Severe depression of host immune functions following closed-bone fracture, soft-tissue trauma, and hemorrhagic shock

被引:66
作者
Wichmann, MW
Ayala, A
Chaudry, IH [1 ]
机构
[1] Brown Univ, Sch Med, Surg Res Ctr, Providence, RI 02903 USA
[2] Brown Univ, Sch Med, Dept Surg, Providence, RI 02903 USA
[3] Rhode Isl Hosp, Providence, RI 02903 USA
关键词
closed-bone fracture; soft-tissue trauma; hemorrhagic shock; macrophage function; splenocyte function; interleukin-1; interleukin-2; interleukin-3; interleukin-6;
D O I
10.1097/00003246-199808000-00024
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To determine the contribution of soft-tissue trauma plus hemorrhage, bone fracture and hemorrhage, as well as the contribution of bone fracture, soft-tissue trauma and hemorrhage on host immune function. Subjects: Adult male mice (n = 6/group). Design: Prospective, randomized, controlled study. Setting: Animal laboratory at a university-affiliate hospital. Interventions: Closed-bone fracture (right lower leg; external fixation) and/or soft-tissue trauma (2.5-cm midline laparotomy, closed in two layers) were induced before hemorrhagic shock (mean arterial blood pressure of 35 +/- 5 (SEM) mm Hg for 90 mins, followed by fluid resuscitation) in male C3H/HeN mice and the animals were killed at 72 hrs after initiation of the experiment. Measurements and Main Results: Splenocyte interleukin (IL)-2 and IL-3 release capacity, as well as splenic and peritoneal macrophage IL-l and IL-6 release capacity were determined. Different traumatic insults, i.e., bone fracture or soft-tissue trauma in conjunction with hemorrhage, produced comparable immune depression. More significant depression of splenocyte IL-2 and IL-3 release capacity as well as macrophage IL-l and IL-6 release capacity occurred with the combined insult (i.e., bone fracture/soft-tissue injury and hemorrhage) than after bone injury or tissue trauma alone with hemorrhage. Conclusions: The combination of closed-bone fracture and soft-tissue trauma before hemorrhage leads to even more compromised immunity than either soft-tissue trauma or closed-bone fracture along with hemorrhage. The markedly depressed immune function following bone injury, soft-tissue trauma, and hemorrhagic shock may contribute to the increased susceptibility of severely injured patients to sepsis and the ensuing multiple organ failure in the clinical situation.
引用
收藏
页码:1372 / 1378
页数:7
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