CRRT联合ECMO对犬ARDS肺保护作用的实验研究

doi:10.3969/j.issn.1002-1949.2018.01.019

摘要
图/表
参考文献(18)
相关文章 (15)

全文: PDF (1133 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：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-related SIRS）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2~4 h和1~2 h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。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	贺玉钦
	梅雪
	尚明煦
	张京京
	詹庆元

收稿日期: 2017-07-27

基金资助:国家自然科学基金资助项目（81470270；81401629）

通讯作者: 詹庆元（1970-），男，博士，主任医师，科主任，教授，博士生导师，E-mail：zhanqy0915@163.com。

作者简介: 贺玉钦(1983-),男，硕士，主治医师，E-mail:doctorhe_2015@163.com。

引用本文:

贺玉钦，梅雪，尚明煦，张京京，詹庆元. CRRT联合ECMO对犬ARDS肺保护作用的实验研究[J]. 中国急救医学, 2018, 38(1): 84-88.
He Yu-qin, Mei Xue, Shang Ming-xu, Zhang Jing-jing, Zhan Qing-yuan. Protective effect of CRRT combined with ECMO against acute respiratory distress syndrome (ARDS) in canines. Chinese Journal of Critical Care Medicine, 2018, 38(1): 84-88.

链接本文:

http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.01.019 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I1/84

［1］Fan E, Gattinoni L, Combes A, et al.Venovenous extracorporeal membrane oxygenation for acute respiratory failure: A clinical review from an international group of experts［J］. Intensive Care Med, 2016, 42(5):712-724. ［2］Hodgson CL, Hayes K, Everard T, et al. Long-term quality of life in patients with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation for refractory hypoxaemia［J］. Crit Care, 2012, 16(5):R202. ［3］McILwain RB, Timpa JG, Kurundkar AR, et al. Plasma concentrations of inflammatory cytokines rise rapidly during ECMO-related SIRS due to the release of preformed stores in the intestine［J］. Lab Invest, 2010, 90(1):128-139. ［4］Adrian K, Mellgren K, Skogby M, et al. Cytokine release during long-term extracorporeal circulation in an experimental model［J］. Artif Organs,1998, 22(10):859-863. ［5］Landis RC, Arrowsmith JE, Baker RA, et al. Consensus statement: Defining minimal criteria for reporting the systemic inflammatory response to cardiopulmonary bypass［J］. Heart Surge Forum, 2008, 11(5):E316-322. ［6］Peng Y, Yuan Z, Li H.Removal of inflammatory cytokines and endotoxin by veno-venous continuous renal replacement therapy for burned patients with sepsis［J］. Burns, 2005, 31(5):623-628. ［7］Chen H, Yu RG, Yin NN, et al. Combination of extracorporeal membrane oxygenation and continuous renal replacement therapy in critically ill patients: a systematic review［J］. Crit Care, 2014, 18(6):675. ［8］Gattinoni L, Carlesso E, Langer T. Clinical review: Extracorporeal membrane oxygenation［J］. Crit Care, 2011, 15(6):243. ［9］Fortenberry JD, Bhardwaj V, Niemer P, et al. Neutrophil and cytokine activation with neonatal extracorporeal membrane oxygenation［J］. J Pediatr, 1996, 128(5 Pt 1):670-678. ［10］Mu TS, Palmer EG, Batts SG, et al. Continuous renal replacement therapy to reduce inflammation in a piglet hemorrhage-reperfusion extracorporeal membrane oxygenation model［J］. Pediatr Res, 2012, 72(3):249-255. ［11］Thangappan K, Cavarocchi NC, Baram M, et al. Systemic inflammatory response syndrome (SIRS) after extracorporeal membrane oxygenation (ECMO): Incidence, risks and survivals［J］. Heart Lung, 2016, 45(5):449-453. ［12］van Bommel E, Bouvy ND, So KL, et al. Acute dialytic support for the critically ill: intermittent hemodialysis versus continuous arteriovenous hemodiafiltration［J］. Am J Nephrol, 1995, 15(3):192-200. ［13］Lonnemann G, Bechstein M, Linnenweber S, et al. Tumor necrosis factor-alpha during continuous high-flux hemodialysis in sepsis with acute renal failure［J］. Kidney Int Suppl, 1999, 72:S84-87. ［14］Ballard-Croft C, Wang D, Sumpter LR, et al. Large-animal models of acute respiratory distress syndrome［J］. Ann Thorac Surg, 2012, 93(4):1331-1339. ［15］Sieberth HG, Kierdorf HP. Is cytokine removal by continuous hemofiltration feasible［J］. Kidney Int Suppl,1999, 72:S79-83. ［16］Bruenger F, Kizner L, Weile J, et al. First successful combination of ECMO with cytokine removal therapy in cardiogenic septic shock: a case report［J］. Int J Organs, 2015, 38(2):113-116. ［17］Xie Z, Ghosh CC, Parikh SM, et al. Mechanistic classification of the systemic capillary leak syndrome: Clarkson disease［J］. Am J Respir Crit Care Med, 2014, 189(9):1145-1147. ［18］Yimin H, Wenkui Y, Jialiang S, et al. Effects of continuous renal replacement therapy on renal inflammatory cytokines during extracorporeal membrane oxygenation in a porcine model［J］. J Cardiothorac Surg, 2013, 8:113.