结果:(1)部分大鼠出现口腔及鼻腔血性泡沫痰,所有大鼠撞击致伤后均出现呼吸频率加快,随着撞击重量的增加,呼吸急剧加重情况明显增加,并出现呼吸窘迫及呼吸矛盾运动。受伤较轻动物伤后4-8小时基本恢复至撞击前水平。受伤后大鼠心率加快、股动脉搏动有力。极重致伤大鼠随即出现心率缓慢,呼吸减少很快死亡。严重受伤动物心脏听诊可及受缩期杂音及明显的肺部湿罗音。重伤后随着时间的延长,呼吸、心率逐渐减慢,血压降低,降至基础生命体征的60%时,大鼠很快死亡。濒死前动物瞳孔散大,呼吸变为浅慢,张口呼吸,抽泣样呼吸,口唇发绀,股动脉搏动细弱,不久呼吸、心跳停止死亡。随着致伤重量的增加,大鼠伤后生命体征变化更为明显,与伤前相比有明显差异(P<0.05),生命体征曲线峰值明显提前,下降趋势更为明显。第3组大鼠伤后血气分析血氧、PH值明显减小(P<0.05)。随着致伤重量的增加,致伤大鼠24小时存活数明显减少。解剖结果及病理结果示大鼠致伤程度随着致伤重量的增加致伤程度明显增加。
(2)相同动量致伤A、B两组大鼠,两组大鼠伤后生命体征变化显著,与伤前相比有明显差异(P<0.05),与A组相比伤后B组生命体征曲线变化更为明显,生命体征曲线峰值明显提前,下降趋势更为明显。伤后4小时血气示B组血氧,及PH下降明显(P<0.05)。B组24小时存活数明显少于A组,解剖结果及病理结果示伤情明显较A组重。
(3)不同接触面积致伤A、B两组大鼠,两组大鼠伤后生命体征变化显著,与伤前相比有明显差异(P<0.05),伤后A、B组生命体征曲线变化基本相同,24小时存活数无明显差异,解剖结果及病理结果示A、B两组伤情判断基本相似。
结论:(1)随着撞击重量的增加,致伤程度明显增加,成功复制出大鼠胸部创伤模型,本方法具有设备要求简单、操作方便,重复性好,成功率高等特点。
(2)相同动量下,速度与质量相比,速度对胸部撞击致伤程度起更重要作用。
(3)在撞击重量及速度相同条件下,撞击面积对胸部撞击伤的程度影响较小。
Objective:
Surgical trauma is the most important areas of basic problems. And establishing an animal model of clinical disease processes and impact of animal research is to study the injury degree of the basic conditions for trauma-related issues. Through this set of experiments to establish the chest animal model and study the factors affecting the chest trauma, the trauma of the diagnosis and treatment provide a theoretical basis. Different conditions of injury, the severity of the impact of the injury.
Methods:
(1) Take 30 6 months old between 350-450g SD rats of either gender, werenumbered 1-30 numbers, were randomly divided into 6 groups, n = 5, namely, control group , 1、2、3、4、5 group. After anesthesia, take the right lateral, fixed on the animal fixation, the left femoral artery access HP four-lead physiological recorder, the contact area 9.62cm2, weight were 200g, 250g, 300g, 350g, 400g of cylindrical objects, from a high of 1.0 meters Feeney 1、2、3、4、5 group rats the left chest, rib 3-6. The general performance of the rats. 4 polygraph record before injury in rats, 0.5 hours after injury, 1 hour, 4 hours, 8 hours, 12 hours, 24 hours heart rate, blood pressure, breathing. Group 3 rats in the injury front, 1 hour after injury, 4 hours after injury, blood gas analysis. Rats underwent thoracic and abdominal anatomy of death, injury did not die within 24 hours after the rats were sacrificed underwent neck pull the corresponding anatomical structure. On lung tissue damage fixed in formalin, HE staining, to understand the pathological changes of lung tissue.
(2) Take 10 6 months old between 350-450g SD rats of either gender, were numbered 1-10, were randomly divided into 2 groups, n = 5 were set to A, B group . After anesthesia, take the right lateral, fixed on the animal fixation, the left femoral artery access H P four-lead physiological recorder, the contact area 9.62cm2, cylindrical mass of 300g of objects, from the height of 1.0 m Department Feeney A group of rats the left thoracic ribs 3-6. The contact area 9.62cm2, cylindrical mass of 150g of objects, from a high of 4.0 meters Feeney Group B rats the left thoracic ribs 3-6 to observe the project ibid.
