新型腹腔降温法对心肺复苏后兔肠黏膜损伤的影响

doi:10.3877/cma.j.issn.1674-0793.2010.04.004

目的

探讨心肺复苏后腹腔降温法对肠黏膜损伤的保护作用。

方法

36只健康成年新西兰大白兔用交流电致颤的方式建立室颤模型，自主循环恢复后，模型动物随机分为常温治疗组（NT）、体表降温组（SC）和腹腔降温组（PC）。观察每组自主循环恢复（ROSC）后鼓膜温度和腹腔温度的变化，ROSC后12 h处死动物，观察肠黏膜损伤情况和炎症因子TNF-α和VCAM-1的表达情况。

结果

每组12只动物，NT、SC和PC组各有9、10和9只动物CPR成功，ROSC后动物均需要行机械通气2~4 h，各组分别有5、6和8只动物存活到实验结束。NT组的鼓膜、腹膜温度均维持在正常范围内，SC和PC两组的鼓膜温度达到目标温度的时间分别为（29±6.55）min和（62±8.27）min。维持亚低温阶段，SC组腹腔内温度和鼓膜温度维持在33℃~35℃，而PC组腹腔温度维持在31℃~34℃。PC组肠黏膜损伤评分为1.43±0.53，低于NT组的3.40±0.55（P<0.01）和SC组的3.17±0.41（P<0.05），而NT组和SC组之间差异不明显（P=0.30）。肠黏膜内TNF-α的表达NT组为（9.98±1.79）%，高于SC组的（5.87±1.43）%和PC组的（2.54±0.96）%，差异有统计学意义（P<0.05）；SC组和PC组之间差异有统计学意义（P<0.05）。SC组肠黏膜内VCAM-1的表达为（5.92±1.06）%，PC组为（3.78±0.53）%，两组VCAM-1表达水平显著低于NT组（8.53±1.53）%，P分别小于0.01和0.05，PC组VCAM-1表达水平也显著低于SC组，P<0.05。

结论

CPR后腹腔降温法除能快速诱导亚低温外还能减轻ROSC后的肠黏膜损伤。

关键词: 新型腹腔降温法, 心肺复苏术, 亚低温, 兔

Objective

To explore whether the peritoneal cooling after cardiopulmonary resuscitation could improve the injured of intestinal mucous in rabbits.

Methods

Thirty-six adult New Zealand rabbits were induced ventricular fibrillation by AC current. After restore of spontaneous circulation(ROSC), the rabbits were randomly divided into three groups according to the way of body temperature controlling, i.e. nomothermia group (NT), surface cooling group(SC) and peritoneal cooling group(PC). The changing of tympanic temperature and peritoneal temperature were observed after ROSC. The animals were sacrificed by over anesthesia after ROSC for 12 h, the end ileum was removed and fixed in formalin,the histological injured and the expression of TNF-α and VCAM-1 in ileum were observed by HE staining and immune chemical methods.

Results

Twelve animals in each group,9 in group NT,10 in group SC and 9 in group PC were successfully resuscitated. All animals were need mechanical ventilation for 2 to 4 h, 5, 6 and 8 animals in each group survived to the end of the experiment respectively.The temperatures of tympanic and peritoneal cavity of animals in group NT were maintained in normal range.The tympanic temperature of animals in group SC and PC was arrived target temperatures at (29±6.55) min and (62±8.27) min. During the stage of maintenance of hypothermia, the tympanic and peritoneal temperatures of animals in group SC were in range 33℃ to 35℃, while the peritoneal temperatures of animals in group PC were in range 31℃ to 34℃,1℃ to 2℃ lower than the tympanic temperature. The scores of histological injured of ileum were 1.43±0.53 in group PC,3.4±0.55 in group NT and 3.17±0.41 in group SC. The differences among them were significantly, PC versus SC or NT, P<0.05; while SC versus NT, P=0.30. The expression of TNF-α in ileum was (9.98±1.79)% in group NT, (5.87±1.43)% in group SC and (3.78±0.53)% in group PC, the differences among them were significantly. The phenomenon of the expression of VCAM-1 was (3.78±0.53)% in group PC, (8.53±1.53)% in group NT and (5.92±1.06)% in group SC.

