CAJ | 학술논문

目的：筛选不同缺血后处理（ischemic postconditioning，IPost）方案对家兔挤压综合征（crush syndrome，CS）损伤保护效应的最佳时间窗。方法选取48只家兔随机分为对照组（ S组）及5个不同IPost方案组（ IPA～IPE组），每组8只。建立CS模型，并于解压前游离双下肢股动、静脉，解压后IPA组给予阻断下肢血流5 s，再灌注5 s，共5个循环（即5×5 s／5 s），IPB组5×30 s／30 s，IPC组5×1 min／1 min，IPD组5×5 min／5 min，IPE组3×10 min／10 min，继续观察至解压后24 h。分别于建模前，解压即刻及解压后2、6、12、18、24 h时间点检测家兔血液中肌酸激酶（ creatine kinase，CK）、肌红蛋白（ myoglo-bin，Mb）、中性粒细胞明胶酶相关脂质运载蛋白（ neutrophil gelatinase-associated lipocalin，NGAL）的含量。结果与S组相比，各IPost组均可降低解压后CS家兔血清CK、Mb和NGAL的含量。在解压后6、12、18、24 h，IPC、IPD组各指标与S组相比，差异均具有统计学意义（ P＜0．005）；IPC组各指标较IPD组低，但解压后各时间点两组之间比较无显著差异。结论 CS家兔再灌注前给予1～5 min的肢体远隔IPost对损伤具有保护作用，其中给予5个循环的1 min缺血，1 min再灌后处理具有最佳保护效应。
목적：사선불동결혈후처리（ischemic postconditioning，IPost）방안대가토제압종합정（crush syndrome，CS）손상보호효응적최가시간창。방법선취48지가토수궤분위대조조（ S조）급5개불동IPost방안조（ IPA～IPE조），매조8지。건립CS모형，병우해압전유리쌍하지고동、정맥，해압후IPA조급여조단하지혈류5 s，재관주5 s，공5개순배（즉5×5 s／5 s），IPB조5×30 s／30 s，IPC조5×1 min／1 min，IPD조5×5 min／5 min，IPE조3×10 min／10 min，계속관찰지해압후24 h。분별우건모전，해압즉각급해압후2、6、12、18、24 h시간점검측가토혈액중기산격매（ creatine kinase，CK）、기홍단백（ myoglo-bin，Mb）、중성립세포명효매상관지질운재단백（ neutrophil gelatinase-associated lipocalin，NGAL）적함량。결과여S조상비，각IPost조균가강저해압후CS가토혈청CK、Mb화NGAL적함량。재해압후6、12、18、24 h，IPC、IPD조각지표여S조상비，차이균구유통계학의의（ P＜0．005）；IPC조각지표교IPD조저，단해압후각시간점량조지간비교무현저차이。결론 CS가토재관주전급여1～5 min적지체원격IPost대손상구유보호작용，기중급여5개순배적1 min결혈，1 min재관후처리구유최가보호효응。
Objective To screen the best time-window of the protective effect of different ischemia postconditioning ( IPost) scheme on rabbits with crush syndrome ( CS) injury.Methods 48 healthy Japanese white rabbits were selected and randomly divided into control group ( S group) and 5 groups of different IPost scheme ( IPA~IPE group) , 8 rabbits each.CS model was established, and femoral arteries and veins were separated in the groin of both lower limbs before releasing of pressure.After decompression, the ar-teries of IPA group were treated with bulldog climp clamping for 5 s, then releasing 5 s, and repeated for 5 cycles (5 ×5 s/5 s), IPB group was 5 ×30 s/30 s, IPC group was 5 ×1 min/1 min, IPD group was 5 ×5 min/5 min, IPE group was 3 ×10 min/10 min, obser-vation lasted 24 h after releasing of pressure.The concentration of serum creatine kinase ( CK) , myoglobin ( Mb) and neutrophil gela-tinase-associated lipocalin (NGAL) were detected before establishment of CS model, immediateness after decompression and 2, 6, 12, 18 and 24 h after decompression.Results Compared with S group, the concentration of serum CK, Mb and NGAL were reduced in all Ipost groups after decompression.All indexes of groups of IPC and IPD in 6, 12, 18, 24 h after decompression was statistical significant in comparison with S group (P<0.005);All indexes of IPC group were lower than IPD group in each time point after decompression, but there was no significant difference.Conclusions Giving 1-5 min remote ischemia postconditioning for 5 cycles before reperfusion to rabbits with crush syndrome may produce effective protection to organism injuries; among these groups, IPC group ( 5 ×1 min/1 min) showed the most obvious effect.