(3) Take 10 6 months old between 350-450g SD rats of either gender, were numbered 1-10, were randomly divided into 2 groups, n = 5 were set to A, B group . After anesthesia, take the right lateral, fixed on the animals, fixation on the left femoral artery access HP four-lead physiological recorder, the contact area 9.62cm2, cylindrical mass of 300g of objects, from the height of 1.0 m Department Feeney A group of rats the left thoracic ribs 3-6, the contact area of 3.14 cm2, the quality of 300g of cylindrical objects, from 1.0 meters high impact free-falling to the left of B group rats thoracic ribs 3-6. Observation items Ibid.
Results:
(1). Part of the nasal cavity in rats with oral and sputum bloody foam, all the rats were breathing after injury crash frequency to speed up, with the impact the increase in weight, a sharp increase of the apparent increase breathing and respiratory distress and respiratory Contradiction . Less injured animal 4-8 hours after injury recovered to pre-crash levels. Heart rate in rats after injury, strong femoral pulse. Re-injured rats appears extremely slow heart rate, breathing quickly to reduce deaths. Cardiac auscultation can be seriously injured animals and by the significant reduction of noise and lung wet rales. As the time after serious injuries, breathing, heart rate gradually slows down, blood pressure, reduced to 60% of basic vital signs, the rats soon die. Dying before the animals dilated pupils, slow breathing becomes shallow, mouth breathing, sobbing like breathing, cyanotic lips, femoral pulse, thin, long breathing, cardiac arrest deaths. With the injury to increase the weight, vital signs post injury was more obvious than before with the injury were significantly different (P<0.05), vital signs, peak curve significant advance, the downward trend becomes more apparent. Group 3 after injury on oxygen blood gas analysis, PH was significantly reduced (P <0.05). With the injury to increase the weight, the number of injured rats significantly reduced 24-hour survival. Anatomical findings and pathology showed the extent injury in rats with injury to increase the weight significantly increased degree of injur y.
(2). The same momentum injury A, B two groups of rats, two groups of rats after injury vital signs changed significantly, and there were significant differences between pre-injury (P <0.05), A compared with group B after injury, vital signs curve is more obvious signs of life curve peak significantly earlier downward trend becomes more apparent. 4 hours after injury, group B blood gas showed hypoxemia, and PH decreased significantly (P <0.05). Group B was less than 24 hours the number of A group survival, anatomical findings and pathology showed significantly higher than A group of re-injury.
(3). Different injury contact area A, B two groups of rats, two groups of rats after injury vital signs changed significantly, and there were significant differences between pre-injury (P<0.05), wound A, B group curves of vital signs same, 24 hours no significant difference in survival numbers, anatomical findings and pathology showed A, B groups were similar injury judgments.
Conclusion:
(1). With the increased weight of the impact, extent of injury increased significantly, to replicate the successful model of chest trauma in rats, with the equipment requirements of this method is simple and easily reproducible, high success rate and so on.
(2). The same momentum, the speed and quality than the rate on the extent of thoracic impact injury play a more important role.
(3). The impact weight and speed under the same conditions, the impact area of the degree of impact injury to the chest less affected.
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[5]王春亭王可富主编现代重症抢救技术人民卫生出版社242
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[7]Hardy WN, Shah CS, Mason MJ, Kopacz JM, Yang KH, King AI, Van Ee CA, BishopJL, Banglmaier RF, Bey MJ, Morgan RM, Digges KH. Mechanisms of traumatic rupture of the aorta and associated peri-isthmic motion and deformation. Stapp CarCrash J. 2008 Nov;52:233-65.
[8]Bertrand S, Cuny S, Petit P, Trosseille X, Page Y, Guillemot H, Drazetic P.Traumatic rupture of thoracic aorta in real-world motor vehicle crashes.Traffic Inj Prev. 2008 Jun;9(2):153-61
[9]Ripple MG, Grant JR, Mealey J, Fowler DR Evaluation of aortic injury in driver fatalities occurring in motor vehicle accidents in the State of Maryland for 2003 and 2004. Am J Forensic Med Pathol. 2008 Jun;29(2):123-7.
[10]Lee SH, Kent R. Blood flow and fluid-structure interactions in the human aorta during traumatic rupture conditions. Stapp Car Crash J. 2007 Oct;51:211-33.
