依托咪酯持续输注对失血性休克犬炎症因子的影响

Effects of continuous infusion of etomidate on inflammatory factors in dogs with hemorrhagic shock

目的对比观察不同剂量依托咪酯持续输注对失血性休克犬血清TNF-α、IL-6及IL-10含量的影响。方法健康成年雄性犬24只,体重12~14 kg,随机分为4组,每组6只。即：C组、对照组,S组、休克组,E1组、依托咪酯10μg/（kg·min）持续输注,E2组依托咪酯20μg/（kg·min）持续输注。4组犬基础麻醉后行气管插管,右侧股动脉、股静脉及左侧股动脉穿刺置管,全身肝素化。C组不作任何处理;S组、E1组和E2组在气管插管后建立失血性休克模型,平均动脉压（MAP）维持在40~50 mm Hg,E1和E2组在犬休克后分别持续输注依托咪酯10和20μg/（kg·min）1 h,然后回输血液进行复苏观察2 h。各组每30 min追加维库溴铵（0.05 mg/kg）,脑电双屏指数（BIS）维持在40-60。观察并记录休克前（T0）、休克1 h（T1）、复苏1 h（T2）及复苏2 h（T3）的MAP、中心静脉压（CVP）、心率（HR）、BIS、Sp O2和PETCO2,并抽取相应时间静脉血进行离心,采用放射免疫分析法测定血清TNF-α、IL-6及IL-10的含量。结果 C组各时间犬血清TNF-α、IL-6及IL-10含量比较差异无统计学意义（P〉0.05）;S组、E1组和E2组在T1时的血清IL-6、TNF-α含量升高（P〈0.05）,IL-10含量无明显变化（P〉0.05）;与S组比较,E1组各时间TNF-α、IL-6及IL-10含量无明显变化（P〉0.05）,而E2组在T1时的血清TNF-α、IL-6含量显著下降（P〈0.01）,IL-10含量亦降低（P〈0.05）。结论依托咪酯持续输注对失血性休克犬血清IL-6、TNF-α有抑制作用,20μg/（kg·min）依托咪酯持续输注对TNF-α、IL-6及IL-10抑制作用更明显。

[Objective] To study the infuence of continuous infusion of etomidate of different doses on TNF-α, IL-6 and IL-10 in dogs with hemorrhagic shock. [Methods] Twenty-four healthy adult male dogs weighing 12-14 kg were randomly divided into four group with 6 in each group： group C （control group）, group S （shock group）, group E1 [10 μg /（kg.min） etomidate continuous infusion] and group E2 [20 μg/（kg. min） etomidate continuous infusion]. The dogs also had basical anesthesia with 2.5% sodium pentobarbitone （25 mg/kg） and endotracheal intubation with veeuronium （0.1 mg/kg）. All were cathetered in femoral artery and femoral vein and totally heparinized. MAP, CVP, HR, PETCO2, SpO2 and BIS were continuous monitored. The group C did not receive any treatment. In the experimental groups the model of hemorrhagic shock was built and MAP wear maintained between 40-50 mmHg, while the dogs in the groups El and E2 had continuous etomidate infusion for 1 h and then the blood reinfusion for recovery, and were observed for 2 h. In all the groups vecuronium （0.05 mg/kg） were added every 30 minutes to maintain muscle relaxation. Radioimmunoas say was used to decect the content of serum IL-6, IL-10 and TNF-α before hemorrhagic shock （T0）, 1 h after shock （T1）, 1 h after resuscitation （T2） and 2 h after resuscitation （T3）. [Results] In the group C no statistically significant differences were found in IL-6, TNF-α or IL-10 between different time points （P〉 0.05）. Compared with the group C, the concentrations of IL-6 and TNF-α in the groups S, E1 and E2 at T1 were increased （P〈 0.01）, that of IL-10 did not change （P〉 0.05）. Compared with the group S, there were no differences in the levels of IL-6, TNF-α IL-10 in the group E1 （P〉0.05）, but the levels of IL-6 and TNF-α in the group E2 were decreased with statistical differences （P 〈 0.01）, and the level of IL-10 was also decreased in the group E2 （P 〈 0.05）. [Conclusion] Continuous etomidate infusion may inhibit the levels of IL-6 and TNF-α, and the effect of continuous etomidate infusion on TNF-α, IL-6 and IL-10 is more obvious at the rate of 20 μg / （kg.min）.