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目的探讨腹部爆炸伤致脑间接伤的早期诊断指标。方法制作犬腹部爆炸伤动物模型。伤后测定不同时相点血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)浓度,并于相应时相点观察皮层神经元NSE免疫组织化学反应强度及反应阳性细胞数目的变化。结果伤后即刻血清NSE水平显著高于伤前(P<0.01),伤后1.5 h达峰值,12 h以后迅速下降,到伤后24 h基本接近伤前水平(P>0.05)。皮层神经元NSE免疫组织化学反应强度伤后即刻明显低于正常对照组(P<0.01),且持续下降,至伤后24 h仍显著低于正常对照组(P<0.01)。NSE免疫组织化学染色阳性细胞计数伤后6 h明显减少,并持续到伤后24 h,与正常对照组比相差显著(P<0.01)。结论血清NSE水平的检测可作为腹部爆炸伤后脑损伤的早期诊断指标之一。血清标本的采集应尽可能在12 h以内进行。
Objective To investigate the early diagnosis of indirect brain injury caused by blast injury in the abdomen. Methods Animal model of explosive abdominal injury was made. After injury time points measured serum neuron-specific enolase (neuron-specific enolase, NSE) concentration, and the respective time points was observed in cortical neurons NSE immunohistochemical reactions strength and number of positive cells changes. Results Serum levels of NSE immediately after injury were significantly higher than those before injury (P <0.01), peaked at 1.5 h and rapidly decreased after 12 h. The level of serum NSE was almost the same as that before injury (P> 0.05) 24 h after injury. The intensity of NSE immunohistochemical reaction in cortical neurons immediately after injury was significantly lower than that in the normal control group (P <0.01), and continued to decline, still significantly lower than that of the normal control group 24 h after injury (P <0.01). NSE immunohistochemical staining positive cells 6 h after injury significantly reduced, and continued until 24 h after injury, compared with the normal control group, a significant difference (P <0.01). Conclusion Serum NSE levels can be used as one of the early diagnostic indicators of brain injury after abdominal explosive injury. Serum samples should be collected within 12 h as much as possible.