[11]Southam S,Jutila C ,Ketai L .Contrast-enhanced card MRI in blunt chest trauma: differentiating cardiac contusion from acute peir-traumatic myocardial infarction[ J] . Those Imaging,20 06,21(15 ): 17 6一17 8
[12] Seholten C ,Rosenhek R ,BindeT ,et al .Hand-held miniaturized Cardiac ultra sound instruments for rapid and effective bedside diagnosis and patient sereening [J] . E-val Clin Pract,2005,11(4) :67-7 2
[13] Nirula R, Allen B, Layman R, Falimirski ME, Somberg LB Rib fracture stabilization in patients sustaining blunt chest injury. Am Surg. 2006 Apr;72(4):307-309
[14] Schumacher H, B?ckler D, von Tengg-Kobligk H, Allenberg JR.Acute traumatic aortic tear: open versus stent-graft repair. Semin Vasc Surg. 2006 Mar;19(1):48-59
[15]Iannelli G, Piscione F, Di Tommaso L, Monaco M, Chiariello M, Spampinato N.Thoracic aortic emergencies: impact of endovascular surgery. Ann Thorac Surg.2004 Feb;77(2):591-6
[16]刘功俭.体外膜肺氧合技术的临床应用进展[J].国外医学麻醉学与复苏分册,2005,26(5):308—311
[17]黄伟明.荣健,朱艳玲,等.体外膜肺氧合在心肺辅助循环中的应用[J],中国体外循环杂志,2005,3(4):233-235.
[18]Thourain VH,Kimhbom PM,Kanter KR,et a1.Veno arterial extraloromal membrane oxygenation(VA·ECMO)in pediauic cardiac support[J].Ann Thorae Surg,2006,82(1):138—145.
[19]Funk DJ, Lujan E, Moretti EW, Davies J, Young CC, Patel MB, Vaslef SN A brief report: the use of high-frequency oscillatory ventilation for severe pulmonary contusion. J Trauma. 2008 Aug;65(2):390-5
[20] Rotta AT, Viana ME, Wiryawan B, Sargentelli GA, Dowhy MS, Zin WA, FuhrmanBP Combining lung-protective strategies in experimental acute lung injury: The impact of high-frequency partial liquid ventilation. Pediatr Crit Care Med. 2006 Nov;7(6):562-70
[1]Pisani P, Parkin DM, Bray F, et al. Estimates of the world-wide mortality from 25 cancers in 1990 [ J ]. Int J Cancer,1999, 83(2): 18-29.
[2] Yoshioka S, Fujiwara Y, Sugita Y, et al. Real-time rap id reverse transcriptase-polymerase chain reaction for intraoperative diagnosis of lymph node micrometastasis: clinical app lication for cervical lymph node dissection in esophageal cancers [ J ]. Surgery, 2002,132 (1) : 34-40.
[3]Raj GV, Moteno JG , Gomella LG. Utilization of polymetase chain teachtion technologyin the detection of solid tumors[J]. Cancer, 1998.82(8):1419-1442.
[4]Gudemanu CJ , Weitz J , Kienle P , et al . Detection of the hematogenous micrometastasis in patients with transitional cell carcinoma [ J ] . J Urol ,2000 ,164 (2) :532 - 536.
[5]Wang Z, Liu XY, Liu FY, et al. A study of correlation between early postoperative relapse with lymph node micrometastasis in patients with N0 esophageal cancer.Zhonghua Wai Ke Za Zhi. 2004, 42(2):68-71.
[6]Kitagawa Y, Ohgami M, Fujii H, .et al. Laparoscopic detection of sentinel lymph nodesin gastrointestinal cancer: a novel and minimally invasive approach. Ann Surg Oncol. 2001,8(9 Suppl):86S-89S.
[7] Natsugoe S, Nakashima S, Nakajo A,et al. Bone marrow micrometastasis detected by RT-PCR in esophageal squamous cell carcinoma. Oncol Rep. 2003 ,10(6):1879-1883.
[8]Macadam R, Sarela A, Wilson J,et al. Bone marrow micrometastases predict early post-operative recurrence following surgical resection of oesophageal and gastric carcinoma. EurJ Surg Oncol. 2003 ,29(5):450-454.
[9]杜好信,杜可军,常文辉,等.肋骨骨髓CK18mRNA基因表达与食管癌微转移的关系第31卷第3期2005年5月吉林大学学报(医学版).
