Mattos Gustavo M, Lopes Daniel Dias, Mamede Rui Celso Martins, Ricz Hilton, Mello-Filho Francisco V, Neto José Barbieri
Ribeirão Preto Medical SchoolRibeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
Laryngoscope. 2006 Mar;116(3):456-60. doi: 10.1097/01.mlg.0000199935.74009.60.
Solid caustic soda (CS) ingestion levels continue high in Brazil. The aggressiveness of a caustic agent depends, among other factors, on its concentration and time of contact with mucosa. However, the interdependence of these factors in the production of caustic lesion in the esophageal mucosa is not known, especially regarding CS as the strongest corrosive agent. We analyze the effects of concentration and time of contact on the aggressiveness of CS to the esophagus of live animals.
STUDY DESIGN/METHODS: One milliliter of CS at concentrations between 1.83% and 73.33% was applied to rats. The solution was kept in contact with the mucosa for 10 to 120 minutes. Internal and external organ aspects were analyzed and the epithelium, submucosa, muscle layer, and adventitia were analyzed microscopically
Epithelial necrosis was observed at all concentrations. Among the necrotic layers, the submucosa was observed starting at the 7.33% concentration, and the muscular layer and adventitia were observed at 14.66% concentration. Damage to the pulmonary parenchyma and trachea occurred at 33.66% after 10 minutes, and perforation of the esophagus was observed only after 120 minutes. After 10 minutes, important corrosive lesions installed in the esophageal layers, expanding in depth and superficial extension. The use of heparin had no effect on the production of lesions.
Ten minutes were sufficient to provoke necrosis, and longer contact increased the area of necrosis. Solution concentration levels were more important in damage production: 1.83% was sufficient for epithelial necrosis, 7.33% caused submucosal necrosis, and 14.66% muscle and adventitia necrosis; 33.66% solutions caused lung and trachea damage after 10 minutes and esophageal perforation after 120 minutes.
在巴西，固体烧碱（CS）的摄入量持续居高不下。腐蚀性物质的侵袭性取决于多种因素，其中包括其浓度以及与黏膜的接触时间。然而，这些因素在食管黏膜腐蚀性损伤形成过程中的相互依存关系尚不清楚，尤其是对于作为最强腐蚀性物质的CS而言。我们分析了浓度和接触时间对CS对活体动物食管侵袭性的影响。
研究设计/方法：将浓度在1.83%至73.33%之间的1毫升CS应用于大鼠。该溶液与黏膜接触10至120分钟。分析内部和外部器官情况，并对上皮、黏膜下层、肌层和外膜进行显微镜检查。
在所有浓度下均观察到上皮坏死。在坏死层中，从7.33%的浓度开始观察到黏膜下层坏死，在14.66%的浓度下观察到肌层和外膜坏死。10分钟后，33.66%的浓度导致肺实质和气管受损，仅在120分钟后观察到食管穿孔。10分钟后，食管各层出现严重的腐蚀性损伤，深度和表面范围均有扩展。使用肝素对损伤的产生没有影响。
10分钟足以引发坏死，更长时间的接触会增加坏死面积。溶液浓度水平在损伤产生中更为重要：1.83%足以导致上皮坏死，7.33%导致黏膜下层坏死，14.66%导致肌层和外膜坏死；33.66%的溶液在10分钟后导致肺和气管损伤，120分钟后导致食管穿孔。
