新型腹腔降温法对心肺复苏后兔肠黏膜损伤的影响

目的探讨心肺复苏后腹腔降温法对肠黏膜损伤的保护作用。方法 36只健康成年新西兰大白兔用交流电致颤的方式建立室颤模型,自主循环恢复后,模型动物随机分为常温治疗组(NT)、体表降温组(SC)和腹腔降温组(PC)。观察每组自主循环恢复(ROSC)后鼓膜温度和腹腔温度的变化,ROSC后12h处死动物,观察肠黏膜损伤情况和炎症因子TNF-α和VCAM-1的表达情况。结果每组12只动物,NT、SC和PC组各有9、10和9只动物CPR成功,ROSC后动物均需要行机械通气2～4h,各组分别有5、6和8只动物存活到实验结束。NT组的鼓膜、腹膜温度均维持在正常范围内,SC和PC两组的鼓膜温度达到目标温度的时间分别为(29±6.55)min和(62±8.27)min。维持亚低温阶段,SC组腹腔内温度和鼓膜温度维持在33℃～35℃,而PC组腹腔温度维持在31℃～34℃。PC组肠黏膜损伤评分为1.43±0.53,低于NT组的3.40±0.55(P0.01)和SC组的3.17±0.41(P0.05),而NT组和SC组之间差异不明显(P=0.30)。肠黏膜内TNF-α的表达NT组为(9.98±1.79)%,高于SC组的(5.87±1.43)%和PC组的(2.54±0.96)%,差异有统计学意义(P0.05);SC组和PC组之间差异有统计学意义(P0.05)。SC组肠黏膜内VCAM-1的表达为(5.92±1.06)%,PC组为(3.78±0.53)%,两组VCAM-1表达水平显著低于NT组(8.53±1.53)%,P分别小于0.01和0.05,PC组VCAM-1表达水平也显著低于SC组,P0.05。结论 CPR后腹腔降温法除能快速诱导亚低温外还能减轻ROSC后的肠黏膜损伤。

Effects of Neotype peritoneal cooling on the injured of intestinal mucous after cardiopulmonary resuscitation in rabbits

Objective To explore whether the peritoneal cooling after cardiopulmonary resuscitation could improve the injured of intestinal mucous in rabbits.Methods Thirty-six adult NewZealand rabbits were induced ventricular fibrillation by AC current.After restore of spontaneous circulation（ROSC）, the rabbits were randomly divided into three groups according to the way of body temperature controlling, i.e.nomothermia group （NT）, surface cooling group（SC） and peritoneal cooling group（PC）.The changing of tympanic temperature and peritoneal temperature were observed after ROSC.The animals were sacrificed by over anesthesia after ROSC for 12 h, the end ileum was removed and fixed in formalin,the histological injured and the expression of TNF-α and VCAM-1 in ileum were observed by HE staining and immune chemical methods.Results Twelve animals in each group,9 in group NT,10 in group SC and 9 in group PC were successfully resuscitated.All animals were need mechanical ventilation for 2 to 4 h, 5, 6 and 8 animals in each group survived to the end of the experiment respectively.The temperatures of tympanic and peritoneal cavity of animals in group NT were maintained in normal range.The tympanic temperature of animals in group SC and PC was arrived target temperatures at （29±6.55） min and （62±8.27） min.During the stage of maintenance of hypothermia, the tympanic and peritoneal temperatures of animals in group SC were in range 33℃ to 35℃, while the peritoneal temperatures of animals in group PC were in range 31℃ to 34℃,1℃ to 2℃ lower than the tympanic temperature.The scores of histological injured of ileum were 1.43±0.53 in group PC,3.4±0.55 in group NTand 3.17±0.41 in group SC.The differences amongthemwere significantly, PC versus SC or NT, P0.05; while SC versus NT, P=0.30.The expression of TNF-α in ileum was （9.98±1.79）% in group NT, （5.87±1.43）% in group SC and （3.78±0.53）% in group PC, the differences amongthem were significantly.The phenomenon of the expression of VCAM-1 was （3.78±0.53）% in group PC, （8.53±1.53）% in group NT and （5.92±1.06）% in group SC.Conclusion The neotype peritoneal cooling can improve the injured ofileum mucous beside quickly induce hypothermia after ROSC in rabbits.