亚低温治疗对猪心脏骤停体外心肺复苏后凝血功能及炎性因子的影响

doi:10.11958/20230001

天津医药 ›› 2023, Vol. 51 ›› Issue (9): 968-971.doi: 10.11958/20230001

亚低温治疗对猪心脏骤停体外心肺复苏后凝血功能及炎性因子的影响

王晋祥¹(), 续国武¹, 靳衡¹, 贺斌², 柴艳芬¹^,^△()

1.天津医科大学总医院急诊医学科（邮编300052）
2.天津中医药大学第一附属医院肿瘤科

收稿日期:2023-01-05 修回日期:2023-04-18 出版日期:2023-09-15 发布日期:2023-09-13
通讯作者: △E-mail：chaiyanfen2012@126.com
作者简介:王晋祥（1985），男，主治医师，主要从事心肺复苏、体外膜肺氧合的基础与临床方面研究。E-mail：wangjx_192@tmu.edu.cn
基金资助:
天津市教委科研计划项目(2021KJ211)

Effects of mild hypothermia treatment on coagulation function and inflammatory factors in a swine model after cardiac arrest and extracorporeal cardiopulmonary resuscitation

WANG Jinxiang¹(), XU Guowu¹, JIN Heng¹, HE Bin², CHAI Yanfen¹^,^△()

1. Department of Emergency Medicine, Tianjin Medical University General Hospital,Tianjin 300052, China
2. Department of Oncology, the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine

Received:2023-01-05 Revised:2023-04-18 Published:2023-09-15 Online:2023-09-13
Contact: △E-mail：chaiyanfen2012@126.com

王晋祥, 续国武, 靳衡, 贺斌, 柴艳芬. 亚低温治疗对猪心脏骤停体外心肺复苏后凝血功能及炎性因子的影响[J]. 天津医药, 2023, 51(9): 968-971.

WANG Jinxiang, XU Guowu, JIN Heng, HE Bin, CHAI Yanfen. Effects of mild hypothermia treatment on coagulation function and inflammatory factors in a swine model after cardiac arrest and extracorporeal cardiopulmonary resuscitation[J]. Tianjin Medical Journal, 2023, 51(9): 968-971.

摘要/Abstract

摘要：

目的探讨亚低温治疗对猪心脏骤停（CA）体外心肺复苏（ECPR）后凝血功能及炎性因子的影响。方法采用随机数字表法将12只巴马香猪分为对照组、常温组和亚低温组，每组4只。常温组和亚低温组经右心室诱颤建立CA模型，随后采用体外膜肺氧合（ECMO）进行ECPR，常温组目标体温37 ℃，亚低温组目标体温34 ℃，对照组仅进行造模常规置管。24 h后处死动物，取静脉血检测凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）及D-二聚体（D-D）水平。采用酶联免疫吸附试验（ELISA）测定肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）的表达水平。结果常温组和亚低温组PT、APTT、TT、FIB、D-D、TNF-α及IL-6表达水平均高于对照组，亚低温组各指标低于常温组（P<0.05）。结论亚低温治疗可显著改善猪CA经ECPR后凝血功能，并降低炎性因子表达水平，从而减轻ECPR相关并发症及炎症反应的发生。

关键词: 亚低温, 心脏骤停, 体外心肺复苏, 凝血功能, 炎性因子

Abstract:

