高分辨率超声评价盲肠结扎穿孔术致脓毒症大鼠心功能的实验研究  

Experimental study of cardiac function by high-resolution ultrasound in sepsis rats with cecal ligation and puncture

作　　者：肖雅文 盖敏涛 王毅[1] 滑晓莉 于湘友[1] Xiao Yawen;Gai Mintao;Wang Yi;Hua Xiaoli;Yu Xiangyou(Department of Critical Care Medicine,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,Xinjiang Uygur Autonomous Region,China;Xinjiang Key Laboratory of Cardiovascular Disease,Clinical Medical Research Institute,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆医科大学第一附属医院重症医学科,乌鲁木齐830054 [2]新疆医科大学第一附属医院临床医学研究院新疆心血管疾病研究重点实验室,乌鲁木齐830054

出　　处：《中华危重病急救医学》2019年第11期1345-1350,共6页Chinese Critical Care Medicine

基　　金：新疆维吾尔自治区高校科研计划项目(XJEDU2018I011)。

摘　　要：目的探讨高分辨率超声对盲肠结扎穿孔术(CLP)致脓毒症模型大鼠心功能的评价表现。方法将48只雄性成年SD大鼠按随机数字表法分为正常对照组及脓毒症6、12、24、30、48 h组,每组8只。采用CLP法制备脓毒症模型;正常对照组仅做麻醉及苏醒处理。观察各组大鼠制模后一般情况;于各时间点进行高分辨率超声心动图检测;取腹主动脉血,采用酶联免疫吸附试验(ELISA)检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)及肌酸激酶同工酶(CK-MB)水平;取心肌组织,苏木素-伊红(HE)染色后,光镜下观察大鼠心肌组织病理学改变。结果CLP制模后脓毒症组大鼠均出现精神萎靡、竖毛、蜷缩、饮食和活动减少等症状,符合脓毒症大鼠模型的一般表现,且随时间延长症状逐渐加重。高分辨率超声可清晰显示各组大鼠左心室结构,并可获得满意的左心室M型超声心动图。高分辨率超声测得脓毒症各组大鼠心率(HR)随制模时间延长而逐渐增快,12、24、30 h组明显高于正常对照组(次/min:359.66±23.33、361.35±12.85、392.67±11.33比306.24±29.79,均P<0.05);脓毒症大鼠每搏量(SV)、心排血量(CO)均随制模时间延长呈降低趋势,而左室射血分数(LVEF)、左室短轴缩短率(LVFS)均表现为先升高后降低,脓毒症48 h组SV和LVEF均明显低于正常对照组〔SV(μL):78.43±17.52比122.61±15.88,LVEF:0.763±0.018比0.902±0.011,均P<0.05〕;脓毒症各组大鼠左心室质量(LVM)较正常对照组大鼠均有不同程度增加,左室收缩期末和舒张期末前壁厚度(LVAWs、LVAWd)及后壁厚度(LVPWs、LVPWd)均有增加趋势,与正常对照组相比,脓毒症12 h组LVPWd、LVPWs和脓毒症48 h组LVAWd均显著增加。随制模时间延长,脓毒症大鼠血清炎性因子TNF-α、IL-1β和心肌酶指标CK-MB水平均呈先升高后下降趋势,48 h组上述指标仍明显高于正常对照组〔TNF-α(ng/L):61.59±3.99比16.87±4.89,IL-1β(ng/L):255.03�Objective To evaluate the cardiac function of cecal ligation and puncture(CLP)induced sepsis rats with high-resolution ultrasound.Methods According to the method of random number table,48 adult male Sprague-Dawley(SD)rats were randomly divided into normal control group and sepsis 6,12,24,30,48 hours groups,with 8 rats in each group.The sepsis model was produced by CLP,and the rats in the normal control group were only anesthetized and resuscitated.The general situation after modeling in each group was observed,and the left ventricular function was assessed by high-resolution echocardiography at all the time points.The abdominal aorta blood of rats was collected,and the serum levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and MB isoenzyme of creatine kinase(CK-MB)were determined by enzyme-linked immunosorbent assay(ELISA).The myocardial tissue was harvested,and the pathological changes in myocardial tissue were observed by hematoxylin-eosin(HE)staining.Results The rats challenged to CLP displayed symptoms of sepsis,such as depression,ruffled fur,decreased diet and activity,and the symptoms became more obvious with the extension of time.High-resolution echocardiography could clearly show the structure of left ventricle in each group and obtain satisfactory M-mode echocardiography of left ventricle.The heart rate(HR)of rats in all sepsis groups was elevated with the increase in model time as measured by high-resolution ultrasound,and it was significantly higher than that in the normal control group at 12,24,30 hours(bpm:359.66±23.33,361.35±12.85,392.67±11.33 vs.306.24±29.79,all P<0.05).Stroke volume(SV)and cardiac output(CO)in sepsis rats were decreased with the increase in model time,while left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)were increased first and then decreased,and SV and LVEF in sepsis 48 hours group were significantly lower than those in the normal control group[SV(μL):78.43±17.52 vs.122.61±15.88,LVEF:0.763±0.018 vs.0.902±0.011,bot

关 键 词：高分辨率超声 盲肠结扎穿孔术 脓毒症 心功能 

分 类 号：R65[医药卫生—外科学] R45[医药卫生—临床医学]