Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany.
Department of Trauma, University Hospital of Zurich, Zurich, Switzerland.
PLoS One. 2020 Jun 25;15(6):e0235220. doi: 10.1371/journal.pone.0235220. eCollection 2020.
Approximately 30,000 patients with blunt cardiac trauma are recorded each year in the United States. Blunt cardiac injuries after trauma are associated with a longer hospital stay and a poor overall outcome. Organ damage after trauma is linked to increased systemic release of pro-inflammatory cytokines and damage-associated molecular patterns. However, the interplay between polytrauma and local cardiac injury is unclear. Additionally, the impact of surgical intervention on this process is currently unknown. This study aimed to determine local cardiac immunological and structural alterations after multiple trauma. Furthermore, the impact of the chosen fracture stabilization strategy (reamed versus non-reamed femoral nailing) on cardiac alterations was studied.
15 male pigs were either exposed to multiple trauma (blunt chest trauma, laparotomy, liver laceration, femur fracture and haemorrhagic shock) or sham conditions. Blood samples as well as cardiac tissue were analysed 4 h and 6 h after trauma. Additionally, murine HL-1 cells were exposed to a defined polytrauma-cocktail, mimicking the pro-inflammatory conditions after multiple trauma in vitro.
After multiple trauma, cardiac structural changes were observed in the left ventricle. More specifically, alterations in the alpha-actinin and desmin protein expression were found. Cardiac structural alterations were accompanied by enhanced local nitrosative stress, increased local inflammation and elevated systemic levels of the high-mobility group box 1 protein. Furthermore, cardiac alterations were observed predominantly in pigs that were treated by non-reamed intramedullary reaming. The polytrauma-cocktail impaired the viability of HL-1 cells in vitro, which was accompanied by a release of troponin I and HFABP.
Multiple trauma induced cardiac structural alterations in vivo, which might contribute to the development of early myocardial damage (EMD). This study also revealed that reamed femoral nailing (reamed) is associated with more prominent immunological cardiac alterations compared to nailing without reaming (non-reamed). This suggests that the choice of the initial fracture treatment strategy might be crucial for the overall outcome as well as for any post-traumatic cardiac consequences.
美国每年约有 30,000 例钝性心脏创伤患者。创伤后钝性心脏损伤与住院时间延长和整体预后不良有关。创伤后器官损伤与促炎细胞因子和损伤相关分子模式的全身释放增加有关。然而，多发伤与局部心脏损伤之间的相互作用尚不清楚。此外，目前尚不清楚手术干预对此过程的影响。本研究旨在确定多发伤后局部心脏免疫和结构改变。此外，还研究了选择的骨折固定策略（扩髓与非扩髓股骨髓内钉）对心脏改变的影响。
15 只雄性猪要么暴露于多发伤（钝性胸部创伤、剖腹术、肝裂伤、股骨骨折和失血性休克），要么暴露于假手术条件下。在创伤后 4 小时和 6 小时采集血液样本和心脏组织进行分析。此外，将鼠 HL-1 细胞暴露于定义明确的多发伤鸡尾酒中，在体外模拟多发伤后的促炎条件。
多发伤后，左心室观察到心脏结构变化。更具体地说，发现肌动蛋白和结蛋白的表达发生改变。心脏结构改变伴随着局部硝化应激增加、局部炎症增加和全身高迁移率族蛋白 1 水平升高。此外，在接受非扩髓髓内扩髓的猪中观察到心脏改变更为明显。多发伤鸡尾酒在体外损害 HL-1 细胞的活力，同时释放肌钙蛋白 I 和 HFABP。
多发伤在体内引起心脏结构改变，可能导致早期心肌损伤（EMD）的发展。本研究还表明，扩髓股骨髓内钉（扩髓）与非扩髓髓内钉（非扩髓）相比，与更明显的免疫性心脏改变相关。这表明初始骨折治疗策略的选择可能对整体结果以及任何创伤后心脏后果都至关重要。
