内毒素和细胞因子在腹部火器伤肠管穿透后血液中的变化及意义

目的：探讨内毒素和细胞因子在腹部火器伤肠管穿透后血液中的变化规律及意义。方法：健康长白仔猪42头随机等分为对照组和伤后1h、2h、4h、8h、12h和24h组,实验组建立腹部火器伤肠管穿透模型后,用显色基质鲎试剂法检测各组血浆内毒素水平,采用双抗体夹心ELISA法测定各组动物血清TNF-α、IL-6水平,并观察各个时间点的体温变化。结果：实验各组的血浆内毒素水平及血清TNF-α、IL-6水平均明显高于对照组（P〈0.05）,血浆内毒素于伤后8h达到高峰,伤后12h仍维持在高峰值水平（P〈0.05）;血清TNF-α在伤后12h为（94.36±10.18）ng/L,IL-6在伤后12h为（1218.35±74.00）ng/L,二者均于伤后12h达到高峰并与伤后血浆内毒素水平变化一致。伤后动物体温逐渐升高,在伤后12h、24h实验组的平均体温达40℃以上。结论：腹部火器伤肠穿孔后内毒素血症可能诱导了血液中TNF-α、IL-6的产生,并参与了腹部肠管火器伤后机体的病理生理过程。

The changes of both endotoxin and cytokines in blood and its significance after intestinal perforations due to abdominal firearm wound in pigs

Objective： To investigate the changes of both endotoxin and cytokines in blood and its significance after intestinal per- forations due to abdominal firearm wound. Methods： A total of 42 Chang-Bai piglets were randomized into 7 groups： control group and wounded lhour group, 2hour group, 4hour group, 8hour group, 12hour group, 24hour group. The model of intestinal perforations due to abdominal firearm wound was established in wounded groups. Levels of plasma endotoxin was measured by using ehromogenic limulus amehoeyte lysate test. Serum TNF-α and IL-6 levels were determined by ELISA. Body temperature was measured. Results： Levels of plasma endotoxin, serum TNF-α and IL-6 in wounded groups were all significantly elevated compared to control group （P〈0.05）. Plasma endotoxin reached the peak in 8h group, and it was still at the peak level in 12h group. At the time of 12 hours, the serum concentrations of TNF-α and IL-6 were （94.36± 10.18） and （1218.35± 74.00）ng/L, both reaching their peak.and according with plasma endotoxin. Body temperature was gradually elevated from the control group to 24h group.It was increased to higher than 40℃ in the 12h and 24h groups. Conclusion： After intestinal firearm wound, endotoxemia provokes the serum concentrations of TNF-α and IL-6, which partici- pate in the pathophysiological process after intestinal firearm wound.