Maier Marcus, Geiger Emanuel V, Wutzler Sebastian, Lehnert Mark, Wiercinski Andreas, Buurman Wim A, Marzi Ingo
Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
Eur J Trauma Emerg Surg. 2009 Oct;35(5):463-9. doi: 10.1007/s00068-009-9123-z. Epub 2009 Sep 17.
Multiple trauma is often accompanied by lung contusion leading to secondary pulmonary inflammation and organ dysfunction. The particular role of lung contusions on the systemic inflammatory response remains unclear. Therefore, the aim of the present study was to compare the degree of lung contusion with markers of inflammation and multiple organ failure (MOF) in trauma patients.
According to the Injury Severity Score (ISS), 45 patients were assigned to a low (< 25 points) and a high ISS group (> 25 points), respectively. Both groups were subdivided into minor and major lung injury groups as defined by computed tomography (CT) scan. Plasma levels of interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor (TNF) receptors, C-reactive protein (CRP), and polymorphonuclear (PMN) elastase were assessed, as well as the Murray lung score (MLS) and the MOF score.
Patients with low ISS present moderate activation of inflammation which is not influenced by the degree of lung contusion. In contrast, patients with a high ISS develop significant posttraumatic inflammation and MOF. Patients with high ISS and severe lung contusions present significantly higher MLS and MOF scores. Interestingly, patients of the high ISS group without severe lung contusions develop a similar degree of MLS and MOF only after 5 days following the traumatic insult. However, the initial plasma levels of IL-6 and IL-8 differ significantly in this group.
Our data show that severe lung contusions contributes to an immediate onset of posttraumatic inflammation in severely traumatized patients, resulting in MOF, while in severely injured patients without lung contusion, this development requires up to 5 days.
多发性创伤常伴有肺挫伤，导致继发性肺部炎症和器官功能障碍。肺挫伤在全身炎症反应中的具体作用仍不清楚。因此，本研究的目的是比较创伤患者肺挫伤程度与炎症标志物及多器官功能衰竭（MOF）的关系。
根据损伤严重程度评分（ISS），将45例患者分别分为低ISS组（<25分）和高ISS组（>25分）。两组均根据计算机断层扫描（CT）分为轻度和重度肺损伤组。评估血浆白细胞介素6（IL-6）、白细胞介素8（IL-8）、肿瘤坏死因子（TNF）受体、C反应蛋白（CRP）和多形核（PMN）弹性蛋白酶水平，以及默里肺评分（MLS）和MOF评分。
低ISS患者存在中度炎症激活，不受肺挫伤程度影响。相比之下，高ISS患者发生明显的创伤后炎症和MOF。高ISS且伴有严重肺挫伤的患者MLS和MOF评分显著更高。有趣的是，高ISS组无严重肺挫伤的患者仅在创伤后5天出现相似程度的MLS和MOF。然而，该组患者IL-6和IL-8的初始血浆水平有显著差异。
我们的数据表明，严重肺挫伤会导致重度创伤患者创伤后炎症立即发作，进而导致MOF，而在无肺挫伤的重度受伤患者中，这一过程需要长达5天时间。
