亚低温治疗对心肺复苏后肿瘤坏死因子α和白细胞介素2水平的影响

摘要

目的 探讨亚低温治疗对心搏骤停后心肺复苏患者外周血肿瘤坏死因子α(TNF-α)、白细胞介素2(IL-2)水平的影响.方法 回顾性分析2008年1月至2011年1月我院收治的心搏骤停经心肺复苏后患者30例,按干预方式不同分为亚低温治疗组与常温治疗组,各15例,监测2组患者TNF-α、IL-2在入院后各时间段的变化,并比较2组患者的严重并发症及病死率.结果 随着观察时间的延长,常温治疗组外周血清TNF-α含量逐渐升高,24h出现峰值,72 h降至12h水平,而亚低温治疗组在30 min到2h与常温治疗组无明显差异,但6、12、24、72 h亚低温治疗组血清TNF-α明显低于常温治疗组,且无峰值出现,组间差异均有统计学意义[6 h:(28.67±5.54)ng/L比(58.56±3.34) ng/L,12 h:(38.56±2.67) ng/L比(73.65±7.12) ng/L,24 h:(46.96 ±6.54) ng/L比(93.45 ± 8.43) ng/L,72 h:(43.53 ± 7.32) ng/L比(73.21 ±6.65) ng/L,均P ＜0.05].、常温治疗组和亚低温治疗组IL-2含量均逐渐升高,且均无峰值出现,但亚低温治疗组各时间点IL-2含量均低于常温治疗组,在各时间点组间差异均有统计学意义[30 min:(0.18 ±0.03)ng/L比(0.24±0.04)ng/L,1 h:(0.22 ±0.06) ng/L比(0.33±0.05) ng/L,2 h:(0.30±0.04) ng/L比(0.41±0.03) ng/L,6 h:(0.35 ±0.05) ng/L比(0.56 ±0.04) ng/L,12 h:(0.36 ±0.03) ng/L比(0.60 ±0.06) ng/L,24 h:(0.44±0.03) ng/L比(0.63±0.04) ng/L,72 h:(0.44±0.04) ng/L比(0.69 ±0.01)ng/L,均P＜0.05].常温组休克、成人呼吸窘迫综合征、上消化道出血、肾功能衰竭和弥散性血管内凝血的发生率分别为26.7％(4例)、33.3％(5例)、26.7％(4例)、20.0％(3例)和40.0％(6例),亚低温组相应并发症的发生率分别为33.3％(5例)、20.0％(3例)、13.3％(2倒)、13.3％(2例)和26.7％(4例),亚低温治疗组的严重并发症发生率均低于常温治疗组,组间差异有统计学意义(均P＜0.05)；常温组和亚低温组的病死率分别为73.3％(11例)和53.3％(8例),组间差异有统计学意义(P＜0.05).结论 亚低温治疗可以减少心搏骤停患者复苏后TNF-α、IL-2的释放,抑制炎症反应,降低各种严重并发症发生率和病死率.%Objective To explore the influence of therapeutic hypothermia on tumor necrosis factor α (TNF-α)and interleukin 2 (IL-2) in peripheral blood in cardiopulnonary resuscitation of cardiac arrest patients.Methods Totally 30 patients of successful cardiopulmonary resuscitation from January 2008 to January 2011 were divided into the hypothermia therapy group(n =15) and the routine therapy group(n =15).The changes of TNF-α,IL-2 of the two groups were observed in each time period in hospital,serious complications and mortality rate were compared between two groups.Results TNF-α in the therapeutic hypothermia increased.There was no significant difference of TNF-α at 30 min and 2 hour between hypothermia therapy group and the routine therapy group.IL-2 in the hypothermia therapy group was lower than that in the routine therapy group from 6 hours to 72 hours [6 h:(28.67±5.54)ng/L vs (58.56 ±3.34)ng/L,12 h:(38.56 ± 2.67) ng/L vs (73.65 ±7.12)ng/L,24 h:(46.96±6.54)ng/L vs (93.45 ± 8.43) ng/L,72 h:(43.53 ±7.32)ng/L vs (73.21 ±6.65)ng/L,P ＜0.05].IL-2 in the hypothermia therapy group was low than that in the routine therapy group at 30 min,1 hour,2 hours,6 hours,12 hours,24 hours and 72 hours; but IL-2 in the hypothermia therapy group was low than that in the routine therapy group [30 min:(0.18 ± 0.03) ng/L vs (0.24 ± 0.04) ng/L,1 h:(0.22 ± 0.06) ng/L vs (0.33 ±0.05)ng/L,2 h:(0.30±0.04)ng/L vs (0.41 ±0.03) ng/L,6 h:(0.35 ± 0.05) ng/L vs (0.56 ±0.04) ng/L,12 h:(0.36 ±0.03)ng/L vs (0.60 ±0.06)ng/L,24 h:(0.44 ±0.03)ng/L vs (0.63 ±0.04) ng/L,72 h:(0.44±0.04)ng/L vs (0.69±0.01) ng/L,P＜0.05].The serious complications and mortality rate in the hypothermia therapy group were lower than those in the routine therapy group(P ＜0.05).Conclusions Moderate hypothermia can reduce TNF-α and IL-2,inhibit inflammatory responses and reduce serious complications and mortality rate.