兔心肺复苏后全身炎症反应综合征的动态变化

The dynamic changes of systemic inflammatory response syndrome after cardiopulmonary resuscitation in rabbits

目的探讨心搏骤停心肺复苏后全身炎症反应综合征（systemic inflammatory response syndrome，SIRS）的变化规律，为临床防治提供理论依据。方法将日本大耳白兔40只随机（随机数字法）分为假手术组和心搏骤停4，5，6min组，每组10只。假手术组仅进行麻醉和逆行气管插管、动脉血压监测，不进行气管夹闭窒息；心搏骤停组采用气管夹闭窒息法致使心脏骤停，分别于心搏骤停后4，5，6min进行复苏，分别在0，24，48，72，96，120h6个时点观察动物生理参数，取血样测定炎性因子肿瘤坏死因子-α（TNF-α）、C-反应蛋白（C—reactive protein，CRP）和白细胞的水平。多时点资料比较采用重复测定方差分析。结果复苏组心肺复苏后24h均呈现SIRS，TNF-α，CRP的表达明显升高，与心搏骤停前基础值相比差异具有统计学意义（P〈0．01）。心搏骤停4min复苏组，SIRS水平以24～48h较高，于复苏后72h基本消失。心搏骤停5，6min组，SIRS水平以24—72h较高，持续至复苏后96h。结论心搏骤停4min，SIRS较轻，容易恢复。心搏骤停5min以上，SIRS严重。心搏骤停复苏后血清TNF—α是反映SIRS程度的敏感指标，可作为SIRS的辅助诊断指标，并指导临床早期诊断、早期治疗。

Objective To explore the changes of systemic inflammatory response syndrome （SIRS） after cardiopulmonary resuscitation to provide basis for clinical prevention and treatment. Methods Forty rabbits were divided into the sham-operated group ; the cardiac arrest for 4 minutes, 5 minutes and 6 minutes groups randomly （random number）. Then the rabbits were anaesthetized, retrograde tracheal intubated . The cardiac arrest were induced by aphysia to all rabbits except the sham-operated group and the cardiopulmonary resuscitation were performed after 4, 5 and 6 minutes. The physiological parameters were evaluated at 24, 48, 72, 96 and 120 h after cardiac arrest. The serum samples were taken at the same to detect the level of tumor necrosis factor-α（TNF-α） , C-reactive protein （CRP） and white blood cell The data were analysed by repeated measure variance. Results The SIRS were presented at all cardiopulmonary resuscitation groups after 24 h of cardiac arrest. Compared to the sham-operated group, the level of TNF-α and CRP in resuscitation groups was significantly increased （ P 〈 0.01 ）. To the group arrested for 4 minutes, the SIRS were higher at 24 - 48 h and dissipated at 72 h. To the groups arrested for 5 or 6 minutes, SIRS were lasted for 96 h. Conclusions SIRS is easy to recover if resuscitation was taken within 4 minutes after cardiac arrest. After 5 minutes, SIRS is severe and hard to recover. Serum TNF-α is a sensitive marker to evaluate SIRS and can be used as the supplymentary diagnosic marker of SIRS to providing early treament and prevention.