体外膜肺氧合联合持续肾替代治疗对肠黏膜屏障功能影响的实验研究

Extracorporeal membrane oxygenation combined with continuous renal replacement treatment little affects the function of intestinal mucosal barrier in vitro

目的体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)逐渐成为以多器官联合支持为核心的体外生命支持(extracorporeal life support,ECLS)研究领域的热点,实验利用静脉-静脉体外膜肺氧合联合持续肾替代治疗(continuous renal replacement treatment,CRRT)观察ECMO联合CRRT对正常小型猪肠黏膜屏障功能的影响。方法将18只健康小型猪按完全随机设计方法分为假手术组(S组)、ECMO组(E组)和ECMO+CRRT组(EC组),每组6只。于实验前后行血培养,取肝、脾、肾、肠系膜淋巴结等组织行细菌培养,同时观察肠道显微及超微结构;分别于实验前1 h、实验后2、6、12和24 h测定血浆二胺氧化酶(diamine oxidase,DAO)和肠型脂肪酸结合蛋白(intestinal fatty acid binding protein,I-FABP)。结果 EC组小型猪肠黏膜组织病理评分低于S组和E组,差异有统计学意义(P<0.05)。血培养阳性例数S组和EC组均为1例,E组为2例;EC组肝、脾、肾和肠系膜淋巴结组织平均菌落数低于S组和E组,差异有统计学意义(P<0.05);EC组DAO呈下降趋势,S组无明显波动,E组呈逐渐升高趋势,24 h时达到最高,与EC组比,差异有统计学意义(P<0.05)。I-FABP在EC组治疗2 h时达到高峰,随后逐渐下降。结论 ECMO联合CRRT治疗优于单独使用ECMO治疗,对肠黏膜屏障功能影响较小。

Objective Extracorporeal membrane oxygenation （ECMO） is becoming a focus in the studies of extracorporeallife support. This study aimed to determine whether ECMO combined with continuous renal replacement treatment （CRRT） could alleviate the damage to the function of the intestinal mucosal barrier in piglets. Methods We randomly divided 18 healthy piglets into three groups of equal number, sham （S）, ECMO （E） and ECMO ＋ CRRT （EC）, and treated the latter two groups by ECMO and ECMO com-bined with CRRT, respectively, for 24 hours. We collected samples from the liver, spleen, kidney and mesenteric lymph node for bacteri al culture and observed the micro and ultra-structure of the intestine. At 1 hour before and 2, 6, 12 and 24 hours after treatment, wedetermined the concentrations of plasma diamine oxidase （DAO） and intestinal fatty acid binding protein （I-FABP）. Results The histopathological score of the intestinal mucus membrane was significantly lower in the EC group than in the S and E groups （ P 〈 0.05 ）. There were 2 cases of positive blood culture in the E group, but only 1 case in the S and the EC group, respectively. The mean number of bacterial colonies in the liver, spleen, kidney and mesenteric lymph node was remarkably lower in the EC group than in the other two （ P 〈 0.05 ）. The DAO concentration showed a trend of decreasing in the EC, no obvious change in the S, and a gradual ele vation in the E group, reaching the peak at 24 hours, significantly higher than in the EC group （ P 〈 0.05 ）. The level of I-FABP rose to the peak at 2 hours after treatment but then gradually descended. Conclusion ECMO combined with CRRT produces a better therapeutic effect than ECMO alone and exerts little influence on the function of the intestinal mucosal barrier.