大剂量肾上腺素对心肺复苏大鼠心肌超微结构的影响  

Effect of highdose epinephrine on ultrastructure changes in myocardium in rats during cardiopulmonary resuscitation

作　　者：高瑞奚 万山 陈伟宏[1,2] 姜利人[1,2] 薄爱华[1,2] 李利华[1,2] 

机构地区：[1]北京军区第二五一医院 [2]河北省张家口医学院电镜室

出　　处：《中国危重病急救医学》1998年第11期648-651,共4页Chinese Critical Care Medicine

基　　金：北京军区科研课题基金

摘　　要：目的：观察用大剂量肾上腺素对心肺复苏大鼠心肌超微结构的影响，为心肺复苏时正确合理使用肾上腺素提供依据。方法：Ｗｉｓｔａｒ大鼠５０只随机分为５组：正常对照组（Ａ组）、模型对照组（Ｂ组）、标准剂量肾上腺素组（Ｃ组）、大剂量肾上腺素组（Ｄ组）和超大剂量肾上腺素组（Ｅ组）。用窒息使大鼠心脏停搏作为动物模型，进行心肺复苏，电镜观察心肌超微结构的变化。结果：Ａ组和Ｂ组心肌细胞超微结构正常，无明显区别。Ｃ组在复苏１０分钟时心肌超微结构无明显变化；复苏３０分钟时，心肌细胞肌丝排列不整齐，线粒体轻度扩张。Ｄ组复苏１０分钟时心肌超微结构无明显变化；复苏３０分钟时，心肌细胞部分损害，损害程度比Ｃ组复苏３０分钟时严重。Ｅ组复苏１０分钟时心肌超微结构略有部分改变；复苏３０分钟时，其损害比Ｄ组更加严重。结论：在复苏早期使用标准剂量肾上腺素和大剂量肾上腺素对心肌细胞超微结构无明显影响。在复苏晚期使用大剂量肾上腺素或超大剂量肾上腺素对心肌细胞超微结构有明显破坏。忽略其它复苏措施，单靠加大肾上腺素剂量有危险，应合理使用肾上腺素。Objective:To observe effects of highdose of epinephrine on ultrastructure changes in myocardium in rats during cardiopulmonary resuscitation (CPR).Methods:A cardiac arrest model was induced by asphyxiation in rats,and then CPR was performed in these animals.Fifty Wistar rats were randomly divided into 5 groups:normal control (group A),asphyxiated and CPR control (group B),standarddose epinephrine treatment (group C),highdose epinephrine treatment (group D),and superhighdose epinephrine treatment (group E).Pathological changes in myocardium were examined under electron microscopy.Results:No obvious differences in ultrastructure changes in myocardium were found between group A and group B.In group C,no marked abnormality in myocardium was noted at 10 minutes following CPR.At 30 minutes postCPR,however,it revealed pathologic lesions in group C including abnormality of myofilament arrangement and mild mitochondrial swelling.Similarly,no abnormal alterations in myocardial ultrastructure were observed in group D and mild changes occured in group E at 10 minutes postCPR;while the severity of myocardium damage was much greater in group D than group C,moreover,these lesions were remarkable in group E compared to D at 30 minutes following resuscitation.Conclusions:Our data suggest that during the early phase of CPR,use of epinephrine both in standard and high doses has no marked effect on myocardial ultrastructure.Treatment with high or superhighdose epinephrine during late phase of CPR,however,may lead to pathologic lesions in myocardium.Thus it is advisable that appropriate dose of epinephrine should be used in CPR,particularly during late phase.

关 键 词：心肺复苏 心肌 超微结构 肾上腺素 剂量 

分 类 号：R654.1[医药卫生—外科学]