目的 探讨脂多糖（LPS）、白细胞介素-6（IL-6）和血小板活化因子（PAF）与重症胸腹创伤后凝血功能紊乱发生的相关性及可能的致病机理。方法 收集2009年1月至2011年12月期间在中国人民解放军第二五三医院急诊科就诊、创伤指数≥17分且除外合并颅脑损伤及在急诊科内死亡的胸腹创伤患者62例，在予以抢救、治疗的同时抽血检查血小板计数（PLT）、血浆D-二聚体（D-D）、部分活化凝血酶原时间（APTT）、凝血酶原时间（PT）、LPS、IL-6和PAF，并对其结果进行相关性分析。结果 本组患者就诊时检测的PLT为（157.73±78.11）×109/L， D-D为（1 023.88±208.72） U/L，APTT为（46.95±17.85） s，PT为（19.44±6.95） s，TT为（58.27±12.44）s，除PLT降低外，其余4项指标均升高或延长； LPS为（322.85±104.54） U/L，IL-6为（285.51±81.46） ng/mL，PAF为 （14 714.70±4 427.95） ng/L， 三者均升高； PLT与LPS、IL-6和PAF之间呈负相关关系（P＜0.001），而D-D、APTT、PT和TT与LPS、IL-6和PAF之间均呈正相关关系（P＜0.001）。结论 LPS、IL-6及PAF可能参与了重症胸腹创伤后凝血功能障碍的发生；重症胸腹损伤后出现的微循环障碍及内毒素血症是凝血功能障碍发生的重要机理。针对LPS、IL-6和PAF进行早期干预，有可能改善重症胸腹创伤患者的凝血功能障碍。
ObjectiveTo investigate the correlation between tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), phospholipase A2 (PLA2) and myocardial cell function disorders in severe chest-abdominal injury patients. MethodsEighty-two subjects with severe chest-abdominal injury were collected from January 2009 to June 2012, of whom the trauma index were all above or equal to 17 points. As the rescue and treatment were in progress, the patients were examined for their creatine kinase-MB (CK-MB), cardiac troponin T (cTnT), TNF-α, IL-6, and PLA2 for correlation analysis. Another 82 subjects undergoing physical examination during the same time were chosen as the controls, who were again divided into myocardial cell function control group with 46 subjects and injury factors control group with 36 subjects. ResultsFor the myocardial cell function control group, CK-MB was (8.13±3.64) U/L, and cTnT was (26.71±11.58) pg/mL; for the injury group, those two indexes were respectively (158.74±31.59) U/L and (496.25±58.46) pg/mL. For the injury factors control group, TNF-α was (1.28±0.59) ng/mL, IL-6 was (63.93±41.49) ng/mL, and PLA2 was (7.47±5.27) ng/mL; for the injury group, those three indexes were respectively (36.41±18.09) ng/mL, (393.83±143.86) ng/mL, and (41.35±14.26) ng/mL. For severer chest-abdominal injury patients, all correlation factors between CK-MB and TNF-α, IL-6, PLA2 were above 0.911, and the factors between cTnT and TNF-α, IL-6, PLA2 were all above 0.912, and all correlations were positive. ConclusionTNF-α, IL-6 and PLA2 all participate in the process of acute myocardial cell function disorders in severe chest-abdominal injury patients. Early intervention of TNF-α, IL-6, and PLA2 may reduce myocardial cell damage, and improve patients' survival rate.
ObjectiveTo investigate the interventive effect of xuebijing for injection combined with nalmefene hydrochloride injection in treatment of acute hepatocyte functional injury after severe thoracoabdominal injuries. MethodsClinal data of 169 patients with severe thoracoabdominal injuries who treated in The 253th Hospital of PLA between January 2009 and June 2013 were collected retrospectively. The trauma indexes of the 169 patients were all higher than 17 scores. Patients were divided into the intervention group (n=112) and the control group (n=57) according to their receptive treatment:patients of control group underwent traditional treatments such as antishock, hemostasis, and so on; but patients of intervention group received xuebijing for injection combined with nalmefene hydrochloride injection (intravenous infusion). Patients of intervention group were tested at the time of arriving at and leaving the emergency department to the inpatient department with alanine aminotransferase (ALT), aspartate aminotransferase (AST), tumor necrosis factor-α (TNF-α), lipopolysaccharide (LPS), and interleukin-6 (IL-6); the patients of control group were just tested at the time of leaving the emergency department to the inpatient department, then comparison of the indexes between the 2 groups was performed. ResultsIn intervention group, the levels of ALT, AST, TNF-α, LPS, and IL-6 after the interventive treatment were all lower than those of before interventive treatment (P<0.05). Compared with control group, there was no significant difference in the levels of ALT, AST, TNF-α, LPS, and IL-6 before the interventive treatment of intervention group (P>0.05); but the levels ALT, AST, TNF-α, LPS, and IL-6 were all lower after the interven-tive treatment (P<0.05). ConclusionsXuebijing for injection combined with nalmefene hydrochloride injection can evidently improve the acute hepatocyte functional injury after severe thoracoabdominal injuries, and improve the prognosis.
ObjectiveTo investigate the correlations between lipopolysaccharide(LPS), phospholipase A2 (PLA2) and platelet-activating factor (PAF) with coagulopathy after severe chest and abdominal injuries and their mechanisms. MethodsClinical data of 82 patients with severe chest and abdominal injuries whose trauma index (TI) was greater than or equal to 17 points in No. 253 Hospital of People's Liberation Army from January 2009 to June 2012 were retrospectively analyzed (severe chest and abdominal injury group). Those patients who had concomitant traumatic brain injuries or died in the Emergency Department were excluded from this study. There were 58 male and 24 female patients with their age of 16-76 (43.59±16.33)years. There were 17 patients with open injuries and 65 patients with closed injuries. There were 23 patients with fall injuries, 47 patients with traffic injuries, 8 patients with blunt force injuries, and 4 patients with penetrating injuries. Forty-two healthy volunteers who received routine medical examinations in the outpatient department of our hospital were chosen as the control group, including 27 males and 15 females with their age of 24-47 (37.32±10.45) years. Blood platelet (PLT) count, D-dimer (D-D), activated partial thromboplastin time (APTT), LPS, PLA2 and PAF were compared between the 2 groups, and linear correlation analysis was performed. ResultsPLT of the severe chest and abdominal injury group patients were significantly lower than that of the control group[(83.44±38.52)×109/L vs. (191.52±23.31)×109/L]. D-D[(1 823.89±608.02) U/L vs. (105.78±44.53) U/L], APTT [(68.24±24.12) s vs. (22.47±9.41) s], LPS[(438.66±106.02) U/L vs. (87.38±46.51) U/L], PLA2 [(41.35±14.26) ng/ml vs. (7.47±5.27)ng/ml] and PAF[(15 765.31±4 431.65) ng/L vs. (3 823.45±529.72) ng/L] of the severe chest and abdominal injury group patients were significantly higher than those of the control group(P < 0.001). PLT was significantly negatively correlated with LPS, PLA2 and PAF with all the respective correlation coefficient(r)less than-0.933 5. D-D and APTT were significantly positively correlated with LPS, PLA2 and PAF with all the respective r larger than 0.921 6. ConclusionLPS, PLA2 and PAF participate in the pathogenesis of coagulopathy in patients with severe chest and abdominal injuries. Early intervention against LPS, PLA2 and PAF may improve coagulopathy and survival rate of patients with severe chest and abdominal injuries.