可溶性P-选择素、血小板激活因子与心肺复苏的关系探讨

Study of soluble P-selectin and PAF during and after cardiopulomonary resucitation

目的 探讨可溶性P -选择素、血小板激活因子 (PAF)能否成为恢复自主循环 (ROSC +)及其后全身炎性反应综合征 (SIRS)与脓毒血症评定的标准。方法 将心肺复苏 (CPR)组 6 0例分为ROSC +组 2 5例和未恢复自主循环 (ROSC - )组35例。ROSC +组又分为SIRS15例、非SIRS 9例 ,2 4～ 2 8h存活 1例 ,脓毒血症 13例、非脓毒血症 11例。各组血标本获取时间是 :ROSC +组分别于心跳骤停 (CA)时、ROSC +后、ROSC +4 8h后 ;ROSC -组分别在CA时、CPR失败后 ;脓毒血症患者和非脓毒血症患者在ROSC +4 8h后 ;以上血标本分别测血浆P -选择素及PAF浓度 ,此外动态观察ROSC +组TNF -α。凝血酶原时间 (PT)、活化部分凝血活酶时间 (APTT)、可溶性纤维蛋白单体复合物 (SFMC)为常规检查。 10例普通非危重病患者 (对照组 )处理同复苏组。结果 CPR组PT、APTT明显短于对照组 (P <0 .0 5 ) ;SFMC呈阳性 (P <0 .0 1) ;CA时、CPR后P -选择素、PAF、TNF -α明显高于对照组 (P <0 .0 5、P <0 .0 1)。ROSC -组患者CA时、CPR后P -选择素、PAF分别较ROSC +组患者浓度高 (P>0 .0 5 )。SIRS组、脓毒血症组P -选择素、PAF、TNF -α分别高于非SIRS组、非脓毒血症组及对照组 (P <0 0 1)。结论 可溶性P -选择素、PAF、TNF -α可预测SIRS及脓毒血?

Objective It is not known whether P-selectin or PAF might help to identify return spontaneour circulation(ROSC)?the systemic inflammatory reponse syndrome(SIRS)?sepsis after.Method Sixty hospital cardiac arrest patients were classified into two groups;those who achieved ROSC(n=25)?Trhose without ROSC(n=35).those with ROSC included SIRS n=15?Non SIRS n=9?24～48 hour survial n=1?sepsis n=13?Non sepsis n=11.In ROSC group vein blood was obtained in cardiac arrest (CA)after ROSC?48 hourafter ROSC.In non-ROSC group vein blood was obtained in CA and after CPR<Sepsis or non-sepsis group obtained vein blood by judgement sepsis during one week,All vein blood was measured sP-selectin?PAF or TNF was observed in those with ROSC a PT?APTT?SFMC were conventional inspection.Control subjects is ordinary non-critically ill control in our hospital,they were treated as CPR group.Results PT?APTT levels were lower in patients during CPR compared with non-critieally ill control patients( P <0.05),SFMC was positive( P <0.01);sP-selectin?PAF?levels were higher in patients without ROSC than patients with ROSC( P >0.05),sP-selectin?PAF?TNFα levels were higher in CA or after CPR;sP-selectin?PAF?TNFα levels were higher in patients with SIRS?sepsis compared with patients without SIRS?sepsis or control group.Conclusion sP-selectin?PAF?TNFα might help identify SIRS sepsis in patients with ROSC,they can not estimate ROSC.