火器多发伤时骨折早期固定减轻肠道屏障功能损害的研究

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目的 探讨多发伤时骨折早期固定能否减轻肠道屏障功能的损害。 方法  12只小型猪制作火器多发伤模型 ,即颅骨切线伤加双股骨干粉碎骨折 ,损伤严重度评分≥ 16后 ,随机分为对照组 (n =6 )和骨折内固定组 (n =6 )。伤前及伤后 6、12、2 4、4 8和 72h ,采用酶学分光光度法检测血浆D 乳酸水平 ,观察肠道通透性的变化 ;分光光度法检测血浆和小肠组织中二胺氧化酶 (DAO)含量 ;偶氮显色法鲎试验定量测定门静脉血浆内毒素浓度 ;常规方法做门静脉血细菌培养。 结果 对照组伤后血浆D 乳酸和DAO水平显著升高 ,并维持高水平到 72h ;小肠组织DAO含量明显降低 ,门静脉血浆内毒素水平明显升高 ,门静脉血细菌培养阳性率为 6 3 3%。骨折内固定组伤后 6和 12h血浆D 乳酸、DAO和内毒素水平也明显升高 ,但 2 4或 4 8h以后明显回落 ,72h与对照组相比差异有显著意义(P <0 0 5 ) ,细菌培养阳性率也低 (30 0 % ,P <0 0 5 )。 结论 多发伤后出现肠道通透性增高 ,肠黏膜完整性受损 ,有细菌、内毒素移位发生。骨折早期内固定可以减轻肠道屏障功能的损害 ,减少肠源性感染的机会。 Objective To investigate whether the early fixation of fractures in multiple trauma can reduce the damage of intestinal barrier function. Methods Twelve miniature pigs were randomly divided into control group (n = 6) and fracture internal fixation group (n = 6), which were injured by tangential trauma and double femoral shaft fracture. . Pre-injury and post-injury 6,12,2,4,48 and 72h, enzymatic spectrophotometric determination of plasma D lactate levels were observed changes in intestinal permeability; spectrophotometric determination of plasma and intestinal tissue diamine oxidation Enzyme (DAO) content; azo colorimetry test quantitative determination of portal vein plasma endotoxin concentration; routine method of portal vein blood culture. Results The levels of plasma D-lactate and DAO in the control group were significantly increased and maintained at a high level for 72 hours. The content of DAO in the small intestine was significantly decreased, and the level of endotoxin in the portal vein was significantly increased. The positive rate of portal vein blood culture was 63.3%. The levels of plasma D-lactate, DAO and endotoxin also increased significantly at 6 and 12 h after injury in the fracture fixation group, but dropped significantly after 24 h and 48 h, and the difference was significant at 72 h compared with the control group (P <0.05) , The positive rate of bacterial culture was also low (30 0%, P <0 05). Conclusions After multiple injuries, intestinal permeability increased, intestinal mucosal integrity was impaired, bacteria and endotoxin translocation occurred. Internal fixation of early fracture can reduce the damage of intestinal barrier function and reduce the chance of intestinal infection.
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