摘要
目的 探讨亚低温对猪脓毒性休克时心肌的保护作用.方法 24头贵州小型猪随机（随机数字法）分为休克前亚低温组、休克后亚低温组和常温对照组,每组8头.麻醉后股静脉注入大肠杆菌内毒素制作猪脓毒症模型.制模后各组同时用输液泵以相同速度股静脉持续输入生理盐水,休克前亚低温组用4℃的生理盐水,常温对照组和休克后亚低温组用38℃的生理盐水,休克后亚低温组在动脉收缩压降至基础值的60%,维持1 h后,开始改用4℃的生理盐水.制模前和制模后温度干预6 h、12h时观察各组心脏血流动力学指标、血乳酸、肌钙蛋白I（CTnI）、冠状动脉造影TIMI血流、电镜下心肌超微结构变化.结果 6 h,12 h后,休克前亚低温组各项指标均显著优于休克后亚低温组和常温对照组（P〈0.01）.6 h后,休克后亚低温组的CTnI、超微结构损伤变化轻于常温对照组（P〈0.05）,但两组血乳酸、TIMI血流、血流动力学指标变化差异无统计学意义（P〉0.05）.12 h后,休克后亚低温组各项指标和常温对照组差异无统计学意义（P〉0.05）.结论 亚低温对猪脓毒症时的心肌有一定的保护作用;猪脓毒性休克发生以前早期使用亚低温对心肌的保护作用和改善心功能较明显;猪脓毒性休克发生以后,亚低温可以延缓心肌损伤的速度,但并不减轻心肌损伤的程度,也不能减少心功能的丧失.
Objective To investigate the protective effects of mild hypothenmia on myocardium of porcine with septic shock. Method A total of 24 Guishou miniature pigs were randomly（random number） divided into the pre-shock mild hypothermia group, shock mild hypothermia group and shock normothermia control group with 8 in each group. After the anesthesia of pigs, E. coli endotoxin was injected into femoral vein to establish the sepsis model of swine. After modeling, normal saline was continuously administered into femoral vein of pigs in three groups with in-fusion pump at steady speed. In the pre-shock mild hypothermia group,4 ℃ normal saline was used for intravenous injection to produce mild hypothermia before E. eoli endotoxin injection. In the shock mild hypothermia group, 38 ℃ saline was used at first and the 4 ℃ saline was employed after the systolic pressure of mice dropped to 60% of the o-riginal pressure for one hour. In shock normothermia group,38 ℃ saline was used from the beginning to the end of the experiment. The hemodynamics, blood lactate, CtnI, coronary angiography for detecting TIMI flow and the ultra-structural changes under electron microscopy were observed 6 h and 12 h after temperature intervention. Results （1） In pre-shock mild hypothermia group, the findings in all of observation were better than those in shock mild hy-pothermia group and shock normothennia group 6 h and 12 h after temperature intervention （P 〈 0.01）. （2） In shock mild hypothermia group, the CtnI was lower and the ultra-structural changes were less severe than those in shock normothermia group （P 〈 0.05）, but there were no significant differences in blood lactate, TIMI and hemody-namies between shock mild hypotherrnia group and shock normothermia group （P 〉 0.05）. （3） There were no sig-nificant differences in all measurements between shock mild hypothermia group and shock normothennia group after 12 hours later （P 〉 0.05）. Conclusions Mild hypothermia has some protective effects on myocardium of swine with sepsis. If the mild hypothermia is employed before the emergence of shock, the protective effects would be more ef-fective and the cardiac function would maintain at higher efficiency. If the hypothermia is used after the occmTence of shock, it could blunt the cardiac damage and preserve the cardiac function in some extent.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2010年第3期269-272,共4页
Chinese Journal of Emergency Medicine
基金
湖北省卫生厅基金资助项目（301140299）
关键词
亚低温
猪
脓毒性休克
心肌
心功能
Mild hypothermia
Pig
Septic shock
Myocardium
Cardiac function