[10]Liu Z, Jiang M, Zhao J, et al. Circulating tumor cells in perioperative esophageal cancer patients: quantitative assay system and potential clinical utility. Clin Cancer Res. 2007 ,13(10):2992-2997.
[11] Liu Z, Jiang M, Yan F,et al. Multipoint quantification of multimarker genes in peripheral blood and micrometastasis characteristic in peri-operative esophageal cancer patients. Cancer Lett. 2008 ,261(1):46-54.
[12]Komukai S, Nishimaki T, Suzuki T, et al Significance of immunohistochemical nodal micrometastasis as a prognostic indicator in potentially curable oesophageal carcinomaBr JSurg. 2002 ,89(2):213-219.
[13]Li SH, Wang Z, Liu XY, et al. Lymph node micrometastasis: a predictor of early tumor relapse after complete resection of histologically node-negative esophageal cancer. Surg Today. 2007,37(12):1047-1052.
[14]Liu XY, Chen G, Wang Z,et al. Clinical significance of detecting mucin 1 mRNA in diagnosing occult lymph node micrometastasis in esophageal cancer patients. Ai Zheng. 2007 ,26(2):194-199.
[15] Nakamura T, Ide H, Eguchi R,et al. Clinical implications of lymph node micrometastasis in patients with histologically node-negative (pN0) esophageal carcinoma. J Surg Oncol. 2002 ,79(4):224-229.
[16]Glickman JN, Torres C, Wang HH,et al. The prognostic significance of lymph node micrometastasis in patients with esophageal carcinoma. Cancer. 1999 ,85(4):769-778.
[17] Natsugoe S, Matsumoto M, Nakashima S,et al. Effect of neoadjuvant chemotherapy for lymph node micrometastasis and tumor cell microinvolvement in the patients with esophageal carcinoma. Cancer Lett. 2000 ,159(2):119-125.
[18]Tangoku A, Seike J, Nakano K,et al. Current status of sentinel lymph node navigationsurgery in breast and gastrointestinal tract. J Med Invest. 2007 ,54(1-2):1-18.
[19]Natsugoe S, Matsumoto M, Okumura H, et al. Initial metastatic, including micrometastatic, sites of lymph nodes in esophageal squamous cell carcinoma. J Surg Oncol. 2005 ,89(1):6-11.
[20]Matsumoto M, Natsugoe S, Ishigami S,et al. Rapid immunohistochemical detection of lymph node micrometastasis during operation for upper gastrointestinal carcinoma. Br J Surg.2003May;90(5):563-566.
[21] Sato F, Shimada Y, Li Z, Kano M,et al. Paratracheal lymph node metastasis is associated with cervical lymph node metastasis in patients with thoracic esophageal squamous cell carcinomaAnn. Surg Oncol. 2002 ,9(1):65-70.
[2]王正国.我国创伤研究的现况和未来,中国急救医学,2009(29)4.368-371
[3] Cohn SM, Zieg PM. Experimental pulmonary contusion : review of the literature and description of a new porcine model [J ] . J Trauma,,1996 ,41 (3) :565– 571
[4]廖克龙,朱佩芳,王正国.大鼠胸部撞击伤肺损伤模型的建立.创伤外科杂志。2001,3(4),263-265
[5]刘宝松王正国胸部撞击发生机理的式样研究.第三军医大学学报.1994,16(1):34-37
[6]徐善明,钮海弟.全身多发伤合并肺挫伤的早期诊断和治疗[J].中国临床医学,2005,12(2):21l一212.
[7] Lau VK,Viano DC.influence of impact velocity and chest compression on experimentai pulmonary injury sererity in rabbits [J].J trauma,1981,21(12):1022-1028
[8]王正国,孙立英,刘宝松,等E生物撞击机的研制及撞击伤发生机制的研究[J].中华创伤杂志,1999,15,(4):293-297
[9]王春亭王可富主编现代重症抢救技术人民卫生出版社242.
[10]吴秋平蒋耀光闵家新声门关闭与开放状态下兔肺撞击伤的损伤特点.中国胸心血管外科临床杂志。2005,12(3):189-193
[1]中国安全网
[2]王正国.交通医学.天津:天津科技出版社,1997.1-5
[3]张良,周继红,尹志勇高速撞击下猪右侧胸腔内压力分布特点研究创伤外科杂志,2005(7).360-363
[4]徐善明,钮海弟.全身多发伤合并肺挫伤的早期诊断和治疗[J].中国临床医学,2005,12(2):21l一212.
