地塞米松对脓毒症大鼠心肌保护作用的研究  

Protective effects of dexamethasone on myocardium in rats with sepsis

作　　者：王国兴[1] 沈潞华[1] 谢苗荣[1] 金明[1] 龙维[1] 阴赪宏[1] 张淑文[1] 

机构地区：[1]首都医科大学附属北京友谊医院急诊科,北京100050

出　　处：《中国危重病急救医学》2006年第4期206-209,F0006,共5页Chinese Critical Care Medicine

基　　金：北京市科技计划重大项目课题(2002641);首都医学发展科研基金(20021007)

摘　　要：目的观察脓毒症大鼠心脏功能、心肌力学的改变并探讨地塞米松对心脏的保护作用及其机制。方法将96只Wistar大鼠随机分为对照组(32只)、脂多糖(LPS)组(32只,静脉注射LPS4mg/kg)及LPS+地塞米松组(32只,注射LPS的同时静脉注射地塞米松2mg/kg)。各组动物均于实验前(0h)及给药后2、4和6h采血(每个时间点8只)。经右颈总动脉左心室内插管,监测各组动物左心室功能变化并检测血清肿瘤坏死因子α(TNFα)、血浆肌钙蛋白T(TnT)含量。结果1脓毒症状态下TnT显著升高;应用地塞米松后TnT明显降低〔给药后6h为(1.76±0.57)μg/L比(0.70±0.36)μg/L,P<0.01〕。2脓毒症状态下左心室收缩峰压(LVPP)、左心室压力上升/下降最大速率(±dp/dtmax)均有不同程度变化,左心室舒张末期压(LVEDP)升高;应用地塞米松后可明显改善各项指标。3脓毒症状态下TNFα浓度明显升高,应用地塞米松可显著降低TNF浓度〔给药后2h为(11.22±2.38)pmol/L比(7.62±3.21)pmol/L,P<0.01〕。结论脓毒症状态下心肌可发生明显损伤;TNFα为脓毒症状态下心肌损害因素;应用地塞米松可明显减轻内毒素对心肌的损伤。Objective To investigate the changes in heart function and myocardial mechanics in murine sepsis model, and the mechanism of the protective effect of dexamethasone on heart. Methods Wistar rats were randomly divided into control group, lipopolysaccharide （LPS） group （4 mg/kg LPS intravenously）, LPSA-dexamethasone group （4 mg/kg LPS＋2 mg/kg dexamethasone intravenously）, with 32 rats in each group. A catheter was passed through right common carotid artery to the left cardiac ventricle. Function of the left ventricle was monitored, and blood was drawn at 0, 2, 4, 6 hours to detect concentrations of tumor necrosis factor -α （TNF -α）, troponine T （TnT）, with 8 rats for each time point. Results In sepsis rats, TnT increased significantly and could be lowered by dexamethasone [at 6 hours after the treatment （1.76±0. 57） μg/L vs. （0. 70±0.36）μg/L, P〈0. 01]. There were changes in left ventricular peak systolic pessure （LVPP） and maximum rate of intraventricular pressure rise/down （±dp/dt max） to certain extent, and increase in left ventricular end-diastolic pressure （LVEDP）, but these changes could be ameliorated by using dexamethasone. TNF - α increased significantly in sepsis rats, but dexamethasone could lower its level [at 2 hours after the treatment （11.22±2.38） pmol/L vs. （7.62±3.21） pmol/L, P〈0. 01]. Conclusion Myocardium is remarkably damaged in rats with sepsis. TNF - α could be regarded as one of the factors which could produce injury to myocardium. Dexamethasone could alleviate cardiac damage produced by endotoxin in sepsis model.

关 键 词：脓毒症 脂多糖 肿瘤坏死因子-Α 地塞米松 

分 类 号：R631[医药卫生—外科学]