Aufmkolk M, Fischer R, Voggenreiter G, Kleinschmidt C, Schmit-Neuerburg K P, Obertacke U
Department of Trauma Surgery, University of Essen, Germany.
Crit Care Med. 1999 Aug;27(8):1441-6. doi: 10.1097/00003246-199908000-00005.
The aim of this study was to investigate the direct influence of lung contusion on pulmonary surfactant in multiple trauma patients.
Prospective, nonrandomized study.
University hospital, trauma intensive care unit.
Eighteen multiple trauma patients with unilateral lung contusions and Injury Severity Scores >19 were studied prospectively.
Bronchoalveolar lavage was performed daily until either day 7 or extubation. Samples from the side of lung contusion (n = 62) and the contralateral, uninjured side (n = 62) were obtained at the same time in 14 patients. Total phospholipids, total phospholipid classes, and surfactant apoprotein A were quantified. Additionally, surfactant function was measured with a pulsating bubble surfactometer in four patients. All data are presented as mean +/- SEM. Statistical analyses were performed using programs of SPSS for Windows 6.1.3 (SPSS Inc., Chicago, IL) (Student's t-test; p < .05).
Total phospholipids were significantly increased on the side of lung contusion (contusion side, 40+/-7 microg/mL; contralateral side, 21+/-3 microg/mL; p = .004). The percentage contents of phosphatidylcholine (contusion side, 87.1%+/-1.0%; contralateral side, 84.3%+/-1.0%; p = .04) and sphingomyelin (contusion side, 2.9%+/-0.3%; contralateral side, 1.9%+/-0.2%; p = .004) were significantly higher. In contrast, the percentage content of phosphatidylglycerol was significantly decreased (contusion side, 4.1%+/-0.1%; contralateral side, 6.9%+/-0.6%; p = .001). No alterations were found for the relative contents of phosphatidylethanolamine (contusion side, 2.4%+/-0.2%; contralateral side, 2.2%+/-0.2%; p = .47), phosphatidylinositol (contusion side, 3.5%+/-0.4%; contralateral side, 4.6%+/-0.5%; p = .06), and surfactant apoprotein A (contusion side, 7177+/-1404 ng/mL; contralateral side, 4513+/-787 ng/mL, p = .10). There was no statistical difference for minimal surface tension measured with the pulsating bubble surfactometer after 5 mins of oscillation (contusion side, 29.5+/-2.3 mN/m; contralateral side, 23.7+/-2.1 mN/m; p = .08).
Direct damage of lung parenchyma by lung contusion alters the composition of surfactant. No additional changes in surfactant function were observed that would argue in favor of functional compensation.
本研究旨在调查肺挫伤对多发伤患者肺表面活性物质的直接影响。
前瞻性、非随机研究。
大学医院创伤重症监护病房。
18例单侧肺挫伤且损伤严重度评分>19分的多发伤患者进行前瞻性研究。
每天进行支气管肺泡灌洗，直至第7天或拔管。14例患者同时从肺挫伤侧（n = 62）和对侧未受伤侧（n = 62）获取样本。对总磷脂、总磷脂类别和表面活性蛋白A进行定量分析。此外，用脉动气泡表面张力仪测量4例患者的表面活性物质功能。所有数据均以平均值±标准误表示。使用SPSS for Windows 6.1.3（SPSS公司，伊利诺伊州芝加哥）程序进行统计分析（学生t检验；p <.05）。
肺挫伤侧总磷脂显著增加（挫伤侧，40±7μg/mL；对侧，21±3μg/mL；p =.004）。磷脂酰胆碱（挫伤侧，87.1%±1.0%；对侧，84.3%±1.0%；p =.04）和鞘磷脂（挫伤侧，2.9%±0.3%；对侧，1.9%±0.2%；p =.004）的百分比含量显著升高。相比之下，磷脂酰甘油的百分比含量显著降低（挫伤侧，4.1%±0.1%；对侧，6.9%±0.6%；p =.001）。磷脂酰乙醇胺（挫伤侧，2.4%±0.2%；对侧，2.2%±0.2%；p =.47）、磷脂酰肌醇（挫伤侧，3.5%±0.4%；对侧，4.6%±0.5%；p =.06）和表面活性蛋白A（挫伤侧，7177±1404 ng/mL；对侧，4513±787 ng/mL，p =.10）的相对含量未发现改变。振荡5分钟后用脉动气泡表面张力仪测量的最小表面张力无统计学差异（挫伤侧，29.5±2.3 mN/m；对侧，23.7±2.1 mN/m；p =.08）。
肺挫伤对肺实质的直接损伤改变了表面活性物质的组成。未观察到表面活性物质功能的额外变化，这表明不存在功能代偿。