[5]王春亭王可富主编现代重症抢救技术人民卫生出版社242
[6]Sehreiter D,Reske A,Stiehert B。et a1.Alveolar recruitment in coinbination with sufficient positive end—expiratory pressure increases oxygenation and lung aeration in patients with BeVele chest trauma [J].Crit Care Med,2004,32(4):968-975.
[7]Hardy WN, Shah CS, Mason MJ, Kopacz JM, Yang KH, King AI, Van Ee CA, BishopJL, Banglmaier RF, Bey MJ, Morgan RM, Digges KH. Mechanisms of traumatic rupture of the aorta and associated peri-isthmic motion and deformation. Stapp CarCrash J. 2008 Nov;52:233-65.
[8]Bertrand S, Cuny S, Petit P, Trosseille X, Page Y, Guillemot H, Drazetic P.Traumatic rupture of thoracic aorta in real-world motor vehicle crashes.Traffic Inj Prev. 2008 Jun;9(2):153-61
[9]Ripple MG, Grant JR, Mealey J, Fowler DR Evaluation of aortic injury in driver fatalities occurring in motor vehicle accidents in the State of Maryland for 2003 and 2004. Am J Forensic Med Pathol. 2008 Jun;29(2):123-7.
[10]Lee SH, Kent R. Blood flow and fluid-structure interactions in the human aorta during traumatic rupture conditions. Stapp Car Crash J. 2007 Oct;51:211-33.
[11]Southam S,Jutila C ,Ketai L .Contrast-enhanced card MRI in blunt chest trauma: differentiating cardiac contusion from acute peir-traumatic myocardial infarction[ J] . Those Imaging,20 06,21(15 ): 17 6一17 8
[12] Seholten C ,Rosenhek R ,BindeT ,et al .Hand-held miniaturized Cardiac ultra sound instruments for rapid and effective bedside diagnosis and patient sereening [J] . E-val Clin Pract,2005,11(4) :67-7 2
[13] Nirula R, Allen B, Layman R, Falimirski ME, Somberg LB Rib fracture stabilization in patients sustaining blunt chest injury. Am Surg. 2006 Apr;72(4):307-309
[14] Schumacher H, B?ckler D, von Tengg-Kobligk H, Allenberg JR.Acute traumatic aortic tear: open versus stent-graft repair. Semin Vasc Surg. 2006 Mar;19(1):48-59
[15]Iannelli G, Piscione F, Di Tommaso L, Monaco M, Chiariello M, Spampinato N.Thoracic aortic emergencies: impact of endovascular surgery. Ann Thorac Surg.2004 Feb;77(2):591-6
[16]刘功俭.体外膜肺氧合技术的临床应用进展[J].国外医学麻醉学与复苏分册,2005,26(5):308—311
[17]黄伟明.荣健,朱艳玲,等.体外膜肺氧合在心肺辅助循环中的应用[J],中国体外循环杂志,2005,3(4):233-235.
[18]Thourain VH,Kimhbom PM,Kanter KR,et a1.Veno arterial extraloromal membrane oxygenation(VA·ECMO)in pediauic cardiac support[J].Ann Thorae Surg,2006,82(1):138—145.
[19]Funk DJ, Lujan E, Moretti EW, Davies J, Young CC, Patel MB, Vaslef SN A brief report: the use of high-frequency oscillatory ventilation for severe pulmonary contusion. J Trauma. 2008 Aug;65(2):390-5
[20] Rotta AT, Viana ME, Wiryawan B, Sargentelli GA, Dowhy MS, Zin WA, FuhrmanBP Combining lung-protective strategies in experimental acute lung injury: The impact of high-frequency partial liquid ventilation. Pediatr Crit Care Med. 2006 Nov;7(6):562-70
[1]Pisani P, Parkin DM, Bray F, et al. Estimates of the world-wide mortality from 25 cancers in 1990 [ J ]. Int J Cancer,1999, 83(2): 18-29.
[2] Yoshioka S, Fujiwara Y, Sugita Y, et al. Real-time rap id reverse transcriptase-polymerase chain reaction for intraoperative diagnosis of lymph node micrometastasis: clinical app lication for cervical lymph node dissection in esophageal cancers [ J ]. Surgery, 2002,132 (1) : 34-40.