Conclusion

The neotype peritoneal cooling can improve the injured of ileum mucous beside quickly induce hypothermia after ROSC in rabbits.

Key words: Neotype peritoneal cooling, Cardiopulmonary resuscitation, Hypothermia, Rabbits

图1 ROSC后12 h各组肠黏膜组织学损伤情况：ROSC后12 h兔肠黏膜出现了不同程度的损伤，绒毛出现坏死和肿胀，黏膜下可见不同程度的中性粒细胞浸润，PC组肠黏膜损伤评分为1.43±0.53，低于NT组的3.40±0.55（P<0.01）和SC组的3.17±0.41（P<0.05），而NT组和SC组之间差异不明显（P=0.30）。

图2 肠黏膜TNF-α情况：ROSC后12h肠黏膜内均可见TNF-α表达，主要位于黏膜内，NT组为（9.98±1.79）%，高于SC组的（5.87±1.43）%，和PC组的（2.54±0.96）%差异有统计学意义（P<0.01）；SC组和PC组之间差异有高度统计学意义（P<0.01）。

图3 ROSC后12 h各组肠黏膜VCAM-1的表达：免疫组化显示VCAM-1主要位于黏膜下层，NT组为（8.53±1.53）%，SC组为（5.92±1.06）%，PC组为（3.78±0.53）%，各组差异有统计学意义，NT vs SC，P<0.05；NT vs PC，P<0.01；SC vs PC，P<0.05。

1	Bottiger BW MJ, Bohrer He. Activation of blood coagulation after cardiac arrest is not balanced adequately byactivation of endogenous fibrinolysis. Circulation, 1995, 92(9):2572-2578.
2	Pugin J, Chevrolet JC. The intestine liver lung axisinseptic syndrome. Schweiz Med Wochenschr, 1991, 121(42):1538-1544.
3	Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med, 2002, 346(8):557-563.
4	Holzer M, Martens P, Roine R, et al. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.N Engl J Med, 2002, 346(8):549-556.
5	廖晓星，胡春林，文杰.兔心肺复苏后经腹腔诱导亚低温的初步研究.中华急诊医学杂志, 2010, 19(1):48-52.
6	Takahashi T, Morishita Y, Ichikawa H, et al. Multiple organ harvesting from a single donor for transplantation.A comparison of simple cooling technique and bypass technique. J Cardiovasc Surg (Torino), 1999, 40(3):347-353.
7	胡春林.兔室颤心搏骤停模型的建立.中华急诊医学杂志, 2009, 11(9):943-947.
8	Esposito E, Mazzon E, Muia C, et al. Splanchnic ischemia and reperfusion injury is reduced by genetic or pharmacological inhibition of TNF-α. J Leukocyte Biology, 2007, 81(4):1032-1043.
9	Cavaillon JM, Adrie C, FittingC, et al. Endotoxin tolerance: is there a clinical relevance. Endotoxin Res, 2003, 9(2):101-107.
10	Cavaillon JM, Fitting C. Cytokine cascade in sepsis. Scand J Infect Dis, 2003, 35(9):535-544.
11	Munford RS, Pujin J. Normal responses to injury prevent systemic inflammation and can be immunosuppressive.Respir Crit Care Med, 2001, 163(2):316-321.
12	黎介寿.肠功能障碍.肠外与肠内营养，1998, 5(2):63-66.
13	Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med, 2002, 346(8):557-563.
14	廖晓星，胡春林，李玉杰,等.心肺复苏后经腹腔诱导亚低温的初步研究.中华急诊医学杂志, 2010, 19(1):48-53.

