亚低温治疗对猪心脏骤停体外心肺复苏后免疫功能及神经功能的影响

doi:10.11958/20230333

天津医药 ›› 2023, Vol. 51 ›› Issue (10): 1076-1079.doi: 10.11958/20230333

亚低温治疗对猪心脏骤停体外心肺复苏后免疫功能及神经功能的影响

王晋祥¹(), 续国武¹, 王太兰², 王乐³, 靳衡¹, 柴艳芬¹^,^△()

1.天津医科大学总医院急诊医学科（邮编300052）
2.山西医科大学第一医院感染病科
3.天津医科大学总医院神经外科

收稿日期:2023-03-16 修回日期:2023-06-24 出版日期:2023-10-15 发布日期:2023-10-18
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资助项目(2021KJ211)

Effects of mild hypothermia treatment on the immune and neurological function in a swine model of extracorporeal cardiopulmonary resuscitation after cardiac arrest

WANG Jinxiang¹(), XU Guowu¹, WANG Tailan², WANG Le³, JIN Heng¹, CHAI Yanfen¹^,^△()

1. Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
2. Department of Infectious Diseases, First Hospital of Shanxi Medical University
3. Department of Neurosurgery, Tianjin Medical University General Hospital

Received:2023-03-16 Revised:2023-06-24 Published:2023-10-15 Online:2023-10-18
Contact: ^∆E-mail：chaiyanfen2012@126.com

王晋祥, 续国武, 王太兰, 王乐, 靳衡, 柴艳芬. 亚低温治疗对猪心脏骤停体外心肺复苏后免疫功能及神经功能的影响[J]. 天津医药, 2023, 51(10): 1076-1079.

WANG Jinxiang, XU Guowu, WANG Tailan, WANG Le, JIN Heng, CHAI Yanfen. Effects of mild hypothermia treatment on the immune and neurological function in a swine model of extracorporeal cardiopulmonary resuscitation after cardiac arrest[J]. Tianjin Medical Journal, 2023, 51(10): 1076-1079.

摘要/Abstract

摘要：

目的探讨亚低温治疗（MHT）对猪心脏骤停（CA）体外心肺复苏后免疫及神经功能指标水平的影响。方法采用随机数字表法将18只巴马香猪分为假手术（Sham）组、常温治疗（NT）组和MHT组，每组6只。NT组和MHT组经右心室诱颤建立CA模型，随后采取体外心肺复苏及体温管理，NT组目标体温37 ℃，MHT组目标体温32~36 ℃，Sham组仅进行造模常规置管，目标体温37 ℃。MHT组复温后对各组进行神经功能缺损（NDS）评分，随后处死动物并采集静脉血，检测脑损伤及免疫功能指标。结果与Sham相比，NT组与MHT组NDS评分升高，神经元特异性烯醇化酶（NSE）和S100B蛋白表达水平升高（均P<0.05）；与NT组相比，MHT组NDS评分降低，NSE和S100B蛋白表达水平下降（均P<0.05）；各组间IgM、IgA、IgG及T细胞亚群CD4、CD8、CD4/CD8水平差异无统计学意义。结论亚低温治疗可显著改善猪CA体外心肺复苏后神经功能，减轻脑损伤，且对免疫功能无显著影响。

关键词: 低温, 人工, 猝死, 心脏, 心肺复苏术, 磷酸丙酮酸水合酶, S100钙结合蛋白β亚基

Abstract:

Objective To investigate the effect of mild hypothermia treatment (MHT) on levels of immune and neurological function indicators in a swine model of extracorporeal cardiopulmonary resuscitation after cardiac arrest (CA). Methods Eighteen Bama miniature pigs were randomly divided into the sham group, the normal temperature (NT) group and the mild hypothermia (MHT) group with 6 pigs in each group. CA model was established by right ventricular fibrillation in the NT group and the MHT group. Then cardiopulmonary resuscitationt and temperature management were followed. The target temperature of the NT group was 37 ℃, and the target temperature of the MHT group was 32-36 ℃. In the sham group, only conventional tube placement was performed, and the target temperature was 37 ℃. At 24 h after resuscitation, neurologic deficit score (NSD) was evaluated. Animals were then euthanized and venous blood sample was taken to detect brain injury and immune function indicators. Results Compared with the sham group, the NDS score increased in the NT group and the MHT group, and expression levels of neuron specific enolase (NSE) and S100B protein increased (P<0.05). Compared with the NT group, the NDS score, NSE and S100B protein expression levels were decreased in the MHT group (P<0.05). There were no significant differences in levels of IgM, IgA, IgG and T cell subsets CD4, CD8, CD4/CD8 between the groups. Conclusion Mild hypothermia treatment can significantly improve NDS, reduce brain injury after CA and has no significant effect on immune function.

