Barber Robert C, Maass David L, White D Jean, Horton Jureta W
Department of Surgery, UT Southwestern Medical Center, Dallas, Texas 75390-9160, USA.
Shock. 2008 Oct;30(4):388-93. doi: 10.1097/SHK.0b013e318164f1cd.
Burn injury has been associated with systemic/compartmental inflammatory responses and myocardial dysfunction. We hypothesized that burn size correlates with the extent of cardiac inflammatory response/contractile dysfunction. Adult male Sprague-Dawley rats were divided to receive anesthesia, a 3-degree burn covering 20%, 30%, 40%, or 60% total body surface area (TBSA) plus fluid resuscitation (lactated Ringer, 4 mL/kg per percent burn); sham burn animals were included as controls. There were seven rats in each group. Rats were euthanized Twenty-four h postburn, and TNF-alpha, IL-1beta, and IL-6 were measured in the plasma and in supernatant from isolated cardiac myocytes by enzyme-linked immunosorbent assay. In addition, left ventricular function (Langendorff) was studied in vitro, and troponin levels were measured by enzyme-linked immunosorbent assay. There were progressive, statistically significant increases in plasma and myocyte inflammatory cytokine levels, as well as plasma troponin with increasing burn size. Similarly, left ventricular pressure (in millimeters of mercury) and +/-dP/dtmax (in millimeters of mercury per second) progressively fell with increasing burn size. However, myocardial contractile depression induced by 60% TBSA burn was similar to that produced by 40% TBSA burn. These data suggest that the degree of inflammatory response, cardiac tissue injury, and myocardial contractile depression were correlated directly with the percent TBSA burn. However, unlike inflammation and cardiac tissue damage, myocardial contractile depression reached a plateau, with maximal myocardial contraction and relaxation defects observed at 40% TBSA burn, which were not further aggravated by a larger (60%) burn.
烧伤与全身/局部炎症反应及心肌功能障碍有关。我们假设烧伤面积与心脏炎症反应/收缩功能障碍的程度相关。将成年雄性Sprague-Dawley大鼠分为几组,分别接受麻醉、20%、30%、40%或60%总体表面积(TBSA)的三度烧伤并进行液体复苏(乳酸林格氏液,每烧伤百分比4 mL/kg);将假烧伤动物作为对照。每组有7只大鼠。在烧伤后24小时对大鼠实施安乐死,通过酶联免疫吸附测定法测量血浆以及分离的心肌细胞上清液中的肿瘤坏死因子-α、白细胞介素-1β和白细胞介素-6。此外,体外研究左心室功能(Langendorff法),并通过酶联免疫吸附测定法测量肌钙蛋白水平。随着烧伤面积增加,血浆和心肌细胞炎症细胞因子水平以及血浆肌钙蛋白水平呈渐进性、统计学上显著的升高。同样,随着烧伤面积增加,左心室压力(以毫米汞柱为单位)和+/-dP/dtmax(以毫米汞柱每秒为单位)逐渐下降。然而,60% TBSA烧伤诱导的心肌收缩抑制与40% TBSA烧伤产生的相似。这些数据表明,炎症反应程度、心脏组织损伤和心肌收缩抑制与TBSA烧伤百分比直接相关。然而,与炎症和心脏组织损伤不同,心肌收缩抑制达到平台期,在40% TBSA烧伤时观察到最大的心肌收缩和舒张缺陷,更大面积(60%)的烧伤并未使其进一步加重。