不同缺血后处理方案对家兔挤压综合征损伤保护效应的实验研究

Experimental study on the protective effect of different ischemic postconditioning scheme in rabbits with crush syndrome

目的筛选不同缺血后处理(ischemic postconditioning,IPost)方案对家兔挤压综合征(crush syndrome,CS)损伤保护效应的最佳时间窗。方法选取48只家兔随机分为对照组(S组)及5个不同IPost方案组(IPA^IPE组),每组8只。建立CS模型,并于解压前游离双下肢股动、静脉,解压后IPA组给予阻断下肢血流5 s,再灌注5 s,共5个循环(即5×5 s/5 s),IPB组5×30 s/30 s,IPC组5×1 min/1 min,IPD组5×5 min/5 min,IPE组3×10 min/10 min,继续观察至解压后24 h。分别于建模前,解压即刻及解压后2、6、12、18、24 h时间点检测家兔血液中肌酸激酶(creatine kinase,CK)、肌红蛋白(myoglobin,Mb)、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)的含量。结果与S组相比,各IPost组均可降低解压后CS家兔血清CK、Mb和NGAL的含量。在解压后6、12、18、24 h,IPC、IPD组各指标与S组相比,差异均具有统计学意义(P<0.005);IPC组各指标较IPD组低,但解压后各时间点两组之间比较无显著差异。结论 CS家兔再灌注前给予1~5 min的肢体远隔IPost对损伤具有保护作用,其中给予5个循环的1 min缺血,1 min再灌后处理具有最佳保护效应。

Objective To screen the best time-window of the protective effect of different ischemia postconditioning （ IPost） scheme on rabbits with crush syndrome （ CS） injury.Methods 48 healthy Japanese white rabbits were selected and randomly divided into control group （ S group） and 5 groups of different IPost scheme （ IPA^IPE group） , 8 rabbits each.CS model was established, and femoral arteries and veins were separated in the groin of both lower limbs before releasing of pressure.After decompression, the ar-teries of IPA group were treated with bulldog climp clamping for 5 s, then releasing 5 s, and repeated for 5 cycles （5 ×5 s/5 s）, IPB group was 5 ×30 s/30 s, IPC group was 5 ×1 min/1 min, IPD group was 5 ×5 min/5 min, IPE group was 3 ×10 min/10 min, obser-vation lasted 24 h after releasing of pressure.The concentration of serum creatine kinase （ CK） , myoglobin （ Mb） and neutrophil gela-tinase-associated lipocalin （NGAL） were detected before establishment of CS model, immediateness after decompression and 2, 6, 12, 18 and 24 h after decompression.Results Compared with S group, the concentration of serum CK, Mb and NGAL were reduced in all Ipost groups after decompression.All indexes of groups of IPC and IPD in 6, 12, 18, 24 h after decompression was statistical significant in comparison with S group （P〈0.005）;All indexes of IPC group were lower than IPD group in each time point after decompression, but there was no significant difference.Conclusions Giving 1-5 min remote ischemia postconditioning for 5 cycles before reperfusion to rabbits with crush syndrome may produce effective protection to organism injuries; among these groups, IPC group （ 5 ×1 min/1 min） showed the most obvious effect.