亚低温治疗及诱导时机对兔复苏后心功能影响的实验研究  

Effects of mild hypothermia and cooling time on cardiac function at the early stage of postresuscitation in rabbits

作　　者：李燕玲[1] 李培杰[1] 曹雯[1] 张立平[1] 李帅[1] 

机构地区：[1]兰州大学第二医院急救中心,甘肃730000

出　　处：《中国急救医学》2011年第8期708-712,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的 明确亚低温治疗及诱导时机对复苏后家兔心功能的影响,同时探讨其可能的作用机制.方法 通过体外致颤法建立家兔心肺复苏模型.18只健康家兔随机分为三组：常温复苏组（A组）、自主循环恢复后亚低温复苏组（B组）、心脏骤停后亚低温复苏组（C组）.A组家兔体温维持在38.3~39.6℃之间,B、C两组从家兔耳缘静脉以1.0 mL/（kg·min）速度泵入4 ℃ 0.9%生理盐水,同时配合体表降温方法诱导亚低温,要求10~15 min降至目标温度（32~34 ℃）.动态观察左室舒张末压（LVEDP）、左室内压上升和下降最大速率（±dp/dtmax）、平均动脉压（MAP）及血清心型脂肪酸结合蛋白（H-FABP）和8-异前列腺素F2α（8-iso-PGF2α）浓度变化.结果 ①与A组比较,B组LVEDP、MAP和±dp/dtmax在复苏成功后120、180、240 min时间点差异有统计学意义（P〈0.05）,C组LVEDP、MAP和±dp/dtmax在复苏成功后60、120、180、240 min时间点差异有统计学意义（P〈0.05）,且C组LVEDP升高幅度及±dp/dtmax降低幅度小于B组（P〈0.05）;②与致颤前比较,三组H-FABP和8-iso-PGF2α浓度在复苏后各时间点均明显升高（P〈0.01）,B、C组血清H-FABP和8-iso-PGF2α浓度升高幅度明显低于A组（P〈0.05）,且C组升高幅度小于B组（P〈0.05）.结论 亚低温治疗可以改善家兔复苏后心功能不全,尤其在心脏骤停即刻诱导亚低温心肌保护效果更显著,其心肌保护机制可能与减少自由基脂质过氧化物8-iso-PGF2α的生成有关.Objective To observe the effects of mild hypothermia and cooling time on postresuseitation ulyocardial dystunction, and to explore the partly underlying mechanism of action. Methods After setting up rabbit model of cardiupuhnonary resuscitation, 18 rabbits were randomly divided into tht^e gruups, group A ：normothermic resuscitation group, in which animals were performed standard CPR after c.ardiae arrest; group B： post- ROSC hypothermia group, in which animals were cooled to 32 - 34 ℃ after successful ROSC; gruup C： cardiac arrest hypothermia group, in which animals were cooled to 32 - 34 ℃ before attempted resuscitation. The left ventricular end - diastulie pressure（ LVEDP）, left ventricular pressure rise and fall rate （ ±dp/dtmax）, mean artery pressure （MAP） ,serum concentrations of H - FABP and 8 - iso - PGF2α were observed. Results ①Compared with group A, LVEDP, MAP and ± dp/dtmax in group B at time point of 120, 180, 240 rain had statistical significance（P 〈 0.05）, and LVEDP, MAP and ± dp/dtmax in group C at time point of 60, 120, 180, 240 rain had statistical significance（P 〈 0.05）. LVEDP increase and ± dp/dtmax decrx;ase were less in group C than in group B （ P 〈 0.05 ）. ② After the resuscitation, H - FABP and 8 - iso - PGF2α in thress groups increased obviously at different times （ P 〈 0.01 ）. The increase of H - FABP and 8 - iso - PGF2α was lower in group B and C than in group A （P 〈 0.05 ）, and the index increase was less in group C than in group B （ P 〈 0. 05 ）. Conclusion Mild hypothermia had a significant cardioprotective effect, especially in cardiac arrest hypothermia group. The cardioprotective effect is possibly associated with the reduction of 8 - iso - PGF2α.

关 键 词：心肺复苏 亚低温 复苏后心功能不全 心型脂肪酸结合蛋白 8-异前列腺素F2Α 

分 类 号：R541[医药卫生—心血管疾病]