亚低温联合瑞芬太尼对家兔心肺复苏后早期心功能影响的实验研究  

Effect of remifentanil combined with mild hypothermia on cardiac function at early stage of postresuscitation in rabbits

作　　者：李帅[1] 李培杰[1] 曹雯[1] 张立平[1] 张正义[1] 罗延年[1] 李燕玲[1] 

机构地区：[1]兰州大学第二医院内科ICU,甘肃730000

出　　处：《中国急救医学》2011年第6期513-517,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的研究亚低温联合瑞芬太尼对家兔心肺复苏后心功能的保护作用，探讨其相关保护机制。方法通过体外致颤法建立家兔心肺复苏模型。30只清洁级家兔随机分为五组，对照组（A组）：仅行麻醉、手术、气管插管，但不致颤；常规复苏组（B组）：仅采用常规方法复苏；亚低温复苏组（C组）：自主循环恢复即刻给予亚低温治疗；瑞芬太尼复苏组（D组）：自主循环恢复即刻给予瑞芬太尼；亚低温联合瑞芬太尼复苏组（E组）：自主循环恢复即刻给予瑞芬太尼及亚低温处理。动态观察左室舒张末压（LVEDP）、左室内压上升和下降最大速率（peak±dp／dt）及血清心型脂肪酸结合蛋白（H—FABP）和8-异前列腺素（8-iso—PGF2α）浓度的变化。结果①与A组比较，其余四组LVEDP和peak±dp／dt在复苏成功后30min差异有统计学意义（P均〈0．01）；与B组比较，C、D组LVEDP和peak4-dp／dt在复苏成功后120min差异有统计学意义（P均〈0．05），但C、D两组比较差异无统计学意义，而E组LVEDP和peak±dp／dt在复苏成功后60min差异有统计学意义（P均〈0．05），且E组LVEDP升高幅度及peak4-dp／dt下降幅度也小于C、D组（P均〈0．05）；②与A组比较，其余四组血清H—FABP和8-iso—PGF2α浓度明显升高（P均〈0．01）；与B组比较，C、D、E组血清H—FABP和8-iso—PGF2α浓度明显降低（P均〈0．05），但E组下降幅度最为明显（P〈0．05）。结论亚低温及瑞芬太尼干预均可改善复苏后心功能不全，两者联用具有协同作用，能进一步提高疗效，其机制可能与自由基清除有关。Objective To observe the effects of remifentanil combined with mild hypothermia on postresuscitation myocardial function in rabbits, and further to explore the partly underlying mechanism of action. Methods After setting up rabbit model of cardiopnlmonary resuscitation, 30 rabbits were randomly divided into five groups - group A： the control group, only anesthesia, surgery and endotracheal intubation, but not flutter; group B： conventional CPR group; group C： in which rabbits were given hypothermia after successful ROSC; group D： in which rabbits were given remifentanil after successful ROSG; group E： in which rabbits were givcn remifentanil combined with mild hypothermia after successful ROSC. The left ventricular end - diastolic pressure （LVEDP） , left ventricular pressure rise and fall rate （ peak ＋ dp/dt ） , serum concentrations of H - FABP and 8 - iso - PGF2a were continuously observed. Results Compared with group A, LVEDP and peak ＋ dp/dt were significantly different in group B, C, D and E at 30 min after complete resuscitation（ all P 〈 0. 01 ） ; compared with group B, there was statistical significance in LVEDP and peak dp/dt at 120 min after successful resuscitation among group C and group D（ all P 〈0. 05 ）, but no differences were found between group C and group D, the above - mentioned data had statistical significances at 60 min after successful resuscitation in group E（ P 〈 0. 05 ）, the increase of LVEDP and decrease of peak ± dp/dt in group E were minor to those in group C and group D（ all P 〈 0.05 ）. Compared with group A, H - FABP and 8 - iso - PGF2ctin the serum significantly increased in other four groups（ all P 〈 0.01 ）. H - FABP and 8 - iso - PGF2αn the serum of group C, D and E were significantly lower in comparison with those in group B,especially in group E （P 〈 0. 05 ）. Conclusion Mild hypothermia and remifentanil can both improve postresuscitation myocardial dysfunction,and a combination of both has even stronger protective effec

关 键 词：心肺复苏 心脏骤停后综合征 亚低温 瑞芬太尼 

分 类 号：R[医药卫生]