辛酸钠对猪创伤性心搏骤停复苏后肾肠缺血再灌注损伤的影响  

Effect of sodium octanoate on renal-intestinal ischemia-reperfusion injury after resuscitation from traumatic cardiac arrest in pigs

作　　者：杨雪林 陈琪[3] 周腾达 陈庆丽 徐杰丰[1] 周光居[1] 张茂[1] Yang Xuelin;Chen Qi;Zhou Tengda;Chen Qingli;Xu Jiefeng;Zhou Guangju;Zhang Mao(Department of Emergency Medicine,Second Affiliated Hospital,Zhejiang University School of Medicine,Key Laboratory of Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province,Clinical Research Center for Emergency and Critical Care Medicine of Zhejiang Province,Hangzhou 310009,China;Department of Emergency Medicine,Lishui Municipal Central Hospital,Lishui 323000,China;Department of Intensive Care Unit,First People′s Hospital of Fuyang District of Hangzhou,Hangzhou 311400,China;Department of Emergency Medicine,Ningbo Huamei Hospital,University of Chinese Academy of Sciences,Ningbo 315000,China;Department of Emergency Medicine,Lishui People′s Hospital,Lishui 323000,China)

机构地区：[1]浙江大学医学院附属第二医院急诊医学科,浙江省严重创伤与烧伤诊治重点实验室,浙江省急危重症临床医学研究中心,杭州310009 [2]丽水市中心医院急诊医学科,丽水323000 [3]杭州市富阳区第一人民医院重症医学科,杭州311400 [4]中国科学院大学宁波华美医院急诊医学科,宁波315000 [5]丽水市人民医院急诊医学科,丽水323000

出　　处：《中华创伤杂志》2022年第12期1123-1131,共9页Chinese Journal of Trauma

基　　金：国家自然科学基金(82072126);浙江省重点研发计划项目(2021C03073,2021C03036);浙江省-国家卫生健康委员会共建重大项目(WKJ-ZJ-2207);丽水市科技计划项目(2022SJZC009)。

摘　　要：目的探讨辛酸钠对猪创伤性心搏骤停复苏后肾肠缺血再灌注损伤(IRI)的影响。方法国产巴马小型猪22头,体重(37.6±2.5)kg,按照随机数字表法分为正常组(7只)、IRI组(7只)和IRI治疗组(8只)。猪肾肠IRI模型的建立:使用血泵,经股动脉放血,速度2 ml·kg-1·min-1,直至心搏骤停,无干预观察6 min,6 min后经股静脉回输全血,速度5 ml·kg-1·min-1,回输50%失血量进行复苏。正常组只进行监测操作,不建立肾肠IRI模型;IRI组建立肾肠IRI模型;IRI治疗组建立肾肠IRI模型,于自主循环恢复(ROSC)后5 min时静脉泵入辛酸钠30 mg/kg,持续1 h。(1)比较三组动物复苏成功率、复苏后4,24 h存活率、达到心搏骤停标准时的失血量、达到ROSC标准时的复苏时间。(2)比较三组动物复苏前及复苏后1,2,4,24 h血清肌酐(SCr)、尿素氮(BUN)、肠型脂肪酸结合蛋白(iFABP)及二胺氧化酶(DAO)水平。(3)复苏后24 h时处死动物,快速获取肾肠组织。采用TUNEL法检测细胞凋亡指数;普鲁士蓝法检测肾肠组织铁沉积面积率;Western blot检测谷胱甘肽过氧化物酶4(GPX4)、长链脂酰辅酶A合成酶4(ACSL4)蛋白表达水平。结果三组动物均100%存活,IRI组、IRI治疗组失血量、复苏时间比较,差异无统计学意义(P均>0.05)。正常组复苏前及复苏后1,2,4,24 h SCr、BUN、iFABP及DAO水平差异无统计学意义(P均>0.05);IRI组、IRI治疗组复苏后1,2,4,24 h SCr、BUN、iFABP及DAO水平逐渐升高,与同组复苏前比较,差异有统计学意义(P均<0.01);正常组、IRI组、IRI治疗组复苏前SCr、BUN、iFABP及DAO水平差异无统计学意义(P均>0.05);IRI组、IRI治疗组复苏后1,2,4,24 h SCr、BUN、iFABP及DAO水平较同时间点正常组升高(P均<0.01);IRI组复苏后1,2,4,24 h SCr、BUN、iFABP及DAO水平较同时间点IRI治疗组升高更明显(P均<0.01)。正常组、IRI组、IRI治疗组复苏后24 h肾组织细胞凋亡指数分别为(2.3±0.8)%、(44.0±5.4)%、(13.8±4.3)%,肠组织�Objective To investigate the effect of sodium octanoate on renal-intestinal ischemia-reperfusion injury(IRI)after resuscitation from traumatic cardiac arrest in pigs.Methods Twenty-two miniature piglets with a body weight of(37.6±2.5)kg were divided into three groups according to the random-number table method:normal group(n=7),IRI group(n=7)and IRI-treated group(n=8).A renal-intestinal IRI model of the pig was established by allowing femoral artery to bleed through blood pump at a rate of 2 ml·kg-1·min-1 until cardiac arrest,followed by whole blood transfusion through the femoral vein at a rate of 5 ml·kg-1·min-1 after observation for 6 minutes,and 50%of total blood loss was reinfused before resuscitation.Both the IRI group and IRI-treated group were with IRI model,while normal group was just monitored without induction of IRI.Besides,IRI-treated group was injected intravenously with sodium octanoate(30 mg/kg)for 1 hour at 5 minutes after restoration of spontaneous circulation(ROSC).(1)The rate of resuscitation success,survival rate at 4,24 hours after resuscitation,blood loss when reaching cardiac arrest criteria and resuscitation time when reaching the ROSC criteria were compared in the three groups.(2)Levels of serum creatinine(SCr),urea nitrogen(BUN),intestinal fatty acid binding protein(iFABP)and diamine oxidase(DAO)were measured before resuscitation and at 1,2,4,24 hours after resuscitation.(3)The animals were sacrificed at 24 hours post-resuscitation to harvest renal and intestinal tissues rapidly.TUNEL test was applied for the cellular apoptosis index.Prussian blue was used to detect the rate of iron deposition.Western blot analysis was used to measure levels of glutathione peroxidase 4(GPX4)and acyl-CoA synthetase long-chain family member4(ACSL4).Results In three groups,all pigs survived.There was no significant difference in blood loss or resuscitation time between IRI group and IRI-treated group(all P>0.05).There was no significant difference in levels of SCr,BUN,iFABP or DAO before resuscitation

关 键 词：心脏停搏 心肺复苏术 再灌注损伤 急性肾损伤 肠 辛酸钠 

分 类 号：R541.78[医药卫生—心血管疾病]