[3]Raj GV, Moteno JG , Gomella LG. Utilization of polymetase chain teachtion technologyin the detection of solid tumors[J]. Cancer, 1998.82(8):1419-1442.
[4]Gudemanu CJ , Weitz J , Kienle P , et al . Detection of the hematogenous micrometastasis in patients with transitional cell carcinoma [ J ] . J Urol ,2000 ,164 (2) :532 - 536.
[5]Wang Z, Liu XY, Liu FY, et al. A study of correlation between early postoperative relapse with lymph node micrometastasis in patients with N0 esophageal cancer.Zhonghua Wai Ke Za Zhi. 2004, 42(2):68-71.
[6]Kitagawa Y, Ohgami M, Fujii H, .et al. Laparoscopic detection of sentinel lymph nodesin gastrointestinal cancer: a novel and minimally invasive approach. Ann Surg Oncol. 2001,8(9 Suppl):86S-89S.
[7] Natsugoe S, Nakashima S, Nakajo A,et al. Bone marrow micrometastasis detected by RT-PCR in esophageal squamous cell carcinoma. Oncol Rep. 2003 ,10(6):1879-1883.
[8]Macadam R, Sarela A, Wilson J,et al. Bone marrow micrometastases predict early post-operative recurrence following surgical resection of oesophageal and gastric carcinoma. EurJ Surg Oncol. 2003 ,29(5):450-454.
[9]杜好信,杜可军,常文辉,等.肋骨骨髓CK18mRNA基因表达与食管癌微转移的关系第31卷第3期2005年5月吉林大学学报(医学版).
[10]Liu Z, Jiang M, Zhao J, et al. Circulating tumor cells in perioperative esophageal cancer patients: quantitative assay system and potential clinical utility. Clin Cancer Res. 2007 ,13(10):2992-2997.
[11] Liu Z, Jiang M, Yan F,et al. Multipoint quantification of multimarker genes in peripheral blood and micrometastasis characteristic in peri-operative esophageal cancer patients. Cancer Lett. 2008 ,261(1):46-54.
[12]Komukai S, Nishimaki T, Suzuki T, et al Significance of immunohistochemical nodal micrometastasis as a prognostic indicator in potentially curable oesophageal carcinomaBr JSurg. 2002 ,89(2):213-219.
[13]Li SH, Wang Z, Liu XY, et al. Lymph node micrometastasis: a predictor of early tumor relapse after complete resection of histologically node-negative esophageal cancer. Surg Today. 2007,37(12):1047-1052.
[14]Liu XY, Chen G, Wang Z,et al. Clinical significance of detecting mucin 1 mRNA in diagnosing occult lymph node micrometastasis in esophageal cancer patients. Ai Zheng. 2007 ,26(2):194-199.
[15] Nakamura T, Ide H, Eguchi R,et al. Clinical implications of lymph node micrometastasis in patients with histologically node-negative (pN0) esophageal carcinoma. J Surg Oncol. 2002 ,79(4):224-229.
[16]Glickman JN, Torres C, Wang HH,et al. The prognostic significance of lymph node micrometastasis in patients with esophageal carcinoma. Cancer. 1999 ,85(4):769-778.
[17] Natsugoe S, Matsumoto M, Nakashima S,et al. Effect of neoadjuvant chemotherapy for lymph node micrometastasis and tumor cell microinvolvement in the patients with esophageal carcinoma. Cancer Lett. 2000 ,159(2):119-125.
[18]Tangoku A, Seike J, Nakano K,et al. Current status of sentinel lymph node navigationsurgery in breast and gastrointestinal tract. J Med Invest. 2007 ,54(1-2):1-18.
[19]Natsugoe S, Matsumoto M, Okumura H, et al. Initial metastatic, including micrometastatic, sites of lymph nodes in esophageal squamous cell carcinoma. J Surg Oncol. 2005 ,89(1):6-11.
[20]Matsumoto M, Natsugoe S, Ishigami S,et al. Rapid immunohistochemical detection of lymph node micrometastasis during operation for upper gastrointestinal carcinoma. Br J Surg.2003May;90(5):563-566.
[21] Sato F, Shimada Y, Li Z, Kano M,et al. Paratracheal lymph node metastasis is associated with cervical lymph node metastasis in patients with thoracic esophageal squamous cell carcinomaAnn. Surg Oncol. 2002 ,9(1):65-70.