CAJ | 학술논문

目的：探讨失血性休克合并内毒素血症“二次打击”致多器官功能衰竭（multiple organ dysfunction syndrome ，MODS）时兔循环内皮细胞（CEC）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、血气指标的变化及其相关性。方法选择新西兰兔24只，随机分为对照组、休克组、M ODS组3组，每组8只。休克组给予股动脉放血，1 h后回输。MODS组于回输后腹腔注射内毒素。对照组给予腹腔注射生理盐水。48 h后取静脉血检测CEC的含量及各组血清IL-6及TNF-α的浓度，取动脉血测定各组pH值、氧分压（PO2）和二氧化碳分压（PaCO2）。结果 MODS组中CEC的含量、IL-6和 TNF-α的浓度均高于对照组和休克组（P ＜0．05），MODS组中 pH值和PaCO2下降幅度也较对照组和休克组明显。相关性分析显示，CEC与血清IL-6和TNF-α的浓度呈正相关性（r ＝0．538，0．627），与PaCO2的改变呈负相关（r ＝-0．543）。结论“二次打击”致MODS时血管内皮细胞损伤与炎症因子的释放和血气指标的变化具有一定的相关性。
목적：탐토실혈성휴극합병내독소혈증“이차타격”치다기관공능쇠갈（multiple organ dysfunction syndrome ，MODS）시토순배내피세포（CEC）、종류배사인자-α（TNF-α）、백세포개소-6（IL-6）、혈기지표적변화급기상관성。방법선택신서란토24지，수궤분위대조조、휴극조、M ODS조3조，매조8지。휴극조급여고동맥방혈，1 h후회수。MODS조우회수후복강주사내독소。대조조급여복강주사생리염수。48 h후취정맥혈검측CEC적함량급각조혈청IL-6급TNF-α적농도，취동맥혈측정각조pH치、양분압（PO2）화이양화탄분압（PaCO2）。결과 MODS조중CEC적함량、IL-6화 TNF-α적농도균고우대조조화휴극조（P ＜0．05），MODS조중 pH치화PaCO2하강폭도야교대조조화휴극조명현。상관성분석현시，CEC여혈청IL-6화TNF-α적농도정정상관성（r ＝0．538，0．627），여PaCO2적개변정부상관（r ＝-0．543）。결론“이차타격”치MODS시혈관내피세포손상여염증인자적석방화혈기지표적변화구유일정적상관성。
Objective To investigate the change and correlation between circulating endothelial cells (CEC) and tumor necrosis factor-α(TNF-α) ,Interleukin-6 (IL-6) ,blood gas index in multiple organ dysfunction score (MODS) was made by“two-hit”which of hemorrhagic shock combine with endotoxemia .Methods Twenty-four healthy rabbits were randomly divided into 3 groups (n = 8):control group ,hemorrhagic shock group ,MODS group .The rabbits were drawn blood from femoral artery and transfused after 1 h in shock group .The rabbits were injected endotoxin into abdominal cavity after that in MODS group .48 hours later ,some indexes were measured ,including CEC ,TNF-α,IL-6 and pH ,PaCO2 ,PO2 .Results The content of CEC and concentration of TNF-α,IL -6 in MODS group were all higher than those in the control group and hemorrhagic shock group (P <0 .05) ,at the same time ,pH value and PaCO2 in MODS group were all lower than those in other groups .The correlation is that the content of CEC is positively re-lated to IL-6 and TNF-α(r =0 .538 ,0 .627) ,but it is negatively related to PaCO2 (r = -0 .543) .Conclu-sion The damage of VEC have some relationship between the inflammatory factor and blood gas index in the processs of MODS because of “two-hit” .