青蒿琥酯对猪心肺复苏后心脑损伤的保护作用  

Protective effect of artesunate on cardiocerebral injury after cardiopulmonary resuscitation in a swine model

作　　者：周萍萍 章杰[2] 嵇朝晖[2] 徐杰丰[1] 张茂[1] Zhou Ping-ping;Zhang Jie;Ji Chao-hui;Xu Jie-feng;Zhang Mao(Department of Emergency Medicine,the Second Affiliated Hospital of Zhejiang University,Zhejiang Key Laboratory of Diagnosis and Treatment of Severe Trauma and Burns,Zhejiang Acute and Critical Care Clinical Medical Research Center,Hangzhou 310009,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,浙江杭州310009 [2]湖州市第一人民医院急诊医学科,浙江湖州313000

出　　处：《中国急救医学》2023年第4期319-324,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨青蒿琥酯(ART)对猪心肺复苏(CPR)后心脑损伤的保护作用。方法国产健康白猪24头,体质量(36.63±2.55)kg,应用随机数字表法分为三组:假手术组(Sham组,n=6)、CPR组(n=10)、ART组(n=8)。CPR组和ART组采用电刺激诱发室颤9 min、CPR 6 min的方法制作心脏骤停复苏模型。Sham组不经历心脏骤停。在制作模型后5 min时,ART组静脉注射青蒿琥酯4.8 mg/kg,维持2 h。另外两组输注等量溶媒。分别于基线及复苏后1、2、4、24 h检测血心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、神经元特异性烯醇化酶(NSE)、钙结合蛋白S100 B(S100B)水平。复苏后24 h实验猪安乐死,获取心脏及大脑组织,检测肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)及细胞凋亡指数。结果与Sham组比较,CPR组血cTnI、CK-MB、NSE、S100B在复苏后1、2、4、24 h均明显升高(P<0.05);ART组血cTnI仅在复苏后4、24 h明显升高(P<0.05),CK-MB仅在复苏后1、2 h明显升高(P<0.05),NSE和S100B仅在复苏后2、4、24 h明显升高(P<0.05)。与CPR组比较,ART组血cTnI在复苏后4、24 h明显降低,CK-MB在复苏后2 h明显降低,NSE在复苏后2、4、24 h明显降低,S100B在复苏后2、4 h明显降低[cTnI(pg/mL):4 h为469.10±55.29 vs.291.15±17.68,24 h为566.35±31.34 vs.333.50±22.50;CK-MB(ng/mL):66.78±5.93 vs.58.65±5.84;NSE(ng/mL):2 h为21.44±1.61 vs.15.91±1.26,4 h为26.08±1.03 vs.19.47±1.22,24 h为31.70±0.87 vs.23.46±1.09;S100B(pg/mL):2 h为2643.10±215.90 vs.2041.46±107.37,4 h为3132.82±178.64 vs.2337.77±112.85,均P<0.05]。与Sham组比较,CPR组心肌及大脑皮层TNF-α、IL-1β均明显升高(P<0.05)。与CPR组比较,ART组心肌TNF-α、IL-1β及皮层IL-1β均明显降低[TNF-α(pg/mL):心肌632.68±33.19 vs.348.69±27.12;IL-1β(pg/mL):心肌1627.29±53.94 vs.982.88±52.79,皮层1606.54±49.56 vs.976.45±44.84,均P<0.05]。与Sham组比较,CPR组心肌及皮层的凋亡指数均明显升高(P<0.05)。与CPR组比较,ART组心肌及皮层的凋亡指�Objective To investigate the protective effect of artesunate(ART)on cardiocerebral injury after cardiopulmonary resuscitation(CPR)in a swine model.Methods Twenty-four healthy domestic pigs,weighing(36.63±2.55)kg,were randomized(random number)to 3 groups:sham operation group(Sham group,n=6),CPR group(n=10)and artesunate intervention group(ART group,n=8).In the CPR group and ART group,the experimental model was established by electrically induced ventricular fibrillation for 9 min and then cardiopulmonary resuscitation for 6 min.Animals in the Sham group did not experience cardiac arrest.At 5 min after resuscitation,the ART group received continuous infusion of 4.8 mg/kg artesunate for 2 h.The same amount of menstruum was administered in the Sham and CPR groups.At baseline,1,2,4 and 24 h after resuscitation,the levels of serum cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB),neuron-specific enolase(NSE)and S100B protein(S100B)were measured.At 24 h after resuscitation,the animals were sacrificed,cerebral cortex and myocardium were obtained for the determination of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and cell apoptosis.Results Compared with the Sham group,serum cTnI,CK-MB,NSE and S100B in CPR group were significantly increased at 1,2,4 and 24 h after resuscitation(P<0.05);in ART group,serum cTnI was significantly increased only at 4 h and 24 h after resuscitation(P<0.05),serum CK-MB was significantly increased only at 1 h and 2 h after resuscitation(P<0.05),and serum NSE and S100B were significantly increased only at 2,4 and 24 h after resuscitation(P<0.05).Serum cTnI was significantly decreased at 4 h and 24 h after resuscitation,serum CK-MB was significantly decreased at 2 h after resuscitation,serum NSE was significantly decreased at 2,4 and 24 h after resuscitation,and serum S100B was significantly decreased at 2 h and 4 h after resuscitation in the ART group compared with the CPR group[cTnI(pg/mL):469.10±55.29 vs.291.15±17.68 at 4 h,566.35±31.34 vs.333.50±22.50 at 24 h;CK-MB(ng/

关 键 词：心脏骤停 心肺复苏 心肌损伤 脑损伤 炎症反应 细胞凋亡 青蒿琥酯 猪 

分 类 号：R285.5[医药卫生—中药学]