Objective To investigate effects of mild hypothermia treatment on coagulation function and inflammatory factors in a swine model of extracorporeal cardiopulmonary resuscitation (ECPR) after cardiac arrest (CA). Methods Using random number table method, twelve Bama pigs were divided into the control group, the normal temperature group and the mild hypothermia group with four pigs in each group. CA model was established by right ventricular fibrillation in the normal temperature group and the mild hypothermia group, and then ECPR was performed by extracorporeal membrane oxygenation (ECMO). The target temperature of the normal temperature group was 37 ℃, and the mild hypothermia group was 34 ℃. Control group was only given conventional tube placement. Pigs were killed 24 hours later, and venous blood was taken to detect levels of prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB) and D-dimer antigen (D-D). Expression levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected by enzyme linked immunosorbent assay (ELISA). Results Compared with the control group, PT, APTT, TT, FIB, D-D and expression levels of TNF-α and IL-6 were significantly increased in the normal temperature group and the mild hypothermia group. Compared with the normal temperature group, the above indicators were decreased significantly in the mild hypothermia group (P<0.05). Conclusion Mild hypothermia treatment can significantly improve coagulation function and reduce the release of inflammatory factors in a swine model of ECPR after CA, so as to alleviate the occurrence of ECPR-related complications and inflammatory reactions.

Key words: mild hypothermia, cardiac arrest, extracorporeal cardiopulmonary resuscitation, coagulation function, inflammatory factor

中图分类号:

