CRRT联合ECMO对犬ARDS肺保护作用的实验研究

Protective effect of CRRT combined with ECMO against acute respiratory distress syndrome （ ARDS ） in canines

目的探讨持续床旁肾脏替代治疗（CRRT）对体外膜肺氧合相关炎症反应（ECMO-reliedSIRS）的清除作用和犬急性呼吸窘迫综合征（ARDS）肺的保护作用。方法选取成年杂种犬30只制成油酸所致ARDS模型，随机分为对照组（Control组）、假手术组（Sham组）、ECMO组（EC组）、ECMO＋CRRT组（EC＋CR组）。不同治疗过程中均留取9个时间点血标本检测IL-6和TNF-α。实验结束后留取肺组织匀浆标本，检测IL-6和TNF-α并测量肺组织湿干比（W／D），分重力依赖区和非重力依赖区留取肺组织进行光镜病理观察。结果治疗开始后血清炎症因子（IL-6、TNF-α）明显升高，与EC组比较EC＋CR组分别在随后2～4h和1-2h下降，与EC组比较差异有统计学意义（P〈0．05）。W／D提示运行ECMO后EC＋CR组较EC组减轻（P〈0．05），EC＋CR组病理学评分及肺组织中炎症细胞因子（IL-6、TNF-α）浓度较EC组均减轻（P〈0．05）。结论ECMO相关性炎症反应加重了肺损伤，CRRT对ECMO相关炎症反应有一定的清除作用，对犬ARDS肺损伤有一定的保护作用。

Objective To investigate the mitigation of continuous renal replacement therapy （CRRT） to extracorporeal membrane oxygenation related systemic inflammatory response syndrome （ECMO- related SIRS） and the lung protection against acute respiratory distress syndrome （ARDS） in canines. Methods Thirty adult canines were randomly divided into four groups： control group; sham group, ECMO （EC） group, ECMO ＋ CRRT （EC ＋ CR） group. Nine points of blood specimen of IL - 6 and TNF - c~ during treatment and homogenate of lungs after treatment were examined. Pathology specimen of canine lung according to gravity dependent or non - gravity dependent space was attained; the lungs tissue wet/dry ratio was assessed. Results Serum inflammatory cytokines （IL -6, TNF -a） significantly increased after the start of treatment. Compared with EC group, the concentration of IL - 6 and TNF - α in EC ＋ CR group decreased after 2 - 4 hours and 1 - 2 hours respectively （ P 〈 O. 05 ）. The pathology score and wet/dry ratio indicated that EC ＋ CR was better than EC group, the lung tissue homogenates revealed that there was a significance between EC group and EC ＋ CR group about inflammatory cytokines （ P 〈 0.05 ）. Conclusion In the ECMO - related SIRS - aggravated lung injury model, there is a certain mitigate effect on ECMO - related SIRS by CRRT, and there might be an alleviated effect to hmg injury.