心肺复苏后大剂量糖皮质激素对脑单胺类神经递质及脑组织结构的影响  

Effects of high-dose glucocorticoid on monoamine neurotransmitters in brain after cardiopulmonary resuscitation

作　　者：赵丽云[1] 龚玉华[2] 于建设[2] 温再和[2] 叶铁虎[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院麻醉科,100730 [2]内蒙古医学院第一附属医院麻醉科

出　　处：《中华麻醉学杂志》2004年第5期352-356,共5页Chinese Journal of Anesthesiology

摘　　要：目的 探讨心肺复苏后大剂量糖皮质激素对脑单胺类神经递质及脑组织结构的影响。方法 21只健康杂种犬随机分为三组,常规复苏组(n=5),大剂量地塞米松组(n=8),大剂量甲基强的松龙组(n=8)。建立Pittsburgh标准室颤-心搏骤停(VF-CA)模型,复苏成功后大剂量地塞米松组和甲基强的松龙组分别经股静脉给予地塞米松5mg/kg和甲基强的松龙30mg/kg,各组动物于复苏后8h在麻醉状态下取右顶叶皮层组织三块,采用高效液相色谱-电化学法(HPLC-ECD)测定脑组织中单胺类神经递质5羟色胺(5-HT)、多巴胺(DA)的含量,显微镜和透射电镜观察其结构变化。结果 应用大剂量糖皮质激素后脑皮层组织中5-HT、DA的含量较常规复苏组明显下降(P<0.05),而大剂量地塞米松组和甲基强的松龙组间差异无显著性(P>0.05)。显微镜及透射电镜观察大剂量糖皮质激素组脑水肿和各细胞器的损害程度明显减轻,且甲基强的松龙组脑水肿减轻程度更为明显。结论 大剂量糖皮质激素具有确切的脑保护作用。Objective To examine if high-dose glucocorticoid has any cerebral protective effects after cardiopulmonary resuscitation. Methods Twenty-one healthy mongrel dogs of both sexes weighing 10 .5-15 kg were subjected to cerebral ischemia using Pittsburgh standard ventricular fibrillation-cardiac arrest (VF-CA) model. The animals were anesthetized with intraperitoneal pentobarbital sodium 30 mg·kg^(-1) and mechanically ventilated ther tracheal intubation (V_T 15 ml·kg^(-1), RR 18-20 bpm). Right femoral vein was cannulated for fluid administration (lactated Ringer's solution 0. 15 ml·kg^(-1)·min^(-1)) and right femoral artery was cannulated for BP monitoring. ECG was continuously monitored. The animals were randomly divided into 3 groups: group A received only routine resuscitation treatment (control, n = 5); group B received dexamethasone 5 mg·kg^(-1) (n = 8) and group C methylprednisolone 30 mg·kg^(-1) (n = 8) after successful cardiopulmonary resuscitation. 8 hours after resuscitation the animals were anesthetized and three pieces of brain tissue were obtained from right parietal lobe for light and electron microscopic examination and determination of dopamine (DA) and 5-hydroxy-tryptamine (5-HT) contents using high-performance liquid chromatography- electrochemical technique (HPLC- ECD ). Results The DA and 5 - HT contents in parietal lobe of cortex were significantly decreased in group B and C as compared with group A (P <0 .05). The degree of brain edema and damage to cell organelle were attenuated in group B and C. Conclusion High dose glucocorticoid has cerebral protective effects.

关 键 词：心肺复苏 大剂量 糖皮质激素 单胺类 神经递质 脑组织 脑损伤 

分 类 号：R459.7[医药卫生—急诊医学]