心搏骤停复苏后不同预后患者血清细胞因子变化及意义

Dynamic changes and significance of serum cytokines in patients with different prognosis after cardiopulmonary resuscitated

目的探讨心搏骤停复苏（CPR）后患者血清细胞因子的动态变化及其临床意义。方法将27例CPR自主循环（ROSC）还真分为复苏失败组（A1）19例和存活出院组（A2）8例，22例死亡者做对照组（B），用ELISA法动态检测CPR时、24、48、72h、7d患者血清IL-4、IL-8、IL-10、IL-8水平变化。结果B组CPR时TNF-α含量高于A1组、A2组（P〈0．05），IL-1β、IL-4、IL-8、IL-10水平三组之间差异无统计学意义（P〉0．05）。A1组复苏后多脏器功能衰竭发病高于A2组（14／19，2／8，P〈0．05），ROSC 24h TNF-α水平高于其CPR时和A2组（P〈0．05），ROSC 48h TNF—α、IL-8水平达峰值，且高于A2组，IL-4、IL—10水平高于其CPR时（P〈0．05），与A2组相比差异无统计学意义（P〉0．05），ROSC 72h TNF-α水平下降，IL-4高于A2组（P〈0．05）。结论细胞因子异常释放参与复苏后缺血-再灌注损伤病理过程，选择时机干预其失衡，提高复苏存活率，改善预后。

Objective To investigate the dynamic changes and significance of serum cytokines in patients with different prognosis after cardiopulmonary resuscitated. Methods The patients undergone CPR were divided into recovers the successful group and anabiosis defeat group. The levels of serum tumor necrosisfactor - α （ TNF - α）, intedeukin - 4 （ IL - 4）, interleukin - 8 （ IL - 8 ）, interleukin - 10 （ IL - 10） were measured in 27 patients after CPR with return of spontaneous circulation（ROSC） by enzyme - linked immunosorbent assay （ELISA）. Results In group B, the levels of serum tumor neerosisfaetor-α（TNF-α） was increased and significantly higher shah group A1 and A2 at cardiac arrest -before CPR （P 〉 0.05）. There no significant difference of the serum IL-4,IL- 8,IL -10 among the three groups. After group A1 recovers the MODS disease incidence rate to be higher than group A2 （14/19,2/8, P 〈0.05 ）. The level of TNF- α in ROSC 24 h was higher than when its CPR and group A2 （ P 〈 0.05 ）, ROSC 48 h TNF - TNF - α, the IL - 8 level reaches the peak value,also was higher than the group A2 ,level of IL -4 and IL - 10 were higher than when its CPR （ P 〈0.05）, and had no statistics significance compared with group A2 （ P 〉 0.05 ）, level of ROSC 72 h TNF - α decrease, IL - 4 was higher than group A2. Conclusions The serum cytokines play an important role in the pathogenesis of lacks the blood - to pour into again after. To intervene and maintain the balance of cytokines may be a way to improve the patients prognosis after CPR.