2种目标体温对体外心肺复苏患者炎症反应、氧化应激、脑代谢、转归及并发症的影响  

Impact of two target body temperatures on inflammatory response,oxidative stress,cerebral metabolism,outcomes and complications in patients undergoing extracorporeal cardiopulmonary resuscitation

作　　者：邓小军 祝勇军 胡成成 DENG Xiaojun;ZHU Yongjun;HU Chengcheng(Emergency Department,Chengdu Third People′s Hospital of Sichuan Province,Chengdu,Sichuan,610000)

机构地区：[1]四川省成都市第三人民医院急诊科,四川成都610000

出　　处：《实用临床医药杂志》2024年第22期88-92,98,共6页Journal of Clinical Medicine in Practice

基　　金：2020年四川省医学(青年创新)科研课题(S20402)。

摘　　要：目的探讨体外心肺复苏后2种目标体温对患者炎症反应、氧化应激、脑代谢、转归及并发症的影响。方法回顾性分析107例体外心肺复苏患者的临床资料,将目标体温控制在32.0~34.0℃的53例患者纳入中低温组,将目标体温控制在34.1~36.0℃的54例患者纳入轻低温组。比较2组目标体温管理前和达到目标体温时的炎症反应指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、核转录因子κB亚基p65(NF-κB p65)]、氧化应激指标[超氧化物歧化酶(SOD)、总抗氧化能力(TAC)、总氧化态(TOS)、丙二醛(MDA)]、脑代谢指标[动脉-颈内静脉血氧含量差值(Da-jvO_(2))、脑氧摄取率(CERO_(2))]水平,并比较2组并发症发生情况和转归情况[预后结局、格拉斯哥-匹兹堡脑功能表现评分(CPC)分级]。结果达到目标体温时,2组患者CRP、IL-6、IL-1β、NF-κB p65水平均低于目标体温管理前,且中低温组低于轻低温组,差异有统计学意义(P<0.05);达到目标体温时,2组SOD、TAC水平均高于目标体温管理前,且中低温组均高于轻低温组,2组TOS、MDA水平均低于目标体温管理前,且中低温组均低于轻低温组,差异有统计学意义(P<0.05);达到目标体温时,2组Da-jvO_(2)、CERO_(2)均低于目标体温管理前,且中低温组低于轻低温组,差异有统计学意义(P<0.05);2组各种并发症发生率比较,差异无统计学意义(P>0.05);中低温组的CPC分级、预后结局情况略优于轻低温组,但差异无统计学意义(P>0.05)。结论心肺复苏后目标体温管理可有效促进患者脑功能恢复,其中32.0~34.0℃目标体温更有利于减轻炎症反应、氧化应激程度和改善脑代谢,从而改善转归结局。Objective To investigate the impact of two target body temperatures on inflammatory response,oxidative stress,cerebral metabolism,outcomes and complications in patients undergoing extracorporeal cardiopulmonary resuscitation.Methods A retrospective analysis was conducted on the clinical data of 107 patients undergoing extracorporeal cardiopulmonary resuscitation.Fifty-three patients with a target body temperature controlled at 32.0 to 34.0℃were included in the moderate hypothermia group,and 54 patients with a target body temperature controlled at 34.1 to 36.0℃were included in the mild hypothermia group.Inflammatory response indicators[C-reactive protein(CRP),interleukin-6(IL-6),interleukin-1β(IL-1β),nuclear factor kappa-B subunit p65(NF-κB p65)],oxidative stress indicators[superoxide dismutase(SOD),total antioxidant capacity(TAC),total oxidant status(TOS),malondialdehyde(MDA)],and cerebral metabolism indicators[arterial-jugular venous oxygen content difference(Da-jvO_(2)),cerebral oxygen extraction ratio(CERO_(2))]were compared between the two groups before temperature management and when the target temperature was achieved.Additionally,occurrence of complications and outcomes[prognosis outcomes and Glasgow-Pittsburgh Cerebral Performance Categories(CPC)score]were compared.Results When the target temperature was achieved,the levels of CRP,IL-6,IL-1β,and NF-κB p65 in both groups were lower than those before temperature management,and their levels in the moderate hypothermia group were lower than those in the mild hypothermia group(P<0.05).At the target temperature,the levels of SOD and TAC in both groups were higher than those before temperature management,and the levels in the moderate hypothermia group were higher than those in the mild hypothermia group(P<0.05).Meanwhile,the levels of TOS and MDA in both groups were lower than those before temperature management,and the levels in the moderate hypothermia group were lower than those in the mild hypothermia group(P<0.05).When the target temperature was a

关 键 词：心搏骤停 心肺复苏 目标体温管理 炎症 氧化应激 脑代谢 转归结局 

分 类 号：R541.7[医药卫生—心血管疾病] R459.7[医药卫生—内科学] R446[医药卫生—临床医学]