挤压综合征家兔模型不同挤压时间后心、肾功能与病理观察
摘要
目的探讨不同挤压时间后再灌注对家兔心肾功能的影响。方法青海大学医学院动物中心提供健康成年新西兰家兔60只,雌雄不拘,体重2.5~3.0 kg,清洁条件下饲养,正常进食,随机(随机数字法)分为实验组(n=50)和对照组(n=10)。其中实验组分为挤压3、6、12、24、48 h 5组,每组各10只。预定挤压时间到达解除后4 h观察家兔受压肌肉改变及血尿情况,在相应时间应用多功能超声诊断仪引导下取颈内静脉血行血生化检测;取心脏、肾脏及挤压肌肉行组织病理学观察。对照组家兔不作挤压处理,按与实验组同样的方法采血及相应组织进行检测比较。结果实验组挤压期间有7只家兔死亡,存活家兔在解除挤压后双后肢均出现明显肿胀伴活动受限;肌酐(Cr)、尿素氮(BUN)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、肌酸激酶(CK)变化组间比较差异有统计学意义(P<0.05),K+组间比较差异无统计学意义(P>0.05),实验组3、6、24、48 h组ALT均显著高于对照组(P<0.05),各时间点AST均显著高于对照组(P<0.05),BUN在3、24、48 h组均显著高于对照组(P<0.05),CK在24、48 h组均显著高于对照组(P<0.05)。实验组挤压3 h局部受压肌肉局部水肿显著,血管扩张充血;24 h后开始出现局灶性坏死,48 h后部分横纹肌出现肌纹理不清,肌纤维断裂,肌纤维间质水肿,细胞结构消失,炎性细胞浸润。实验组挤压3 h时肾小球充血肿胀,间质毛细血管扩张充血;挤压12 h肾小管开始出血;48 h时肾小管管腔狭窄,肾小管上皮细胞坏死水肿。实验组各时间点心肌结构无明显变化。结论不仅挤压时间对家兔的再灌注产生不同的病理生理影响,而且利用本模型可为挤压伤-挤压综合征的预防、早期诊断及治疗提供指导。
引文
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[15]Tsai WH,Huang ST,Liu WC,et al.High Risk of Rhabdomyolysis and Acute Kidney Injury After Traumatic Limb Compartment Syndrome[J].Ann Plast Surq,2015,74(2):S158-S161.
[16]Liang NJ,Shih YT,Shih FY,et al.Disaster epidemiology and medical response in the Chi-Chi earthquake in Taiwan[J].Ann Emerg Med,2001,38(5):549-555.
[2]孔清泉,屠重棋,裴福兴,等.肾脏替代治疗对挤压综合征伤口的影响分析:汶川地震经验总结[J].中国矫形外科杂志,2010,18(2):113-116.
[3]杨效宁,裴福兴,黄富国,等.地震所致挤压综合征的早期诊治[J].中国矫形外科杂志,2008,214(20):1528-1531.
[4]高彩荣,安峰,王英元,等.挤压伤——挤压综合征的实验病理学研究[J].中国法医学杂志,2001,1(1):26-28.
[5]Alavi-Moghaddam M,Safari S,Najafi I,et al.Accuracy of urine dipstick in the detection of patients at risk for crush-induced rhabdomyolysis and acute kidney injury[J].Eur J Emerq Med,2012,19(5):329-332.
[6]Dinesh D,Varghese T.Crush Syndrome Case Report and Literature Review[J].Access Maced J Med Sci,2010,3(3):319-323.
[7]Robert N,Robert R,Probe A.Crush syndrome presenting three days after injury[J].Injury Extra,2004,35(10):73-75.
[8]Darren J,Malinoski DJ,Matthew S,et al.Crush injury and rhabdomyolysis[J].Crit Care Clin,2004,20(1):171-192.
[9]Oda J,Tanaka H,Yoshioka T,et al.Analysis of 372 Patients with Crush Syndrome Caused by the Hanshin-Awaji Earthquake[J].J Trauma,1997,42(3):470-476.
[10]邹圣强,潘鑫,魏超,等.大鼠下肢挤压伤模型不同挤压时间的生化指标观察[J].中华灾害救援医学,2015,3(2):72-75.
[11]Better OS,Rubinstein I.Management of Shock and Acute Renal Failure in Casualties Suffering from the Crush Syndrome[J].Ren Fail,1997,19(5):647-653.
[12]Phalkey R,Reinhardt JD,Marx M.Injury epidemiology after the2001 Gujarat earthquake in India:a retrospective analysis of injuries treated at a rural hospital in the Kutch district immediately after the disaster[J].Glob Health Action,2011,4(5):7196.
[13]Vanholder R,Borniche D,Claus S,et al.When the earth trembles in the Americas:the experience of Haiti and Chile 2010.[J].Nephron Clin Pract,2010,117(3):c184-c197.
[14]Akimau P,Yoshiya K,Hosotsubo H,et al.New Experimental Model of Crush Injury of the Hindlimbs in Rats[J].J Trauma,2005,58(1):51-58.
[15]Tsai WH,Huang ST,Liu WC,et al.High Risk of Rhabdomyolysis and Acute Kidney Injury After Traumatic Limb Compartment Syndrome[J].Ann Plast Surq,2015,74(2):S158-S161.
[16]Liang NJ,Shih YT,Shih FY,et al.Disaster epidemiology and medical response in the Chi-Chi earthquake in Taiwan[J].Ann Emerg Med,2001,38(5):549-555.