心肺复苏后血浆可溶性选择素与脓毒症关系的研究

目的探讨心肺复苏（CPR）后是否会出现血浆可溶性P-选择素、E-选择素增高，并评价其临床意义。方法CPR后存活≥48h的43例患者次日晨采集肘静脉血，采用ELISA定量测定血浆sE-选择素、sP-选择素，按是否发生全身炎症反应综合征（SIRS）及脓毒症进行分组，并与40例非危重病患者作对照。结果①CPR后29例（29／43）发生SIRS，SIRS组血浆sP-选择素水平显著高于非SIRS组及对照组（均P〈0．01），SIRS组与非SIRS组血浆sE-选择素水平虽差异无统计学意义（P〉0．05），但却均高于对照组（均P〈0．01）。②CPR后1周内19例患者发展为脓毒症，脓毒症组血浆sP-选择素水平显著高于非脓毒症组（P〈0．05），二组血浆sE-选择素水平差异无统计学意义（P〉0．05）；③CPR后死亡患者血浆sE-选择素水平明显高于存活患者（P〈0．01），但两组血浆sP-选择素水平差异无统计学意（P〉0．05）。结论SIRS是CPR后一种常见的非特异性反应，血浆sP-选择素水平可能帮助识别脓毒症高危患者，血浆sE-选择素水平可能有助于CPR后不良预后的判断。

Relationship of Plasma soluble sP-and sE-selectin levels to systemic inflammatory response syndrome and sepsis after successful cardiopulmonary resuscitation

Objective To investigate the plasma levels of soluble P （sP）-selectin and soluble E-（sE-） selectin after successful cardiopulmonary resuscitation （CPR） and its relationship to the incidence of systemic inflammatory response syndrome （SIRS） and sepsis. Methods Peripheral blood samples were collected from 43 patients surviving ≥48 hours after CPR, 29 of which suffered from SIRS and 19 of which suffered from sepsis within 1 week after CPR （14 belonging to the SIRS group and 5 belonging to the non-SIRS group）, on the second day after successful CPR. The plasma levels of sE- and sP-selectin were determined by ELISA. Forty non-critically ill patients were used as control group. Results Twenty of the 29 SIRS group patients and 8 of the 14 non-SIRS group patients died 1 -23 days after the collection of blood samples. The plasma level of sP- selectin of the SIRS group was （261.8±97.6） ng/ml, significantly higher than those of the non-SIRS and control groups （110.2±48.8 ）ng/ml and （113.2±84 ）ng/ml respectively, both P 〈0.01]. The Plasma level of sE-selectin of the SIRS group was （102.7±48.1） ng/ml, significantly higher than those of the non-SIRS and control groups （98.6±47.5 ）ng/ml and （43.3±17.20）ng/ml respectively, both P 〈0.01]. The Plasma levels of sP- and sE-selectin of the non-SIRS group were both significantly higher than those of the control group too （both P 〈0.01）. The Plasma level of sP-and sE-selectin of the SIRS group were （346.9±206.5） and （109.5±52.4）ng/ml respectively, both significantly higher than those of the non-sePsis group （158.0±156.4 ）and （98.1±50.7） ng/ml respectively, both P 〈0.01]. The Plasma levels of sP- of the non-survivor group was（356.1±198.0） ng/ml, not significantly higher than that of the survivor group （216.4±167.1） ng/ml, and the sE-selectin of the non-survivor group was （149.4±57.9）ng/ ml, significantly higher then that of the survivor group （98.0±53） ng/ml, P 〈0.01]. Conclusio