四逆汤对复苏后综合征脑保护作用的实验研究  

An experimental study on brain protective effect of Sini decoction on post-resuscitation syndrome

作　　者：王秀娟[1] 钟晓芃[1] 丁钋[1] 张诗武[1] 

机构地区：[1]天津市人民医院急诊科,天津300121

出　　处：《中国中西医结合急救杂志》2017年第4期355-358,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金（81672426）

摘　　要：目的 探讨四逆汤对大鼠心肺复苏（CPR）后综合征的脑保护作用及其机制.方法 将50只SD大鼠按随机数字表法分为假手术组（n=10）、CPR模型组（n=20）和四逆汤治疗组（n=20）.采用气管夹闭法复制大鼠心搏骤停模型,心脏停跳5 min后行CPR.四逆汤治疗组以5 g/kg的四逆汤灌胃治疗,每24 h给药1次,假手术组和CPR模型组给予等量生理盐水灌胃.于复苏前和复苏后6、12、24、48、72 h取大鼠静脉血,用酶联免疫吸附试验（ELISA）测定血清白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平;于复苏后72 h取各组大鼠脑皮质,用免疫组化法检测脑组织天冬氨酸特异性半胱氨酸蛋白酶3（caspase-3）含量,用蛋白质免疫印迹试验（Western Blot）测定大鼠脑组织caspase-3蛋白表达,用原位末端缺刻标记试验（TUNEL）测定脑组织细胞凋亡情况.结果 随时间延长,CPR模型组和四逆汤组IL-6、TNF-α水平均呈先升高后降低的趋势,IL-6于复苏后24 h达峰值,TNF-α于复苏后48 h达峰值,复苏后72 h均降低;自复苏后6 h开始,CPR模型组和四逆汤治疗组血清IL-6（ng/L：61.79±1.31、62.49±1.42比21.48±0.79）、TNF-α（ng/L：48.32±1.98、25.32±1.96比18.34±2.45）水平即显著高于假手术组,四逆汤治疗组IL-6于复苏后12 h起（ng/L：70.41±2.21比88.32±1.59）、TNF-α于复苏后6 h起（ng/L：25.32±1.96比48.32±1.98）明显低于CPR模型组（均P〈0.05）,持续到复苏后72 h,两组IL-6、TNF-α在结束时均未恢复到正常水平（均P〈0.05）.复苏结束后,CPR模型组脑组织caspase-3含量和蛋白表达以及细胞凋亡率均明显高于假手术组〔caspase-3含量（A值,×103）：2.59±0.26比1.57±0.06,caspase-3蛋白（灰度值）：0.80±0.08比0.43±0.04,细胞凋亡率：（2.01±0.08）%比（0.26±0.02）%,均P〈0.05〕,四逆汤治疗组上述指标均显著低于CPR模型组〔caspase-3含量（A值,×103）：1.89±0.08比2.59±0.26,caspase-3蛋白�Objective To approach the brain protective effect and mechanism of Sini decoction on rats with cardiopulmonary resuscitation （CPR） syndrome.Methods Fifty Sprague-Dawley （SD） rats were divided into sham operation group （n = 10）, CPR model group （n = 20） and Sini decoction treatment group （n = 20） by random number table. The rat models were established by trachea clipping to induce cardiac arrest, and after heart beat stopped for 5 minutes, CPR was carried out. In the Sini decoction group, Sini decoction 5 g/kg was given through a stomach tube, once per 24 hours, while in the sham and CPR model groups, the same amount of normal saline was given by the same method at the same time. Venous blood was collected before CPR and 6, 12, 24, 48 and 72 hours after CPR, and the levels of serum interleukin-6 （IL-6） and tumour necrosis factor-α （TNF-α） were determined by enzyme linked immunosorbent test （ELISA）; after CPR for 72 hours, the rat brain tissue was obtained from all the groups, the content of caspase-3 in brain tissue was detected by immunohistochemistry method, and its protein expression caspase-3 was detected by Western Blot; the apoptosis situation of brain tissue was detected by terminal deoxynucleotidyl transferase-mediated duTP nick end labeling （TUNEL）.Results With the prolongation of time, the levels of IL-6 and TNF-α in CPR model and Sini decoction groups showed a tendency firstly increased and then decreased, IL-6 reached its peak value after resuscitation for 24 hours, while TNF-α reached its peak value after resuscitation for 48 hours, and both IL-6 and TNF-α were decreased after resuscitation for 72 hours ; beginning from 6 hours after resuscitation, the levels of serum IL-6 （ng/L： 61.79±1.31, 62.49±1.42 vs. 21.48±0.79） and TNF-α （ng/L： 48.32±1.98, 25.32±1.96 vs. 18.34±2.45） in CPR model and Sini decoction treatment groups were all significantly higher than those in sham group, since 12 hours after resuscitation, the level of IL-6 was significa

关 键 词：四逆汤 复苏后综合征 白细胞介素-6 肿瘤坏死因子-Α 天冬氨酸特异性半胱氨酸蛋白酶3 

分 类 号：R605.974[医药卫生—急诊医学]