ObjectiveTo investigate the correlations between tumor necrosis factor-α (TNF-α) and lipopolysaccharide (LPS) with acute myocardial dysfunction after severe thoraco-abdominal injuries and possible mechanisms. MethodsClinical data of 82 patients with severe thoraco-abdominal injuries who were admitted to the 253rd Hospital of People's Liberation Army from January 2009 to June 2012 were retrospectively analyzed,whose trauma index (TI) were all above or equal to 17 points. Patients with concomitant brain injuries and patients who were brought in dead were excluded from this study. There were 58 male and 24 female patients with their age of 16-76 (43.59±16.33) years. There were 17 patients with open injuries and 65 patients with closed injuries. There were 23 patients with fall injuries,47 patients with traffic injuries,8 patients with blunt injuries,and 4 patients with penetrating injuries. The time from injury to admission was 1.51±0.52 hours. Blood creatine kinase-MB (CK-MB) cardiac troponin T (cTnT) TNF-α and LPS were examined during emergency treatment,and the correlations between the results were analyzed. ResultsMyocardial dysfunction was shown by CK-MB of 158.74±31.59 U/L and cTnT of 496.25±58.46 pg/ml. Injury factors were TNF-α of 36.41±18.09 ng/ml and LPS of 343.66±106.02 U/L. CK-MB was positively correlated with TNF-α and LPS with the correlation coefficient (r) of 0.923 1and 0.883 2 respectively. cTnT was also positively correlated with TNF-α and LPS with r of 0.955 6 and 0.889 1 respectively. ConclusionBoth TNF-α and LPS participate in the pathogenesis and development of acute myocardial dysfunction after severe thoraco-abdominal injuries. Early intervention against TNF-α and LPS may alleviate acute myocardial dysfunction and improve patients' survival rate after severe thoraco-abdominal injuries.
目的 探討脂多糖（LPS）、白細胞介素-6（IL-6）和血小板活化因子（PAF）與重癥胸腹創傷后凝血功能紊亂發生的相關性及可能的致病機理。方法 收集2009年1月至2011年12月期間在中國人民解放軍第二五三醫院急診科就診、創傷指數≥17分且除外合并顱腦損傷及在急診科內死亡的胸腹創傷患者62例，在予以搶救、治療的同時抽血檢查血小板計數（PLT）、血漿D-二聚體（D-D）、部分活化凝血酶原時間（APTT）、凝血酶原時間（PT）、LPS、IL-6和PAF，并對其結果進行相關性分析。結果 本組患者就診時檢測的PLT為（157.73±78.11）×109/L， D-D為（1 023.88±208.72） U/L，APTT為（46.95±17.85） s，PT為（19.44±6.95） s，TT為（58.27±12.44）s，除PLT降低外，其余4項指標均升高或延長； LPS為（322.85±104.54） U/L，IL-6為（285.51±81.46） ng/mL，PAF為 （14 714.70±4 427.95） ng/L， 三者均升高； PLT與LPS、IL-6和PAF之間呈負相關關系（P＜0.001），而D-D、APTT、PT和TT與LPS、IL-6和PAF之間均呈正相關關系（P＜0.001）。結論 LPS、IL-6及PAF可能參與了重癥胸腹創傷后凝血功能障礙的發生；重癥胸腹損傷后出現的微循環障礙及內毒素血癥是凝血功能障礙發生的重要機理。針對LPS、IL-6和PAF進行早期干預，有可能改善重癥胸腹創傷患者的凝血功能障礙。