高血压性灌注对心肺复苏成功后肺的影响

Effects of hypertensive perfusion on lung after successful cardiopulmonary resuscitation

目的猪心肺复苏成功后，用去甲肾上腺素诱导高血压性灌注，研究其对血清TNpa和IL-6、肺组织Na^＋-K^＋-ATP酶以及肺组织形态学的影响。方法10只家猪室颤4min，给予标准心肺复苏，复苏成功后分两组：（1）高血压组（n=5）立即给予去甲肾上腺素，使平均动脉压维持在室颤前血压的130％4h；（2）正常血压组（n=5）给予适量的去甲肾上腺素，维持平均动脉压为室颤前水平4h。监测血流动力学指标；分别在室颤前、复苏成功后10min，2h，4h取血，检测血清TNF—α和IL-6；复苏成功后24h取肺组织，检测Na^＋-K^＋-ATP酶，并行普通病理和超微结构检测。用配对t检验对数据进行统计学分析。结果高血压组除影响血压和心率外，对其他血流动力学指标影响较小，能够减少TNF-α和IL-6的释放（P〈0．01），增强肺泡细胞膜Na^＋-K^＋-ATP酶的活性，减少肺泡表面活性物质的消耗。结论去甲。肾上腺素诱导的高血压性灌注能够减少炎症因子的释放，增强肺泡细胞ATP酶的活性，对肺脏具有重要的保护作用。

Objective To investigate the effect of hypertensive perfusion which induced by norepinephrine on the TNF-α and IL-6 in serum and the activity of Na^＋-K^＋-ATPase in lung tissue and to observe the morphology of lung tissue. Method Ten domestic pigs were suffered from ventricular fibrillation for 4 minutes and applied cardiopulmonary resuscitation. The pigs they were divided into two groups. Hypertensive perfusion group （ n = 5） ： the mean arterial pressure which induced by norepinephrine was maintained as 130% as baseline for 4 hours; normal perfusion group （ n = 5） ： the mean arterial pressure was maintained as baseline for 4 hours, too. Hemodynamic parameters was observed, blood samples were extracted to detect the TNF-α and IL-6 in serum at the time of baseline, 10 min, 2 h and 4 h after successful resuscitation. The expression of Na^＋-K^＋-ATPase in lung tissue and the change of ultrastructure and pathology in lung tissue was detected at 24 h. All values were analyzed by student＇ s t test. Results There was no influence on hemodynamic parameters except the blood pressure and heart rate in hypertensive perfusion group. The release of TNF-α and IL-6 were reduced （ P 〈 0.01） and the activity of Na^＋-K^＋-ATPase was upgraded in hypertensive perfusion group. Hypertensive perfusion could play a protective role on the morphology of alveolar cell. Conclusions Hypertensive perfusion which induced by norepinephrine could reduce the release of inflammatory cytokines, upgrade the activity of the Na^＋-K^＋-ATPase, decrease the consumption of surfactant and have an important protective effect on lung tissue.