Demling R H, Lalonde C
Longwood Area Trauma Center, Brigham and Women's, Beth Israel, Boston, MA 02115.
J Trauma. 1990 Jan;30(1):69-74. doi: 10.1097/00005373-199001000-00010.
We determined the time course of the oxidant-induced systemic lipid peroxidation seen after burn injury. Twelve sheep were given a 15% of total body surface third-degree burn and monitored for 3 or 5 days. Circulating lipid peroxides were monitored by both malondialdehyde (MDA) and conjugated dienes (CD). Lung and liver tissue MDA was also measured and compared to controls. A significant but transient increase in circulating MDA and CD was noted several hours after burn. Venous plasma levels increased again 3-5 days postburn with onset of wound inflammation. Oxygen consumption, VO2, also increased by 35 +/- 12% at this time. Lung MDA, which increased to 64 +/- 5 from a control of 45 +/- 4 nMol/gm, at 12 hours after burn was still increased 3 days after injury. Marked lung inflammation was present early after injury and persisted for the 5-day study period. Liver MDA also increased from control value of 110 +/- 20 to 252 +/- 25 at 12 hours and remained increased over the 5-day period. Serum alkaline phosphatase was also increased. Burn biopsies revealed no infection to explain the ongoing lipid peroxidation process, i.e., bacterial content was less than 10(5) organisms/gram burn tissue. We conclude that an initial system lipid peroxidation occurs immediately after burn injury, and that this process continues well into the post-resuscitation period, corresponding in time with increased VO2, lung inflammation, and evidence of liver dysfunction. The ongoing oxidant changes with the presence of a burn may explain the accentuated organ dysfunction seen with an additional septic insult in burned patients.
我们确定了烧伤后氧化剂诱导的全身脂质过氧化的时间进程。给12只绵羊造成15%体表面积的三度烧伤，并监测3或5天。通过丙二醛（MDA）和共轭二烯（CD）监测循环中的脂质过氧化物。还测量了肺和肝组织中的MDA，并与对照组进行比较。烧伤后数小时，循环中的MDA和CD显著但短暂升高。烧伤后3 - 5天，随着伤口炎症的出现，静脉血浆水平再次升高。此时耗氧量（VO2）也增加了35±12%。烧伤后12小时，肺MDA从对照组的45±4 nMol/gm增加到64±5，在受伤后3天仍升高。受伤后早期出现明显的肺部炎症，并在为期5天的研究期间持续存在。肝MDA在12小时时也从对照组的110±20增加到252±25，并在5天内一直升高。血清碱性磷酸酶也升高。烧伤活检未发现感染可解释持续的脂质过氧化过程，即细菌含量低于10(5)个/克烧伤组织。我们得出结论，烧伤后立即发生初始的全身脂质过氧化，并且这个过程在复苏期后仍持续很长时间，在时间上与VO2增加、肺部炎症和肝功能障碍的证据相对应。烧伤时持续的氧化剂变化可能解释了烧伤患者在遭受额外的脓毒症感染时出现的更严重的器官功能障碍。