R459.7

图/表 3

参考文献 26

[1]	KALRA R, KOSMOPOULOS M, GOSLAR T, et al. Extracorporeal cardiopulmonary resuscitation for cardiac arrest[J]. Curr Opin Crit Care, 2020, 26(3):228-235. doi:10.1097/MCC.0000000000000717.
[2]	XIE X, ZHENG J Q, ZHENG W, et al. Efforts to improve survival outcomes of out-of-hospital cardiac arrest in China:BASIC-OHCA[J]. Circ Cardiovasc Qual Outcomes, 2023, 16(2):e008856. doi:10.1161/CIRCOUTCOMES.121.008856.
[3]	INOUE A, HIFUMI T, SAKAMOTO T, et al. Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest in adult patients[J]. J Am Heart Assoc, 2020, 9(7):e015291. doi:10.1161/JAHA.119.015291.
[4]	SANDRONI C, CRONBERG T, SEKHON M. Brain injury after cardiac arrest:pathophysiology,treatment,and prognosis[J]. Intensive Care Med, 2021, 47(12):1393-1414. doi:10.1007/s00134-021-06548-2.
[5]	逄利, 穆宇航, 邢吉红. 心肺复苏后的目标体温管理[J]. 中华急诊医学杂志, 2023, 32(1):13-16.
	PANG L, MU Y H, XING J H. Target temperature management after cardiopulmonary resuscitation[J]. Chin J Emerg Med, 2023, 32(1):13-16. doi:10.3760/cma.j.issn.1671-0282.2023.01.004.
[6]	FERNANDO S M, DI SANTO P, SADEGHIRAD B, et al. Targeted temperature management following out-of-hospital cardiac arrest:a systematic review and network Meta-analysis of temperature targets[J]. Intensive Care Med, 2021, 47(10): 1078-1088. doi:10.1007/s00134-021-06505-z.
[7]	赵旭岩, 隋欣. 亚低温治疗在心肺复苏后患者中的应用进展[J]. 医学综述, 2021, 27(7):1380-1384.
	ZHAO X Y, SUI X. Application progress of therapeutic hypothermia in patients after cardiopulmonary resuscitation[J]. Medical Recapitulate, 2021, 27(7):1380-1384. doi:10.3969/j.issn.1008-5971.2017.09.017.
[8]	TRĄBKA-ZAWICKI A, TOMALA M, ZELIAŚ A, et al. Adaptation of global hemostasis to therapeutic hypothermia in patients with out-of-hospital cardiac arrest:Thromboelastography study[J]. Cardiol J, 2019, 26(1):77-86. doi:10.5603/CJ.a2017.0080.
[9]	王智渊, 褚莉莉, 刘伯夫, 等. 心脏骤停-心肺复苏猪模型的构建与应用[J]. 中华急诊医学杂志, 2022, 31(3):407-413.
	WANG Z Y, CHU L L, LIU B F, et al. Cardiac arrest-Construction and application of cardiopulmonary resuscitation a swine model[J]. Chin J Emerg Med, 2022, 31(3):407-413. doi:10.3760/cma.j.issn.1671-0282.2022.03.029.
[10]	张媛, 赵昕亚, 何帮顺, 等. 3种凝血功能检测方法的参数差异及在临床应用中的比较[J]. 临床检验杂志, 2022, 40(6):405-408,437.
	ZHANG Y, ZHAO X Y, HE B S, et al. Comparison of parameters of three blood coagulation assays in clinical application[J]. Chin J Clin Lab Sci, 2022, 40(6):405-408,437. doi:10.13602/j.cnki.jcls.2022.06.02.
[11]	LUDWIN K, SAFIEJKO K, SMEREKA J, et al. Systematic review and meta-analysis appraising efficacy and safety of adrenaline for adult cardiopulmonary resuscitation[J]. Cardiol J, 2021, 28(2):279-292. doi:10.5603/CJ.a2020.0133.
[12]	KLEINMAN M E, BRENNAN E E, GOLDBERGER Z D, et al. Part 5:adult basic life support and cardiopulmonary resuscitation quality:2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2015, 132(18 Suppl 2):S414-S435. doi:10.1161/CIR.0000000000000259.
[13]	OLASVEENGEN T M, MANCINI M E, PERKINS G D, et al. Adult basic life support:2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations[J]. Circulation, 2020, 142(16_suppl_1):S41-S91. doi:10.1161/CIR.0000000000000892.
[14]	李佩娟, 龚平. 心肺复苏后目标温度管理的最新评价[J]. 中华急诊医学杂志, 2022, 31(4):432-435.
	LI P J, GONG P. The latest evaluation of target temperature management after cardiopulmonary resuscitation[J]. Chin J Emerg Med, 2022, 31(4):432-435. doi:10.3760/cma.j.issn.1671-0282.2022.04.002.
[15]	MORRISON L J, THOMA B. Translating targeted temperature management trials into postarrest care[J]. N Engl J Med, 2021, 384(24):2344-2345. doi:10.1056/NEJMe2106969.
[16]	TACCONE F S, PICETTI E, VINCENT J L. High quality targeted temperature management (TTM) after cardiac arrest[J]. Crit Care, 2020, 24(1):6. doi:10.1186/s13054-019-2721-1.
[17]	WU C S, XU J F, JIN X H, et al. Effects of therapeutic hypothermia on cerebral tissue oxygen saturation in a swine model of post-cardiac arrest[J]. Experimental and therapeutic medicine, 2020, 19(2):1189-1196. doi:10.3892/etm.2019.8316.
[18]	SANDRONI C, CRONBERG T, SEKHON M. Brain injury after cardiac arrest:pathophysiology,treatment,and prognosis[J]. Intensive Care Med, 2021, 47(12):1393-1414. doi:10.1007/s00134-021-06548-2.
[19]	NGUYEN S M T, RUPPRECHT C P, HAQUE A, et al. Mechanisms governing anaphylaxis:inflammatory cells,mediators,endothelial gap junctions and beyond[J]. Int J Mol Sci, 2021, 22(15):7785. doi:10.3390/ijms22157785.
[20]	BORTOLOTTI P, FAURE E, KIPNIS E. Inflammasomes in tissue damages and immune disorders after trauma[J]. Front Immunol, 2018, 9:1900. doi:10.3389/fimmu.2018.01900.
[21]	MEZGER M, NORDING H, SAUTER R, et al. Platelets and immune responses during thromboinflammation[J]. Front Immunol, 2019, 10:1731. doi:10.3389/fimmu.2019.01731.
[22]	KIM H J, PARK K N, KIM S H, et al. Time course of platelet counts in relation to the neurologic outcome in patients undergoing targeted temperature management after cardiac arrest[J]. Resuscitation, 2019, 140:113-119. doi:10.1016/j.resuscitation.2019.05.019.
[23]	WANG W Y, XIE L, ZOU X S, et al. Pomelo peel oil suppresses TNF-α-induced necroptosis and cerebral ischaemia-reperfusion injury in a rat model of cardiac arrest[J]. Pharm Biol, 2021, 59(1):401-409. doi:10.1080/13880209.2021.1903046.
[24]	WANG W Y, XIE L, ZOU X S, et al. Pomelo peel oil suppresses TNF-α-induced necroptosis and cerebral ischaemia-reperfusion injury in a rat model of cardiac arrest[J]. Pharm Biol, 2021, 59(1):401-409. doi:10.1080/13880209.2021.1903046.
[25]	HASSAN M I, ALI F E, SHALKAMI A G S. Role of TLR-4/IL-6/TNF-α,COX-Ⅱ and eNOS/iNOS pathways in the impact of carvedilol against hepatic ischemia reperfusion injury[J]. Hum Exp Toxicol, 2021, 40(8):1362-1373. doi:10.1177/0960327121999442.
[26]	杨小红, 张颖. 亚低温治疗对心脏骤停体外心肺复苏成功后患者血清TNF-α、IL-6水平的影响[J]. 现代医学与健康研究电子杂志, 2020, 4(1):82-83.
	YANG X H, ZHANG Y. Effect of mild hypothermia treatment on serum levels of TNF-α and IL-6 in patients with successful extracorporeal cardiopulmonary resuscitation after cardiac arrest[J]. Medicine and Health Research, 2020, 4(1):82-83. doi:2096-3718.2020.01.0082.02.

