脓毒血症过程中大鼠心功能及心肌酶指标的动态变化

Dynamic changes of heart function and cardiac enzymes in septic rats

目的: 研究脓毒血症过程中大鼠心功能及心肌酶指标的动态变化,了解二者在病程进展中的作用,探讨脓毒血症早期心功能不全的病理生理学机制。方法: 60只Wistar大鼠随机分为实验组和对照组,实验组采用盲肠结扎穿刺法(CLP)复制脓毒血症动物模型,并根据术后不同时点将大鼠分为CLP术后3、5、7、9 h 共4 个组,每组12只,观察术后心功能指标:平均动脉压(MAP) 、左室收缩内压(LVSP)、左室内压最大变化速率(±dp/dtmax)以及血清心肌酶指标:天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(AKP)、乳酸脱氢酶(LDH)、LDH 1、α羟丁酸脱氢酶(αHBDH)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)的动态变化。对照组行假手术,检测指标同实验组。结果:CLP术后3 h组LVSP、MAP升高,与其余各组相比差异有统计学意义(P<0.05);CLP术后3、5、7 h组±dp/dtmax升高,与对照组CLP 9 h相比差异具有统计学意义(P<0.05)。CLP术后7、9 h组AST升高,与其他各组比差异有统计学意义(P<0.05);CLP术后3 h以后CK、CKMB升高,与对照组相比差异具有统计学意义(P<0.05)。结论:CLP所致大鼠脓毒血症过程中出现心功能先增强后减弱的趋势,这可能是脓毒血症引起心功能不全甚至心力衰竭的机制之一。血清心肌酶学指标的变化,可能为临床早期发现心功能改变提供参考依据。

Objective: To study the dynamic changes of heart function and the levels of cardiac enzymes indexes in the serums during sepsis in rats, and probe their roles, in order to investigate pathophysiological meachnics of heart dysfunction during early sepsis. Method: Sixty Wistar rats were randomly divided into experimental groups and control group. The sepsis model was made by cecal ligation and puncture (CLP). The experimental group was divided into 4 groups of 3, 5, 7, 9 h after CLP, there were 12 rats in each group. Dynamic changes of heart function indexes (MAP, LVSP, ±dp/dtmax) and serum cardiac enzymes indexes (AST, AKP, LDH, LDH 1, α HBDH, CK, CKMB) were measured. Without CLP, control group got the same treatments. Results: LVSP, MAP increased in CLP 3 h group, compared with other groups(P<0.05); ±dp/dtmax increased in CLP 3, 5, 7 h group, compared with other groups(P< 0.05 ); serum levels of AST significantly increased in CLP 7, 9 h group, compared with other groups(P<0.05); serum levels of CK, CKMB significantly increased in after CLP 3 h, compared with control groups(P<0.05). Conclusion: Heart function increased first, then decreased, during sepsis in rats, this may lead to heart dysfunction even heart failure. Changes in serum cardiac enzymes indexes maybe useful to diagnosis and prognosis in sepsis.