作　　者： (潘颜戈辉）; (刘春峰）;

机构地区： 中国医科大学附属盛京医院小儿重症监护室,沈阳110004

出　　处： 《中国小儿急救医学》 2017年第8期580-586,共7页

摘　　要： 目的探讨脓毒性休克大鼠不同程度心功能障碍时，心肌收缩舒张功能的变化情况与心肌兰尼碱受体2（ryanodinereceport2，RyR2）表达水平的关系。方法250～300g雄性Wistar大鼠用随机数字法分为脓毒性休克组与对照组，脓毒性休克组与对照组又依不同时间分为0h、2h、4h、6h组，每组6只。脓毒性休克组予大鼠静脉注射内毒素，大鼠平均动脉压比基础值下降25％～30％被判断为休克。通过股动脉插管监测平均动脉压、颈动脉插管监测左室舒张末压、收缩期左室内压上升最大速率、舒张期左室内压下降最大速率。通过病理切片，观察心功能障碍时心肌组织病理变化，通过免疫组织化学方法观察RyR2蛋白表达总量的变化及磷酸化改变。通过PCR方法检测RyR2的基因表达水平。结果脓毒性休克组与对照组相比，心肌组织出现了结构紊乱、肌肉组织断裂、细胞溶解、细胞核裂解的现象，且脓毒性休克组大鼠心功能障碍随着休克时间的延长而逐渐加重。免疫组织化学可见，脓毒性休克组RyR2表达水平高于对照组（P〈0．01），休克0h组表达最高，随着休克时间的延长，大鼠心功能下降，RyR2的表达水平逐渐下降，但RyR2磷酸化水平随着休克时间延长呈上升趋势。PCR结果可见脓毒性休克组RyR2的mRNA表达水平高于对照组（P〈0．01），休克早期表达较高，随着休克时间的延长，RyR2基因表达水平逐渐下降。结论RyR2作为心肌组织中的Ca2＋通道，在脓毒性休克情况下，心功能障碍的严重程度可能与RyR2受体的表达水平及其磷酸化程度有关。 Objective To investigate the changes of myocardial systolic and diastolic function and the expression of ryanodine receport 2 （ RyR2 ） during different degree of myocardial dysfunction in septic shock rats. Methods We used random number method to divide 250 to 300 g male Wistar rats into septic shock group and the control group which were divided into 4 subgroups at different time intervals of 0 h,2 h, 4 h ,6 h with six rats in each subgroup. The rat model of septic shock was established by intravenous dosing of LPS. When mean arterial pressure reduced by 25 % to 30% from the basic value, a model of septic shock was established. We monitored the mean arterial pressure through femoral arterial catheterization and the left ven- tricular end-diastolic pressure, maximum rate of left ventricular systolic pressure rise （ ＋ dp/dt max） and maximum rate of left ventricular diastolic pressure drop（-dp/dt max）through carotid arterial catheterization. The pathological changes of myocardial tissue were observed via the pathological sections. The changes of RyR2 expression and the phosphorylation of RyR2 were detected via immunohistochemistry. The change of RyR2 gene expression was detected via PCR. Results In septic shock group, myocardial structure disturb- ance was worsen, myocardial tissue was ruptured, and myocardial cells and nucleus was disrupted. Myocardial dysfunction was gradually aggravated with the extension of time. The immunohistochemical results showed that the expression of RyR2 protein in septic shock group was higher than that in the control group （P 〈 0. 01 ）, while the expression at 0 h in septic shock group was the highest. As the extension of shock time ,the myocardial function of rats decreased,the expression of RyR2 gradually declined in protein level ,but the phos- phorylation of RyR2 rised. The PCR results showed that the mRNA expression of RyR2 in septic shock group was higher than that in the control group（P 〈0. 01 ）, while the mRNA expression in septic shock group at early

关 键 词： 脓毒性休克 左心功能 兰尼碱受体