心肺复苏后血清细胞因子与脑组织的变化以及巴曲酶对其影响的实验研究  

Changes of brain tissue and serum cytokines after cardiopulmonary resuscitation and the effect of batroxobin

作　　者：康舟军[1] 霍正禄[1] 曹晖[1] 

机构地区：[1]解放军第二军医大学附属长海医院急诊科,上海200433

出　　处：《中国急救医学》2009年第5期432-437,481,共7页Chinese Journal of Critical Care Medicine

摘　　要：目的研究巴曲酶对兔心肺复苏（CPR）后血液黏度、细胞因子及脑皮质、海马CA1区组织结构的变化与复苏成功率之间的关系。方法40只新西兰大耳白兔随机分为三组：①假手术组：8只；②常规复苏组：16只；③复苏加巴曲酶治疗组：16只。各组均于复苏后4、12h各取血7mL，用以测定全血黏度、血浆黏度、血清TNF-α、血清NO浓度。动物死亡后即刻取脑皮质、海马CA1区进行光镜、电镜检查，未死亡者24h后处死取脑皮质、海马CA1区进行光镜、电镜检查，同时计算死亡率。结果CPR4、12h常规复苏组、巴曲酶组全血黏度（高切、低切）、血浆黏度、血清TNF—α浓度、血清NO浓度均显著增高，与假手术组比较差异有统计学意义（P〈0．05），但巴曲酶组增高程度较常规复苏组小（P〈0．05）。光、电镜检查，假手术组均无异常，常规复苏组和巴曲酶组损伤明显，巴曲酶组优于常规组。复苏后24h存活率假手术组100％、常规复苏组37．5％、巴曲酶组72．2％，常规复苏组存活率显著降低（P〈0．05）。结论CPR后兔全血黏度、血浆黏度增高，血清TNF-α、NO持续升高，巴曲酶可降低全血黏度和血浆黏度，抑制CPR后血清TNF-α、NO升高。巴曲酶可通过上述机制减轻CPR后的脑组织损伤并提高CPR动物24h存活率。Objective To study the changes of blood viscosity, serum cytokines, brain histology and successful rate in rabbits after cardiopulmonary resuscitation （ CPR ） and the effect of Batroxobin. Methods Fourty rabbits were randomly divided into 3 groups ： sham - operated group （ n = 8 ） , conventional resuscitation group（ n = 16） ,Batroxobin group（ n = 16 ）. Sham- operated group was discharged on chest wall, which did not cause ventricular fibrillation. C group and B group were exposed to 6 min of cardiac arrest （CA） induced by ventricular fibrillation. At the beginning of resuscitation a dosage of 0.3 BU/ kg of Batroxobin and 0.03 mL/kg of saline was given to B group and C group. 7 mL blood was drawn at 4,7 h after CPR for evaluation of TNF-α, NO concentration in serum and blood viscosity. Histology of hippocampus of CA1 region and cerebral cortex were observed by light microscope, uhramicrostructure of cortex was examined by electronic microscope if the rabbits were dead in the experiment. 24 h later, all alived rabbits were killed to observe histology and uhramicrostructure by light microscope and electronic microscope, meanwhile, death rate was calculated. Results Whole - blood viscosity at high/low shear rate, plasma viscosity, TNF -α concentration, NO concentration of B,C group at both 4 h and 12 h increased when compared with sham（ P 〈 0.05 ）, but the rate of increase in B group was less than C group （ P 〈 0. 05 ）. Light microscope ： cellular structure of hippocampus of CA1 region and cerebral cortex in sham - operated group was normal on the whole. In conventional resuscitation group, irregular arrangement of pyramidal neurons, cellular edema, nuclear concentration can be observed. Microthrombus can be found in some capillaries . Less severely pathological change was found in Batroxobin group; no microthrombus can be found. Severity of ischemic injury of cortex was in the same turn when observed under electronic microscope. 24 h survival rate is 100% in sham group, 37.5% in

关 键 词：心肺复苏 血黏度 肿瘤坏死因子-α 一氧化氮 巴曲酶 

分 类 号：R605.974[医药卫生—急诊医学]