挤压伤后心肌病理组织与节段旋转功能变化的临床研究
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摘要
目的通过光镜观察家兔挤压伤后不同时间段心肌组织的病理变化情况,并应用超声斑点追踪技术评价地震所致挤压伤伤员治疗前后的心脏节段旋转功能,以评估挤压伤后心肌继发受损的情况。方法 42只新西兰家兔按标准制作挤压伤模型,随机分为对照组、解压即刻、解压后6、12、24、48、72h共7组,每组6只,光镜下观察不同时间段心肌组织的病理变化情况;地震挤压伤伤员37人,男性21人,女性16人,应用斑点追踪技术分别检测抗心衰治疗前后左室节段旋转功能。结果家兔挤压伤后心肌组织出现明显病理变化,以伤后12～24h的改变尤为显著。地震挤压伤伤员左室感兴趣区域的收缩期节段旋转功能在治疗后明显改善(P<0.01)。结论挤压伤后由于缺血再灌注等多种因素导致心肌收缩性能受损,心肌正性变力及变时效应减低,最终导致心肌节段旋转功能降低,伤后12～24h为心肌受损达峰时间段。
Objective To study the changes of rabbits' myocardium pathology by light microscope after crush injury,and to assess the cardiac regional rotation function of the wounded in earthquake by echocardiography speckle tracking imaging after crush injury,so that to assess the myocardium secondary damaged after crush injury.Methods Forty-two New Zealand rabbits were divided into control group(6 rabbits) and crush injury group(36 rabbits),and crush injury group were further divided into immediately,6h,12h,24h,48h and 72h after pressure relief groups with 6 rabbitts in each group.Their myocardium structures were observed by the light microscopy.The wounded were detected the cardiac regional rotation function by echocardiography speckle tracking imaging before and after treatment.Results The most obvious changes of rabbit's myocardium structures occurred at 12-24h after pressure relief,and the wounded cardiac regional rotation function of the region of interest(ROI)were obvious improved after treatment(P<0.01).Conclusion The cardiac regional rotation function were decreased after crush injury,and after loosed pressure 12 to 24 h were its peak time.
Objective To study the changes of rabbits' myocardium pathology by light microscope after crush injury,and to assess the cardiac regional rotation function of the wounded in earthquake by echocardiography speckle tracking imaging after crush injury,so that to assess the myocardium secondary damaged after crush injury.Methods Forty-two New Zealand rabbits were divided into control group(6 rabbits) and crush injury group(36 rabbits),and crush injury group were further divided into immediately,6h,12h,24h,48h and 72h after pressure relief groups with 6 rabbitts in each group.Their myocardium structures were observed by the light microscopy.The wounded were detected the cardiac regional rotation function by echocardiography speckle tracking imaging before and after treatment.Results The most obvious changes of rabbit's myocardium structures occurred at 12-24h after pressure relief,and the wounded cardiac regional rotation function of the region of interest(ROI)were obvious improved after treatment(P<0.01).Conclusion The cardiac regional rotation function were decreased after crush injury,and after loosed pressure 12 to 24 h were its peak time.
引文
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[7]郭进春,赖小今,廖明松,等.家兔严重挤压伤后心肌组织继发损伤的实验研究[J].解放军医学杂志,2011,36(11):1233-1236.
[8]Takeuchi M,Otsuji Y,Lang RM.Evaluation of left ventricularfunction using left ventricular twist and torsion parameters.Curr Cardiol Rep,2009,11(2):225-230.
[9]任卫东,刘爽,马春燕,等.斑点追踪成像评价急性心肌梗死及慢性缺血性心力衰竭患者左心室扭转[J].中国介入影像与治疗学,2010,7(4):409-412.
[10]Bertini M,Mollema SA,Delgado V,et al.Impact of time toreperfusion after acute myocardial infarction on myocardial dam-age assessed by left ventricular longitudinal strain[J].Am JCardiol,2009,104(2):480-485.
[11]赖小今,郭进春,梁燕,等.家兔挤压伤后应变率成像与心肌病理变化对照的实验研究[J].临床超声医学杂志,2011,13(10):656-659.
[12]Adamu U,Schmitz F,Becker M,et al.Advanced speckletracking echocardiography allowing a three-myocardial layer-spe-cific analysis of deformation parameters[J].Eur J Echocardiogr,2009,10:303-308.
[2]Demirkiran O,Dikmen Y,Utku T,et al.Crush syndrome pa-tients after the Marmara earthquake[J].Emerg Med J 2003,20(2):247-250.
[3]Scapellato S,Maria S,Castorina G,et al.Crush syndrome[J].Minerva Chir,2007,62(4):285-292.
[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,2001,16(1):26-28.
[5]李运明,曹文君,陈长生.不等距重复测量设计方差分析用SAS和SPSS实现的对比[J].中国卫生统计,2007,24(4):352-356.
[6]刘水平,陈玉川.严重挤压伤大鼠早期心脏损伤的某些发病机制的探讨[J].中国病理生理杂志,2002,18(6):676-677.
[7]郭进春,赖小今,廖明松,等.家兔严重挤压伤后心肌组织继发损伤的实验研究[J].解放军医学杂志,2011,36(11):1233-1236.
[8]Takeuchi M,Otsuji Y,Lang RM.Evaluation of left ventricularfunction using left ventricular twist and torsion parameters.Curr Cardiol Rep,2009,11(2):225-230.
[9]任卫东,刘爽,马春燕,等.斑点追踪成像评价急性心肌梗死及慢性缺血性心力衰竭患者左心室扭转[J].中国介入影像与治疗学,2010,7(4):409-412.
[10]Bertini M,Mollema SA,Delgado V,et al.Impact of time toreperfusion after acute myocardial infarction on myocardial dam-age assessed by left ventricular longitudinal strain[J].Am JCardiol,2009,104(2):480-485.
[11]赖小今,郭进春,梁燕,等.家兔挤压伤后应变率成像与心肌病理变化对照的实验研究[J].临床超声医学杂志,2011,13(10):656-659.
[12]Adamu U,Schmitz F,Becker M,et al.Advanced speckletracking echocardiography allowing a three-myocardial layer-spe-cific analysis of deformation parameters[J].Eur J Echocardiogr,2009,10:303-308.
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