亚低温治疗对重症病毒性脑炎患儿酸碱平衡及炎症细胞因子水平的影响  

Influence of Mild Hypothermia on Acid-base Balance and Inflammatory Cytokines in Children with Severe Viral Encephalitis

作　　者：陈锋[1] 张芙蓉[1] 何生松 Chen Feng;Zhang Furong;He Shengsong(Intensive Care Unit,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430016,China;Department of Infectious Diseases,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院重症医学科,武汉430016 [2]华中科技大学同济医学院附属协和医院感染科,武汉430022

出　　处：《华中科技大学学报（医学版）》2021年第3期341-346,共6页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：武汉市卫生计生委科研计划资助项目(No.WX14B23)。

摘　　要：目的探讨亚低温治疗对重症病毒性脑炎患儿酸碱平衡及炎症细胞因子(TNF-α、IL-6、IL-10)、可溶性凋亡相关因子(s-Fas)水平的影响。方法以2014年1月~2018年12月武汉儿童医院收治的93例重症病毒性脑炎患儿为研究对象,随机分为亚低温治疗组和常规对照组,亚低温治疗组在肛温32~35℃状态下给予常规治疗,治疗时间为3~10 d,对照组仅给予常规治疗。检测并比较两组治疗后不同时间点患儿动脉血PO_(2)、PCO_(2)、pH值,脑脊液及血清中乳酸以及细胞因子TNF-α、IL-6、IL-10、s-Fas水平变化。结果(1)亚低温治疗48、72 h及治疗后10 d,亚低温治疗组患儿动脉血PO_(2)、PCO_(2)均低于常规对照组(均P<0.05)。两组比较,血pH值在各时段差异均无统计学意义(均P>0.05)。(2)亚低温治疗48 h及72 h后,亚低温治疗组患儿的血清乳酸水平明显低于常规对照组(均P<0.05)。亚低温组的患儿脑脊液乳酸水平在急性期及恢复期均低于常规对照组(均P<0.05)。(3)血清TNF-α、IL-6水平在亚低温治疗后72 h及10 d均明显低于常规治疗组(均P<0.05);在亚低温治疗48、72 h后,亚低温治疗组血清IL-10水平高于常规治疗组(均P<0.05),血清s-Fas水平明显低于常规治疗组(均P<0.05)。(4)亚低温治疗组患儿脑脊液TNF-α水平在恢复期明显低于常规治疗组(P<0.05),脑脊液IL-6水平在急性期及恢复期均明显低于常规治疗组(均P<0.01),脑脊液s-Fas水平在急性期明显低于对照组(P<0.01)。结论亚低温治疗在降低重症病毒性脑炎患儿动脉血PO_(2)、PCO_(2)的同时,也降低了脑脊液乳酸水平,且对动脉血pH值无明显影响。亚低温治疗可以降低重症病毒性脑炎患儿血清及脑脊液TNF-α、IL-6及s-Fas水平,抑制凋亡,并在治疗初期提高IL-10水平,抑制免疫反应。Objective To investigate the effects of mild hypothermia on acid-base balance,inflammatory cytokines(TNF-α,IL-6,IL-10)and soluble factors associated suicide(s-Fas)in children with severe viral encephalitis.Methods In total,93 children with severe viral encephalitis were enrolled in our hospital from January 2014 to December 2018.They were randomly divided into 2 groups:mild hypothermia group and regular therapy group.Mild hypothermia group received cooling(32-35℃)for 3-10 days within 24 hours.Control group received conventional treatment.Arterial blood PO_(2),PCO_(2),pH and cerebrospinal fluid(CSF)lactate level were examined at different time points before and after therapy.The contents of TNF-α,IL-6,IL-10,and s-Fas in the serum and CSF were detected by ELISA.Results(1)Compared with conventional control therapy group,the arterial blood PO_(2),PCO_(2)and lactate in the mild hypothermia group 48 h,72 h,and 10 days after mild hypothermia treatment were significantly decreased(P<0.05).There was no obvious difference in arterial pH between the two groups.(2)After 48 h and 72 h of hypothermia treatment,blood lactate levels were significantly lower(P<0.05)in the hypothermia treatment group than in the control group.CSF lactate levels in the mild hypothermia group were lower than those in the control group in both the acute and convalescent phases(P<0.05).(3)Serum levels of TNF-αand IL-6 were significantly decreased(P<0.05)in the mild hypothermia group than in the conventional treatment group 72 h and 10 days after mild hypothermia treatment.And the serum levels of IL-10 were higher(P<0.05)and s-Fas were lower(P<0.05)in the mild hypothermia treatment group than in the conventional treatment group 48 h and 72 h after hypothermia treatment.(4)The children treated with mild hypothermia had significantly lower CSF TNF-αlevels in the convalescent phase than those treated with conventional therapy(P<0.05),significantly lower CSF IL-6 levels in both acute and convalescent phases were found in the mild hypothermia group th

关 键 词：病毒性脑炎 亚低温治疗 酸碱平衡 细胞因子 凋亡 

分 类 号：R512.3[医药卫生—内科学]