组别	体质量/ kg	中心体温/ ℃	心率/ （次/min）	平均动脉压/mmHg	呼吸频率/ （次/min）
对照组	38.8±2.3	37.2±0.2	112±8	104±5	15±2
常温组	39.3±2.4	37.1±0.2	109±7	107±7	16±3
亚低温组	38.7±2.2	37.3±0.3	113±9	105±5	15±3
F	0.117	1.059	0.402	0.424	0.273

组别	体质量/ kg	中心体温/ ℃	心率/ （次/min）	平均动脉压/mmHg	呼吸频率/ （次/min）
对照组	38.8±2.3	37.2±0.2	112±8	104±5	15±2
常温组	39.3±2.4	37.1±0.2	109±7	107±7	16±3
亚低温组	38.7±2.2	37.3±0.3	113±9	105±5	15±3
F	0.117	1.059	0.402	0.424	0.273

组别	PT/s	APTT/s	TT/s	FIB/（g/L）	D-D/ （mg/L）
对照组	18.8±3.4	35.5±4.1	15.2±2.7	5.3±1.6	0.9±0.4
常温组	40.5±7.2^a	72.8±6.6^a	36.5±7.1^a	13.4±5.5^a	2.6±1.3^a
亚低温组	26.7±5.9^ab	54.2±8.7^ab	22.6±4.3^ab	9.7±3.4^ab	1.7±0.5^ab
F	22.108^＊＊	46.015^＊＊	27.628^＊＊	6.671^＊	6.200^＊

组别	PT/s	APTT/s	TT/s	FIB/（g/L）	D-D/ （mg/L）
对照组	18.8±3.4	35.5±4.1	15.2±2.7	5.3±1.6	0.9±0.4
常温组	40.5±7.2^a	72.8±6.6^a	36.5±7.1^a	13.4±5.5^a	2.6±1.3^a
亚低温组	26.7±5.9^ab	54.2±8.7^ab	22.6±4.3^ab	9.7±3.4^ab	1.7±0.5^ab
F	22.108^＊＊	46.015^＊＊	27.628^＊＊	6.671^＊	6.200^＊

组别	TNF-α	IL-6
对照组	143.5±6.2	51.3±4.7
常温组	370.8±14.3^a	182.6±12.5^a
亚低温组	257.3±7.4^ab	103.4±9.6^ab
F	780.993^＊＊	290.870^＊＊

