山莨菪碱对脓毒症犬多器官功能障碍综合征的影响  

Effect of anisodamine on sepsis-induced multiorgan dysfunction syndrome

作　　者：杨春华[1] 杨雅涵[1] 谢文锋[1] 郑东华[1] 陈丽[1] 丁玉伟[1] 陈雪霞[2] 

机构地区：[1]中山大学附属第一医院急诊科,广州510080 [2]中山大学附属第一医院ICU,广州510080

出　　处：《中华创伤杂志》2015年第11期1041-1044,共4页Chinese Journal of Trauma

基　　金：2012广东省科技计划资助项目（20120314）

摘　　要：目的探讨山莨菪碱对脓毒症犬氧代谢和器官功能的影响。方法比格犬20只建立脓毒症模型后，按随机数字表法分为脓毒症组（8只）、治疗组（12只），于术前、术后1，3，8，24h取血检测两组血栓调节蛋白（TM）、动脉血氧分压（PaO2）、氧摄取率（ERO2）和血乳酸的变化；术后24h取肺组织检测两组肺干湿／重比；并观察两组术后24h多器官功能综合征（MODS）发生率。结果术后两组TM含量均呈进行性升高，脓毒症组术后3，8，24h TM含量分别为（28．7±15．9）ng／ml、（36．5±20．8）ng／ml、（52．6±32．7）ng／ml，均显著高于治疗组[（19．5±10．6）ng／ml、（21．9±12．8）ng／ml、（31．3±18．4）ng／ml]（P〈0．05）；术后两组PaO2均呈缓慢下降，术后24h脓毒症组[（65．6±14．5）mmHg]较治疗组[（83．3±16．3）mmHg]下降更显著（P〈0．05）；术后两组ER02均先上升后下降，术后24h脓毒症组[（16．7±3．1）％]显著低于治疗组[（21．7±2．9）％]（P〈0．05）；术后两组血乳酸浓度均逐渐上升，术后24h脓毒症组[（4．4±1．2）mmol／L]显著高于治疗组[（3．1±0．8）mmol／L]（P〈0．05）；术后24h脓毒症组肺干／湿重比[（510±80）％]明显高于治疗组[（370±50）％]（P〈0．05），MODS发生率（38％）也明显高于治疗组（17％）（P〈0．05）。结论山莨菪碱可延缓和改善脓毒症时血管内皮细胞损伤和氧代谢障碍，从而降低脓毒症MODS的发生率。Objective To investigate the effect of anisodamine on oxygen metabolism and organ function in dogs with sepsis. Methods Twenty beagles were divided into sepsis group （n = 8 ） and anisodamine-treated group （n = 12 ） according to the random number table. The sepsis model was established by cecal ligation and puncture. Changes in thrombomodulin （TM） , arterial oxygen partial pressure （ PaO2 ）, oxgen uptake rate （ ERO2 ） and lactate were mearsured before and 1, 3, 8 and 24 h after operation. Wet/dry ratio of lung tissues and incidence of multiorgan dysfunction syndrome （MODS） were detected 24 h after operation. Results Level of TM was increased progressively after operation, which was significantly higher in sepsis group than in anisodamine-treated group at 3, 8 and 24 h [（28.7±15.9） vs （19.5±10.6）ng/ml, （36.5±20.8） vs （21.9±12.8）ng/ml, （52.6±32.7）vs （31.3 ±18.4）ng/ml respectively] （P 〈 0.05 ）. The PaO2 decreased slowly after operation, with the decrease more significant in sepsis group than in anisodamine-treated group at 24 h [ （65.6±14.5 ） vs （83.3 ±16.3）mmHg] （P 〈0.05）. The ERO2 had a rlse-and-fall trend after operation, with the level lower in sepsis group than in anisodamine-treated group at 24 h [ （ 16.7 ± 3.1 ） % vs （21.7 ± 2.9） % 3 （P 〈 0.05）. Level of blood lactate increased gradually, with the level higher in sepsis group than in aniso- damine-treated group at 24 h [ （4.4 ±1.2） vs （3.1 ±0.8）mmol/L] （P〈0.05）. Wet/dry ratio of lung tissues in sepsis group was （510 ±80）% versus （370 ±50）% in anisodamine-treated group at 24 h （P 〈 0.05 ）. Incidence of MODS in sepsis group was 38% versus 17% in anisodamine-treated group at 24 h （ P 〈 0.05 ）. Conclusion Anisodamine may ameliorate the injury to vascular endothelial cells and oxygen metabolism disorder after sepsis and hence contributes to the reduction of sepsis-induced MODS.

关 键 词：脓毒症 内皮细胞 血栓调节蛋白 

分 类 号：R459.7[医药卫生—急诊医学]