摘要
目的 建立四维数学模式以探索烧伤早期脑水肿病理过程中的时空变化规律。 方法 犬 2 6只分为对照组 (6只 )和烧伤后 6 ,12 ,18和 2 4h组 ,每组 5只。将致伤组犬制成 5 0 %总烧伤面积 (TBSA)Ⅲ度创面 ,伤后 6h按Parkland公式补充 5 0g/L葡萄糖液。动态观察各组犬MRI表现及病理组织学、脑含水量和颅内压的变化 ,并用MRI扫描结果建立四维数学模式。 结果 烧伤早期脑水肿四维数学模式反映了其病理发展中的两个拐点 (分别为伤后 6h和 18h)和三个阶段。第一阶段 (伤后 6h内 )机体处于休克早期 ,应尽早治疗处于亚临床期的烧伤早期脑水肿。第二阶段 (伤后 6～ 18h)是脑水肿的急速发展期 ,具有血管性和细胞毒性脑水肿的共同病理特点。第三阶段 (伤后 18～ 2 4h)是病程发展的危重期。颅腔容积致使颅内压急剧上升 ,极易发生脑疝。 结论 四维数学模式的建立提示烧伤早期脑水肿的病理过程具有S形特征。
Objective To explore the spatio-temporal regularity of cerebral edema in the early stage of severe burn (50% TBSA Grade Ⅲ) with four-dimensional (4D) mathematic model. Methods Twenty-six dogs were randomly divided into control group and 6, 12, 18 and 24 hours post-burn groups. The dogs in the postburn groups suffered severe burn of 50% TBSA GradeⅢ. Six hours after burn, 50 g/L glucose was injected according to Parkland formula. MRI manifestation, histopathological changes, brain water content and intracranial pressure were observed in each group. A 4D mathematic model was established based on the results of MRI scanning. Results Two turning points ( 6 and 18 hours postburn) and three phases of pathologic changes were displayed by 4D mathematic model of cerebral edema in the early stage of severe burn. The first phase (6 hours postburn) was in the subclinical period,when an effective treatment should be taken as quickly as possible so as to prevent deterioration of postburn cerebral edema. The second phase ( 6-18 hours postburn) was in the apostatic period with pathologic characteristic of vasogenic and cytotoxic brain edema. The third stage (18-24 hours postburn) was the critical period of cerebral edema. Intracerebral pressure (ICP) increased rapidly due to limitation of cranial cavity, when cerebral hernia easily happened. Conclusions The 4D model indicates that there is a feature of type S curve in the pathologic process of cerebral edema in the early stage after severe burn.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2003年第12期709-712,共4页
Chinese Journal of Trauma
