换血疗法在MODS新生猪的实验研究

Experimental study on exchange transfusion in neonatal piglets of multiple organ dysfunction syndrome

目的 探讨应用换血疗法治疗新生猪多器官功能障碍综合征（MODS）的效果及临床意义。方法 对8只MODS新生猪进行了换血治疗，观察换血前后外周血血常规、血生化、动脉血气及血清细胞因子等指标的变化。对照组8只MODS新生猪不做换血治疗，观察两组的病死率。结果换血后新生猪红细胞水平明显升高[（4．14±0．70VS4，45±0．49）×10^12／L，P〈0．05]；白细胞水平明显下降[（19．81±3．14vs12，02±2，84）×10^9／L，P〈0.01]；血小板水平变化无显著性意义（P〉0．05）。动脉血氧分压升高（45．75±13．07 vs 50．38±10．16）mmHg（P〈0．05），二氧化碳分压降低（40．91±6．80 vs 35．71±7．52）mmHg（P〈0．05）。换血后血丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮及乳酸水平均下降（P〈0．05）；磷酸肌酸激酶同工酶、C反应蛋白下降（P〈0．01）；肿瘤坏死因子-α、白细胞介素-1β、白细胞介素-6、白细胞介素-8水平均下降（P〈0．05）。治疗组死亡1只（12．5％），对照组死亡6只（75％），两组死亡率差异有显著性（P〈0．05）。结论 换血治疗能在一定程度上改善MODS新生猪受损器官的功能，改变高炎症反应状态，阻断MODS的序贯发生，提示在治疗新生猪MODS中可能有临床价值。

Objective To investigate the effects of exchange transfusion on the outcome of multiple organ dysfunction syndrome（MODS） in neonatal piglet. Methods Sixteen piglet MODS models were established. Exchange transfusion was performed in eight piglets of treatment group, other eight without exchange transfusion served as control. The peripheral blood routine, serum chemical panels, arterial blood gas and serum cytokine levels were detected before and after exchange transfusion. The mortalities of two groups were compared. Results After exchange transfusion, red blood cell count was increased significandy[ （4.14± 0,70 vs 4.45 ±0.49） ×10^12/L, P 〈 0.05 ] ; white blood cell count was markablely decreased[ （ 19.81 ± 3.14 vs 12.02 ± 2.84） × 10^9/L, P 〈 0.01 ]. There was no significant change in platalet counts. PaO2 was increased[ （45.75 ± 13.07） mm Hg vs（50.38 ±10.16） mm Hg, P〈0.05]and PaCO2 was decreased[ （40.91± 6.80） mm Hg vs （35.71 ±7.50） mm Hg, P〈 0.05] significantly. The levels of serum ALT, AST, Cr, BUN, CK-MB, CRP and Lac were all declined significantly（ P 〈 0.05, P 〈 0.01 ）. The levels of serum TNF-α, IL- 1β, IL-6 and IL- 8 were all declined significantly（ P 〈 0.05 ）. One piglet died in treatment group and six in control group, showing the significant difference in mortality between the two group（P 〈 0.05 ）. Conclusion Exchange transfusion can improve the function of damaged organ in neonatal piglet of MODS in some degree. It can relieve inflammatory reaction and hinder the pathogenesis of MODS. Exchange transfusion is an effective and successful treatment for MODS.