亚低温治疗对猪心脏骤停体外心肺复苏后凝血功能及炎性因子的影响

Effects of mild hypothermia treatment on coagulation function and inflammatory factors in a swine model after cardiac arrest and extracorporeal cardiopulmonary resuscitation

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

图/表 3

参考文献 26

相关文章 15

编辑推荐

Metrics

本文评价

[1]	夏雨薇, 乔云阳, 刘雪薇, 施会敏, 曲高婷, 张爱青, 甘卫华. tRF-1:30对高糖诱导的肾小管上皮细胞炎性因子表达的影响[J]. 天津医药, 2024, 52(6): 561-566.
[2]	赵万勇, 李晓红, 王景景, 孙洪涛. 长时程亚低温通过抑制颅内压反弹促进颅脑创伤大鼠的神经保护作用[J]. 天津医药, 2024, 52(1): 68-72.
[3]	胡明月, 李鑫, 高磊, 关明杰. 蒙古黄芪皂苷对铅暴露致发育期大鼠神经炎症与肠道菌群紊乱的影响[J]. 天津医药, 2023, 51(9): 955-960.
[4]	张金武, 谢丁玲, 陈莉. 一叶萩碱对大鼠脑缺血再灌注损伤后神经功能的影响[J]. 天津医药, 2023, 51(9): 977-982.
[5]	王翠, 杨畅, 金玉, 高蜜, 张雯, 王琼, 金海涛. 木犀草苷对阿尔茨海默病模型细胞凋亡和炎性因子表达的研究[J]. 天津医药, 2023, 51(7): 701-706.
[6]	马玲, 钟利国, 崔裕如, 刘彬. 梓醇对IL-1β诱导软骨细胞损伤的保护机制研究[J]. 天津医药, 2023, 51(7): 718-723.
[7]	周莹, 王雅宁, 吴爽, 柯慧娟, 孙鹏飞. 灯盏花素对脓毒症急性肺损伤患者炎性因子、凝血功能的影响及疗效研究[J]. 天津医药, 2023, 51(4): 409-412.
[8]	谭安隽, 杨晶晶, 李天荣. 鸢尾素与新诊断2型糖尿病的相关性研究[J]. 天津医药, 2023, 51(1): 91-94.
[9]	刘浩, 龙利△, 张继波, 金晟, 余建峰, 覃慧群, 徐敏. 新型冠状病毒肺炎患者血清胱抑素C与炎性因子水平变化及其相关性#br#[J]. 天津医药, 2020, 48(8): 753-756.
[10]	陶冉 1，谢露 2，郑君慧 1，谭小风 1，李诺 1，覃涛 1，杨叶桂 1，陈蒙华 1△. ERK抑制剂对心肺复苏后大鼠心肌缺血再灌注损伤和能量代谢的作用研究[J]. 天津医药, 2019, 47(4): 387-390.
[11]	褚庆玉 , 何佳桐 , 贾山移 , 赵斌 . 爆发性1型糖尿病致心脏骤停一例及文献复习[J]. 天津医药, 2019, 47(1): 85-87.
[12]	翟虎, 刘迎午, 王禹, 李鑫, 李彤. 老年心力衰竭合并肺部感染患者病原菌分布及其对血炎性因子水平影响研究[J]. 天津医药, 2018, 46(9): 952-955.
[13]	袁强, 胡锦. 颅脑创伤后凝血功能障碍的临床与循证[J]. 天津医药, 2017, 45(8): 799-803.
[14]	刘佰运. 从2016年美国《重型颅脑创伤治疗指南（第四版）》解读临床救治中的三个重要问题[J]. 天津医药, 2017, 45(8): 791-795.
[15]	彭汤明, 陈礼刚. 颅脑外伤的精准化治疗[J]. 天津医药, 2017, 45(8): 788-790.