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目的探讨肿瘤坏死因子-α(TNF-α)、内毒素(LPS)与重症胸腹创伤后心肌损伤的发生关系及可能的作用机制。方法回顾性分析2009年1月至2012年6月在解放军第二五三医院就诊、创伤指数(TI)≥17分、除外合并颅脑损伤及急诊死亡的胸腹创伤82例患者的临床资料,其中男58例,女24例;年龄16~76(43.59±16.33)岁。开放性损伤17例,闭合性损伤65例;坠落伤23例,交通伤47例,钝性伤8例,锐器剌伤4例。伤后至就诊时间(1.51±0.52)h。在救治的同时抽血检测肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)、TNF-α、LPS,并对检测结果进行相关性分析。结果心肌损伤指标检测结果:CK-MB(158.74±31.59)U/L,cTnT(496.25±58.46)pg/ml;损伤因子检测结果:TNF-α(36.41±18.09)ng/ml,LPS(343.66±106.02)U/L;均高于正常健康人。CK-MB与TNF-α、LPS的相关系数(r)分别为0.923 1和0.883 2,cTnT与TNF-α、LPS的r值分别为0.955 6和0.889 1,均呈显著正相关。结论 TNF-α、LPS参与了重症胸腹创伤后心肌损伤的发生、发展,加强对TNF-α、LPS的早期干预,或有可能减轻重症胸腹创伤后心肌细胞的损伤,提高重症胸腹创伤患者的生存率。
Objective To investigate the relationship between tumor necrosis factor-α (TNF-α), endotoxin (LPS) and myocardial injury after severe thoracoabdominal trauma and its possible mechanism. Methods The clinical data of 82 patients with chest and abdomen trauma except traumatic brain injury and emergency death who were treated at PLA No. 253 Hospital from January 2009 to June 2012 were retrospectively analyzed. There were 58 males and 24 females, aged from 16 to 76 (43.59 ± 16.33) years. Open injury in 17 cases, closed injury in 65 cases; fall injury in 23 cases, 47 cases of traffic injuries, blunt injury in 8 cases, 4 cases of sharp injury. After injury to treatment time (1.51 ± 0.52) h. At the same time of treatment, creatine kinase (CK-MB), cardiac troponin T (cTnT), TNF-α and LPS were determined by blood sampling. Results The results of myocardial injury index test showed that CK-MB (158.74 ± 31.59) U / L and cTnT (496.25 ± 58.46) pg / ml, 106.02) U / L; all higher than normal healthy people. The correlation coefficients (r) between CK-MB and TNF-α and LPS were 0.923 1 and 0.883 2, respectively. The r values of cTnT, TNF-α and LPS were 0.955 6 and 0.8891, respectively. Conclusions TNF-α and LPS are involved in the development of myocardial injury after severe thoracoabdominal trauma and the early intervention of TNF-α and LPS may be attenuated. It is also possible that TNF-α and LPS may reduce the damage of myocardial cells after severe thoracoabdominal trauma and improve the severity of chest and abdomen trauma Patient’s survival rate.