窒息法致心搏骤停家兔心肺复苏后多器官功能障碍模型的建立方法与评价指标  

Reproducing and evaluating a rabbit model of multiple organ dysfunction syndrome after cardiopulmonary resuscitation resulted from asphyxia

作　　者：张东[1] 李南[1] 陈颖[1] 王育珊[1] 

机构地区：[1]吉林大学第一医院ICU,长春130021

出　　处：《中华危重病急救医学》2013年第2期72-75,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金（30870351）;吉林省科技发展计划项目（200705201）

摘　　要：目的探讨心搏骤停（CA）复苏后多器官功能障碍综合征（PR—MODS）家兔模型的建立方法和相关评价指标，为CA复苏后综合治疗研究提供具有实用价值的动物模型及评价方法。方法将35只家兔按随机数字表法分成假手术组（5只）、窒息7min组（15只）和窒息8min组（15只）。以夹闭气管法复制CA模型，心肺复苏（CPR）后观察两个窒息组家兔自主循环恢复（ROSC）率、不同时间点死亡率和全身炎症反应综合征（SIRS）发生率；同时检测两个窒息组家兔复苏前和ROSC后12、24、48血中肌酸激酶同工酶（CK—MB）、丙氨酸转氨酶（ALT）、肌酐（Cr）、血糖（Glu）及动脉血氧分压（PaO2）水平；在ROSC后48h处死存活家兔，光镜下观察心、脑、肺、肾、肝、小肠等器官的病理学变化；并根据主要器官功能及形态学变化判定是否发生CA后PR—MODS。结果①窒息7min组和8min组家兔ROSC率分别为100．0％和86．7％（P〉0．05）。窒息8min组家兔6h死亡率明显高于窒息7min组（46．7％比6．7％，P〈0．05），而12-48h死亡率仅有升高趋势（均P〉0．05）。②ROSC后存活家兔可出现球结膜水肿、呼吸窘迫、血压下降、腹胀和肠鸣音减弱或消失，以及少尿等不同程度器官功能受损的表现。③假手术组家兔未发生SIRS和主要器官功能受损相关指标的变化。两个窒息组家兔在ROSC后12～24h均发生SIRS反应；存活家兔在ROSC后12hCK—MB（U／L）即较窒息前明显升高（窒息7min组：786．88±211．84比468．20±149．45，窒息8min组：894．88±248．80比462．11±115．15，均P〈0．05），24h ALT（U／L）、Cr（μmol／L）、Glu（mmol／L）即明显升高（窒息7min组ALT：174．25±36．28比50．27±9．37，Cr：144．25±41．64比67．71±16．47，Glu：11．21±1．14比5．59±1．10；窒息8min组ALT：205．50±10．61比51．13±10．37，Cr：230．50±88．39比65．93±13．81，Objective To evaluate the reproduction of a model of post resuscitation multiple organ dysfunction syndrome （PR-MODS） after cardiac arrest （CA） in rabbit, in order to provide new methods for post-CA treatment. Methods Thirty-five rabbits were randomly divided into three groups, the sham group （n =5）, the 7-minute asphyxia group （n = 15 ）, and the 8-minute asphyxia group （n = 15 ）. The asphyxia CA model was reproduced with tracheal occlusion. After cardiopulmonary resuscitation （CPR）, the ratio of recovery of spontaneous circulation （ROSC）, the mortality at different time points and the incidence of systemic inflammatory response syndrome （SIRS） were observed in two asphyxia groups. Creatine kinase isoenzyme （CK-MB）, alanine aminotransferase （ALT）, creatinine （Cr）, glucose （Glu） and arterial partial pressure of oxygen （PaO2） levels in blood were measured in the two asphyxia groups before CPR and 12, 24 and 48 hours after ROSC. The survived rabbits were euthanized at 48 hours after ROSC, and heart, brain, lung, kidney, liver, and intestine were harvested for pathological examination using light microscope. PR-MODS after CA was defined based on the function of main organs and their pathological changes. Results （1） The incidence of ROSC was 100.0% in 7-minute asphyxia group and 86.7% in 8-minute asphyxia group respectively （P〉0.05）. The 6-hour mortality in 8-minute asphyxia group was significantly higher than that in 7-minute asphyxia group （46.7% vs. 6.7%, P〈0.05 ）, and the mortality of 8-minute asphyxia group at 12 - 48 hours was slightly higher compared with that of 7-minute asphyxia group （all P〉0.05 ）. （2） There was a variety of organ dysfunctions in survived rabbits after ROSC, including chemosis, respiratory distress, bypotension, abdominal distension, weakened or disappearance of bowel peristalsis and oliguria. （3） There was no SIRS or associated changes in major organ function in the sham group. SIRS was observed at 12 - 24 ho

关 键 词：心搏骤停 心肺复苏 多器官功能障碍综合征 动物模型 

分 类 号：R459.7[医药卫生—急诊医学]