目标温度管理对脓毒性休克犬血流动力学和心脏型脂肪酸结合蛋白的影响

Effects of Target Temperature Management on Heart Type Fatty Acid Binding Protein and Hemodynamics in Dogs with Septic Shock

目的探讨温度管理对脓毒性休克犬血流动力学和心脏型脂肪酸结合蛋白(H-FABP)的影响。方法 30只平均体质量20 kg的健康杂种犬按照随机数字法分为常温非感染组(NTNS)和温度管理非感染组(TMNS)各5只、常温感染组(NTS)和温度管理感染组(TMS)各10只。NTS和TMS感染组麻醉后,经股静脉以0.5 m L/(kg·h)的速度注入大肠埃希菌(1×109CFU/m L)制作犬高动力循环脓毒性休克模型。NTS和TMS组制模后,利用低温恒温槽及血泵装置,对TMNS组及TMS组实施体外血液冷却至温度维持于(33±1)℃。经左侧股动脉置入脉波轮廓温度稀释连续心排量测量技术(Pi CCO)动脉热稀释导管,通过压力传导系统与Pi CC连接,取0.5、24、48、72 h为观察时点,监测各组的全身血流动力学指标及心血管系统实验室指标的变化。结果 NTNS组与TMNS组:心率(HR)、收缩压(SBP)、心排血量(CO)、外周血管阻力(SVR)和左心室收缩力指数(dp/dtmax)在0.5 h时点和24~72 h各时点差异无统计学意义(P>0.05)。24、48、72 h各时点,NTS组和TMS组HR呈上升趋势,各时点TMS组低于NTS组;NTS组和TMS组SBP、SVR、dp/dtmax呈下降趋势,各时点TMS高于NTS组;NTS组和TMS组CO呈先升高后降低趋势,各时点TMS组低于NTS组。两组上述指标组间、时点间、组间·时点间交互作用比较差异均有统计学意义(P<0.05)。NTNS、TMNS不同时点间H-FABP无变化;NTS和TMS组24、48、72 h的H-FABP呈上升趋势,各时点间TMS组H-FABP低于NTS组。结论目标温度管理能改善脓毒性性休克犬的血流动力学指标,能降低H-FABP水平,减轻心肌损伤,改善心脏功能。

Objective To explore effects of target temperature management on hemodynamics and heart type fatty acid binding protein( H-FABP) in dogs with septic shock. Methods A total of 30 healthy dogs with an average weight of 20 kg were randomized into a normal temperature non-infected group( NTNS) and a temperature management non-infected groups( TMNS),of 5 dogs each; a normal temperature infected group( NTS),and a temperature management infected group( TMS),of 10 dogs each. After anesthesia,0. 5 m L/( kg·h) Escherichia coli( 1 × 109 CFU/m L) was injected into NTS and TMS group to set up high power circulatory septic shock models. Combining the blood pump devices and low temperature thermostat bath,the TMNS and TMS group was implemented extracorporeal blood cooling to maintain the blood temperature at( 33 ± 1) ℃. In the 0-72 h,pulse indicates the continuous cardiac output monitor( Pi CCO) monitored systemic hemodynamics. 0. 5,24,48 and 72 h were selected as the observation points to monitor the changes of systemic hemodynamic parameters and cardiovascular system test index. Results The base value of heart rate( HR),systolic blood pressure( SBP),cardiac output( CO),systemic vascular resistance( SVR),left ventricular contractility index( dpmax) and heart type fatty acid binding protein( H-FABP) had no significant differences in both NTNS and TMNS groups at 0. 5,24,48 h and72 h( P > 0. 05),the HR in both NTS and TMS group gradually increased at 24,48,72 h,with the TMS group significantly lower than NTS group at each time point( P < 0. 05); the Dp/Dtmax,SBP and SVR were gradually decreased,compared with NTS group,the TMS group was significantly higher( P < 0. 05) at each time point; the CO increased first and then decreased in NTS and TMS group,with TMS group lower than NTS group at each time point; The above indexes were statistically between groups,time points,and group and time points interaction( P < 0. 05). The H-FABP of NTNS and TMNS did not change at different time points; the H-FABP of NTS and TMS groups at 24,48 and 72 h showed an upward trend,and the H-FABP of TMS group was lower than that of NTS group at each time point. Conclusion Target temperature management has a protective effect on the cardiovascular system in dogs with septic shock,which can effectively lower the level of H-FABP,reduce myocardial injury and improve cardiac function.