Key words: hypothermia, induced, death, sudden, cardiac, cardiopulmonary resuscitation, phosphopyruvate hydratase, S100 calcium binding protein beta subunit

中图分类号:

R459.7

图/表 3

参考文献 15

[1]	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.
[2]	PANCHAL A R, BARTOS J A, CABANAS J G, et al. Part 3:adult basic and advanced life support:2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2020, 142(16_suppl_2):S366-S468. doi:10.1161/CIR.0000000000000916.
[3]	CHEN S, LACHANCE B B, GAO L, et al. Targeted temperature management and early neuro-prognostication after cardiac arrest[J]. J Cereb Blood Flow Metab, 2021, 41(6):1193-1209. doi:10.1177/0271678X20970059.
[4]	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.
[5]	UY-EVANADO A, CHUGH H S, SARGSYAN A, et al. Out-of-hospital cardiac arrest response and outcomes during the COVID-19 pandemic[J]. JACC Clin Electrophysiol, 2021, 7(1):6-11. doi:10.1016/j.jacep.2020.08.010.
[6]	KIGUCHI T, OKUBO M, NISHIYAMA C, et al. Out-of-hospital cardiac arrest across the world:first report from the international liaison committee on resuscitation(ILCOR)[J]. Resuscitation, 2020, 152:39-49. doi:10.1016/j.resuscitation.2020.02.044.
[7]	SHAO F, LI H, MA S, et al. Outcomes of out-of-hospital cardiac arrest in Beijing:a 5-year cross-sectional study[J]. BMJ Open, 2021, 11(4):e041917. doi:10.1136/bmjopen-2020-041917.
[8]	BARTOS J A, GRUNAU B, CARLSON C, et al. Improved survival with extracorporeal cardiopulmonary resuscitation despite progressive metabolic derangement associated with prolonged resuscitation[J]. Circulation, 2020, 141(11):877-886. doi:10.1161/CIRCULATIONAHA.119.042173.
[9]	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.
[10]	HIFUMI T, INOUE A, KOKUBU N, et al. Association between rewarming duration and neurological outcome in out-of-hospital cardiac arrest patients receiving therapeutic hypothermia[J]. Resuscitation, 2020, 146:170-177. doi:10.1016/j. resuscitation.2019.07.029.
[11]	ARRICH J, HERKNER H, MÜLLNER D, et al. Targeted temperature management after cardiac arrest. A systematic review and meta analysis of animal studies[J]. Resuscitation, 2021, 162:47-55. doi:10.1016/j.resuscitation.2021.02.002.
[12]	ENDISCH C, WESTHALL E, KENDA M, et al. Hypoxic-ischemic encephalopathy evaluated by brain autopsy and neuroprognostication after cardiac arrest[J]. JAMA Neurol, 2020, 77(11):1430-1439. doi:10.1001/jamaneurol.2020.2340.
[13]	CUI H, YANG Z, XIAO P, et al. Effects of different target temperatures on angiogenesis and neurogenesis following resuscitation in a porcine model after cardiac arrest[J]. Shock, 2021, 55(1):67-73. doi:10.1097/SHK.0000000000001559.
[14]	王晋祥, 续国武, 靳衡, 等. 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 J X, XU G W, JIN H, et al. Effects of mild hypothermia treatment on coagulation function and inflammatory factors in a swine model of extracorporeal cardiopulmonary resuscitation after cardiac arrest[J]. Tianjin Med J, 2023, 51(9):968-971. doi:10.11958/20230001.
[15]	陈富明, 卓超洲, 贺安勇. 亚低温治疗对心肺复苏成功患者免疫功能与肺功能指标水平的影响[J]. 中华灾害救援医学, 2020, 8(5):296-298.
	CHEN F M, ZHUO C Z, HE A Y. Effect of mild hypothermia treatment on immune function and lung function indexes in patients with successful cardiopulmonary resuscitation[J]. Chinese Journal of Disaster Medicine, 2020, 8(5):296-298. doi:10.13919/j.issn.2095-6274.2020.05.020.

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）
Sham组	39.2±2.0	37.1±0.3	110±7	106±5	15±4
NT组	38.9±1.7	37.3±0.1	109±8	105±6	16±3
MHT组	39.3±1.9	37.2±0.2	111±7	108±4	15±4
F	0.928	0.233	0.899	0.630	0.835

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）
Sham组	39.2±2.0	37.1±0.3	110±7	106±5	15±4
NT组	38.9±1.7	37.3±0.1	109±8	105±6	16±3
MHT组	39.3±1.9	37.2±0.2	111±7	108±4	15±4
F	0.928	0.233	0.899	0.630	0.835

组别	NDS/分	NSE/（μg/L）	S100B/（ng/L）
Sham组	27±9	13.4±2.2	995±56
NT组	175±34^a	42.1±3.3^a	2 102±86^a
MHT组	94±21^ab	28.5±2.9^ab	1 334±70^ab
F	59.590^＊＊	153.661^＊＊	375.803^＊＊

组别	NDS/分	NSE/（μg/L）	S100B/（ng/L）
Sham组	27±9	13.4±2.2	995±56
NT组	175±34^a	42.1±3.3^a	2 102±86^a
MHT组	94±21^ab	28.5±2.9^ab	1 334±70^ab
F	59.590^＊＊	153.661^＊＊	375.803^＊＊

组别	IgM/（g/L）		IgA/（g/L）		IgG/（g/L）
Sham组	1.64±0.22		3.49±0.30		16.12±3.22
NT组	1.71±0.16		3.57±0.21		16.35±3.06
MHT组	1.67±0.20		3.50±0.28		16.54±2.91
F	0.194		0.163		0.028
组别		CD4/%		CD8/%		CD4/CD8
Sham组		43.8±4.2		25.9±1.0		1.77±0.11
NT组		45.2±3.1		24.6±1.3		1.69±0.15
MHT组		44.5±3.5		25.5±1.1		1.72±0.13
F		0.223		2.036		0.559

亚低温治疗对猪心脏骤停体外心肺复苏后免疫功能及神经功能的影响

Effects of mild hypothermia treatment on the immune and neurological function in a swine model of extracorporeal cardiopulmonary resuscitation after cardiac arrest

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