[1]	祝雅, 赵晖, 董莲莲, 金燕. 亚低温治疗对心肺复苏后兔脑组织中基质金属蛋白酶9和神经元特异性烯醇化酶水平及脑复苏的影响[J]. 中华危重症医学杂志(电子版), 2021, 14(05): 374-379.
[2]	廖祥鹏, 安锐. 《2020新生儿复苏指南》和《新生儿复苏项目(8版)》的最新建议解读[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(05): 527-535.
[3]	顾世杰, 马麟, 陈秋源, 崔瑞文, 赖柏聪, 石小红, 孟凡航, 易述红, 曹荣华. 徒手-机器联合复苏在脑死亡供者心脏骤停后器官维护中的作用[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 283-287.
[4]	李亚斌, 李刚, 王希瑞, 尚金星, 赵志煌. 依达拉奉辅助亚低温对重型颅脑创伤的血清细胞因子及凝血功能的影响[J]. 中华神经创伤外科电子杂志, 2020, 06(03): 166-171.
[5]	李玉龙, 焦龙兵, 郑连生. 液氮冷冻法制备兔股骨头坏死模型新方法及效果评估[J]. 中华老年骨科与康复电子杂志, 2022, 08(05): 263-268.
[6]	李变, 王莉娜, 桑田, 李珊, 杜雪燕, 李春华, 张兴云, 管巧, 王颖, 冯琪, 蒙景雯. 亚低温技术治疗缺氧缺血性脑病新生儿的临床分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 639-643.
[7]	李世凯, 梁佳, 何艳艳, 于毅, 李天晓, 常金龙, 贺迎坤. 兔颈动脉粥样硬化性狭窄模型在介入治疗的应用进展[J]. 中华介入放射学电子杂志, 2023, 11(04): 357-362.
[8]	刘新献, 王雅琪, 周斌, 郭严延. 雷帕霉素在兔腐蚀性食管炎性狭窄早期干预中的意义[J]. 中华介入放射学电子杂志, 2023, 11(04): 324-329.
[9]	潘鑫, 王忻, 王超, 顾慧, 吴敏, 唐加波, 崔恒熙, 李政. 亚低温治疗在脑卒中院前急救中的应用[J]. 中华卫生应急电子杂志, 2023, 09(03): 155-158.
[10]	李康荣, 赖娜婷, 杨鸣宇, 何航宇. 心肺复苏后亚低温治疗对心脏骤停患者血流动力学和细胞因子的影响[J]. 中华卫生应急电子杂志, 2021, 07(01): 26-29.
[11]	胡东东, 楼巧珍, 王巍, 郝义伟, 林小娟, 李石岩. 早期冰盐水诱导亚低温对心肺复苏后患者临床疗效的影响[J]. 中华卫生应急电子杂志, 2020, 06(05): 276-280.
[12]	董婷婷, 马秀梅, 林勇, 涂江义, 孙国刚. 经腹心肺复苏有效性及安全性的meta分析[J]. 中华卫生应急电子杂志, 2020, 06(02): 102-108.
[13]	邱甜, 杨苗娟, 胡波, 郭毅, 何奕涛. 亚低温治疗脑梗死机制的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 518-521.
[14]	张钰, 张湘斌, 黄晓松, 潘晓彦. 亚低温联合脑室穿刺引流对老年性高分级动脉瘤性蛛网膜下腔出血患者脑血管状态的影响[J]. 中华脑血管病杂志(电子版), 2023, 17(03): 214-220.
[15]	郭晖, 徐文君, 宋仁兴, 李伟, 庞春晓, 王增武. 支架取栓术后亚低温对急性大血管闭塞性缺血性脑卒中患者血清S100β蛋白水平的影响[J]. 中华脑血管病杂志(电子版), 2020, 14(05): 275-280.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Effects of Neotype peritoneal cooling on the injured of intestinal mucous after cardiopulmonary resuscitation in rabbits

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Effects of Neotype peritoneal cooling on the injured of intestinal mucous after cardiopulmonary resuscitation in rabbits