亚低温对心肺复苏后急性肺损伤研究.docVIP

亚低温对心肺复苏后急性肺损伤的研究 　　【摘要】 目的 通过测定亚低温下心肺复苏后患者肺内TNF-α、IL-8的含量变化,初步探讨亚低温能否减轻缺血再灌注损伤导致的急性肺损伤。方法 将20例心跳骤停、心肺复苏后患者随机分成亚低温组和治疗组,检测患者2、12、24、48、72、92 h及120 h肺泡灌洗液内TNF-α和IL-8含量。结果 心肺复苏后常规组患者TNF-α在各时点呈先升后降,24 h达最高峰,之后下降,亚低温组各时点肺泡灌洗液内TNF-α含量明显低于较常规组,且有统计学意义(P 0.05)。IL-8含量在常规组和亚低温组皆呈上升趋势,但亚低温组在各时点含量显著低于常规组(P 0.05)。结论 亚低温治疗能显著降低心肺复苏后患者肺内的TNF-α、IL-8含量,一定程度上减轻肺内炎症变化,降低ALI的发生率及减轻严重程度。 　　【关键词】 亚低温;心肺复苏;肺泡灌洗;炎性介质;急性肺损伤 　　 　　Influence of mild therapeutic hypothermia in acute lung injury after successful resuscitation from cardiac arrest 　　 　　Department of ICU,People’s Hospital of Huizhou City,Huizhou 516000,China 　　 　　【Abstract】 Objective To determine tumor necrosis factor-alpha(INF-α)and interleukin-8(IL-8) in pulmonary after cardiopulmonary resuscitation ,and evaluate if hypothermia affects acute lung injury after successful cardiopulmonary resuscitation.Methods A total of 20 patients were enrolled.they were randomized to receive mild hypothermia groups or normal control groups,BALF samples were analyzed for levels of interleukin 8, tumor necrosis factor-alpha, after hospital admission 2 hours and after 12, 24, 48,72,92and 120 hours.Results Regardless of outcomes, interleukin 8 and tumor necrosis factor-alpha levels were significantly elevated by the use hypothermia (n = 20,P0.05).Compare with normal control groups the expressions of TNF-a and IL-8 were significantly lower in hypothermia groups,and lung injury Was less sever. Conclusion In this observational study, hypothermia influenced the inflammatory response after cardiopulmonary resuscitation and decrease the severity of lung injury to some extent. 　　【Key words】 Hypothermia;Resuscitation;Lung Lavage; Inflammatory mediators; Acute lung injury 　　 　　缺血-再灌注损伤引起的全身炎症反应是导致急性肺损伤(acute lung injury,ALI)或急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的病因之一。心肺复苏后患者继发ALI、ARDS是心肺复苏后患者死亡原因之一。亚低温目前被认为是保护缺血器官最有效的方法,也是脑复苏的重要措施之一,临床上已被广泛应用[1,2]。而亚低温对缺血再灌注损伤的炎性细胞因子变化,在动物实验和临床实验已经得到证实。本研究通过把20例心肺复苏(Cardiopulmonary resuscitation,CPR