无泵驱动体外膜肺转流治疗急性呼吸衰竭犬过程中血浆及肺组织ET.docVIP

无泵驱动体外膜肺转流治疗急性呼吸衰竭犬过程中血浆及肺组织ET 　【关键词】 急性呼吸衰竭；,内皮素 　　摘要：目的 观察双侧股动脉股静脉无泵驱动体外膜肺(bAVECMO)治疗急性呼吸衰竭(ARF)犬过程中血浆和肺组织肿瘤坏死因子α(TNFα)和内皮素1(ET1)的变化。方法 10只犬在建立ARF模型情况下给予bAVECMO治疗。分别于实验各时段提取肺组织及血浆，应用放射免疫技术检测TNFα、ET1的变化。结果 模型动物血浆ET1含量先降低，1h后开始回升，2h达到高值；肺组织匀浆ET1含量增加在转流2h达到高值。方差分析表明匀浆和血浆各自ET1的均数在转流前后有显著性差异(Plt;0.05)。肺组织匀浆和血浆TNFα含量转流3h后均较术前有所增高，但都呈现出先降低后升高的趋势。方差分析表明匀浆和血浆中各自TNFα的均数在转流前后有显著性差异(Plt;0.05)。结论 bAVECMO早期转流可能减少ET1的释放；而TNFα在转流早期对于ET1释放影响不大。 　　关键词：急性呼吸衰竭； 内皮素1；肿瘤坏死因子α； 无泵驱动体外膜肺 　　　ABSTRACT: Objective To study the changes of endothelin1(ET1) and tumor necrosis factor alpha(TNFα) in lung homogenate and plasm when acute respiratory failure (ARF) animal models are treated by bilateral femoral arteriovenous extracorporeal membrane oxygenation(bAVECMO). Methods Ten ARF dog models were treated by the bAVECMO. Right atrium blood and lung tissues were collected at different time points, and ET1 and TNFα were assayed by radioimmunological method. Results ET1 content in plasm decreased at first, and at 1h it was elevated and at 2h reached the peak. ET1 content in lung homogenate reached the peak at 2h and then started to decrease. The analysis of variance showed notable differences(Plt;0.05). TNFα content in lung homogenate and plasm decreased at 1h and started to increase after that time; it was higher at 3h than that at the beginning of operation and increased continuously. The analysis of variance showed notable differences (Plt;0.05). Conclusion Early bAVECMO can possibly reduce the release of ET1, while TNFα has no obvious effect on ET1 release during bAVECMO. 　　KEY WORDS: acute respiratory failure(ARF); endothelin1(ET1); tumor necrosis factor alpha(TNFα); extracorporeal membrane oxygenation 　　对急性呼吸衰竭(acute respiratory failure, ARF)和急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)有效治疗技术的探索是全球性的研究课题。研究发现，ARF、ARDS时肺组织和血浆中TNFα、ET1明显升高，说明其参与了急性肺损伤的病理生理过程。在治疗ARF、ARDS时，无泵驱动体外膜肺辅助转流技术(arteryvenous extracorporeal membrane oxygenation, AVECMO)应用于临床治疗重症ARDS获得成功[1]。该技术将动脉血引流出体外进行氧合再通过静脉系统进