乌司他丁对改善猪心肺复苏后炎症反应和心肺组织损伤的作用  

Effect of ulinastatin on improving inflammatory response and myocardial and lung tissue injury after cardiopulmonary resuscitation in pigs

作　　者：武军元[1] 王烁[1] 李春盛[1] 袁伟[1] 

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,100020

出　　处：《中华危重病急救医学》2013年第2期106-108,共3页Chinese Critical Care Medicine

基　　金：北京市优秀博士论文专项资助（20121002501）

摘　　要：目的评价乌司他丁（UTI）对猪心肺复苏（CPR）后炎症反应和心肺组织损伤的保护作用。方法雌性家猪20只，通过程控刺激法复制心室纤颤（室颤）动物模型，室颤8min后开始CPR，自主循环恢复（ROSC）的家猪按随机数字表法分为两组，UTI组复苏后即刻给予UTI 100kU溶于生理盐水5ml，缓慢注射，3h1次，直到复苏后24h；对照组复苏后应用生理盐水5ml作为对照。分别于室颤前基础状态及ROSC后即刻、3、12、24h抽取家猪静脉血，采用酶联免疫吸附试验（ELISA）测定肿瘤坏死因子-α（TNF—α）、白细胞介素-1β（IL-1β）、细胞间黏附分子-1（ICAM-1）和血管细胞黏附分子-1（VCAM-1）的水平。ROSC后24h处死家猪，留取心、肺组织进行病理及超微结构观察。结果20只家猪经过8min室颤后复苏成功15只。UTI组8只和对照组7只存活24h。复苏后两组炎症因子均逐渐回升，两组间室颤前和ROSC后即刻TNF-α、IL-1β、ICAM-1和VCAM-1比较差异无统计学意义；UTI组3h起TNF-α（ng／L）、IL-1β（ng／L）水平明显低于对照组（TNF—α：28．79±9．49比44．01±17．01，IL-1β：153．50±67．47比252．09±80．41，均P〈0．05），12h起ICAM-1（μg/L）、VCAM-1（μg/L）水平明显低于对照组（ICAM-1：11．05±5．11比17．09±5．69，VCAM-1：11．17±4．75比16．62±4．63，均P〈0．05）。ROSC后24h时UTI组心、肺组织损伤程度明显轻于对照组。结论复苏后应用UTI可以明显减轻炎症反应和心肺组织损伤程度。Objective To evaluate the effects of ulinastatin （UTI） on improving inflammatory response and myocardial and lung tissue injury after cardiopulmonary resuscitation （CPR） in porcine model. Methods Ventricular fibrillation （VF） was induced in 20 female pigs by programmed stimulation method. CPR was begun 8 minutes after VF. Pigs with recovery of spontaneous circulation （ROSC） were randomly divided into two groups： group UTI, UTI was given immediately after resuscitation, with 100 kU dissolved in 5 ml of normal saline by slow intravenous injection every 3 hours, up to 24 hours after resuscitation. In control group, 5 ml of normal saline was given with same delivery time and frequency as that in the UTI group. Before VF, immediately after ROSC, 3 hours, 12 hours and 24 hours after ROSC, samples of venous blood were collected for examination of tumor necrosis factor-α （TNF-α ）, interleukin-1 （IL-1β）, intercellular adhesion molecule-1 （ICAM-1）, and vascular cell adhesion molecule-1 （VCAM-1）, using the enzyme-linked immunospecific assay （ELISA） method. The pigs were sacrificed at 24 hours after ROSC for myocardium and lung pathological and ultrastructural examinations. Results Among a total of 20 domestic pigs, 15 pigs were successfully resuscitated after 8-minute VF. Eight pigs in UTI group and 7 pigs in control group survived for 24 hours. Pro-inflammatory factors of the both groups were increased gradually after ROSC. Levels of TNF- α , IL-1 β, ICAM-1 and VCAM-1 were not significant different between UTI and control groups before VF and immediately after ROSC. But TNF-α （ng/L） and IL-1β （ng/L） levels were significantly lower in the UTI group than those of the control group beginning from 3 hours after ROSC （TNF-α： 28.79±9.49 vs. 44.01±17.01, IL-1β：153.50±67.47 vs. 252.09±80.41, both P〈0.05 ） ; ICAM-1 （μg/L） and VCAM-1 （μg/L） levels were significantly lower in the UTI group than those of the control group from 12 hours after ROSC （ICAM-1

关 键 词：心肺复苏 乌司他丁 炎症反应 组织损伤 猪 

分 类 号：R45[医药卫生—治疗学]