4℃生理盐水诱导低温对猪心搏骤停复苏后肾脏的影响  

Influence on kidney after resuscitation of heart arrest due to hypothermia induced by 4 ~C normal saline in pig

作　　者：韩奕[1] 李春盛[1] 

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,100020

出　　处：《中华危重病急救医学》2013年第2期76-79,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金项目（30972863）

摘　　要：目的探讨4℃生理盐水诱导的低温状态对心搏骤停（CA）复苏后肾脏的影响。方法将猪致心室纤颤（VF）4min后给予标准心肺复苏（CPR），按随机数字表法将自主循环恢复（ROSC）猪分为两组（n=5），低温组给予4℃生理盐水，以1．33ml·kg-1·min-1的速度持续静脉泵入22min后以10ml·kg-1·min-1的速度维持4h；常温组同法给予常温生理盐水。于CA前基础状态和ROSC后各时间点监测血流动力学、氧代谢指标；取血检测血清尿素氮（BUN）和肌酐（Cr）；于ROSC后24h处死动物取肾脏组织，检测ATP酶活性，并于光镜及电镜下观察组织学改变。结果4℃生理盐水持续静脉泵入可使中心体温较基础状态最多下降1．5℃，心排血量有所降低，对ROSC后心率、平均动脉压和冠状动脉灌注压无明显影响，而氧摄取率较常温组降低。常温组ROSC 2h、4h BUN（mmol／L）和Cr（μmol／L）均较CA前明显升高（BUN：3．80±0．79、4．12±0．85比3．11±0．48．Cr：94．43±18．25、94．15±14．03比79．70±16．03，均P〈0．05）；低温组无明显变化，与常温组比较差异也无统计学意义。低温组ROSC 24h肾脏Na＋-K＋-ATP酶（μmol·mg-1·h-1）、Ca2＋-ATP酶（μmol·mg-1·h-1）活性虽较常温组下降，但差异无统计学意义（1．278±0．664比3．190±0．789，1．727±0．772比2．630±0．816，均P〉0．05）。与常温组相比，低温组肾脏组织损伤程度明显减轻，且线粒体结构完整。结论CPR后持续快速静脉泵入4℃生理盐水可在短时间内造成机体亚低温环境，维持复苏后血流动力学及氧代谢稳定，对肾脏有一定的保护作用。Objective To assess the effects of hypothermia state induced by 4 ℃ normal saline （NS） on kidney after successful cardiopulmonary resuscitation （CPR） in pig. Methods After the induction of a 4-minute ventricular fibrillation （VF） in pigs, standard CPR was performed, and then the surviving pigs were divided into two groups： hypothermia group （n = 5 ） with 4 ℃ NS continuous infusion at the speed of 1.33 ml·kg-1·min-1 for 22 minutes, and then the speed was slowed down to 10 ml·kg-1·min-1 and maintaining for 4 hours; the normal temperature group （n =5） with infusion of NS of normal temperature with the same speed as that of the hypothermia group. The hemodynamic parameters and oxygen metabolism were monitored before CA and also at different time points after recovery of spontaneous circulation （ ROSC ）. Blood samples were collected to determine the serum urea nitrogen （ BUN ） and ereatinine （Cr）. The animals were sacrificed, and the kidneys were collected to determine the ATPase activity, as well as the histological changes with both light and electron microscopy at 24 hours after ROSC. Results Continuous infusion of 4 ℃ NS could lower the central temperature by no more than 1.5 ℃, with a little lowering of cardiac output, without obvious changes in heart rate, mean arterial pressure and coronary perfusion pressure, but the oxygen extraction rate was decreased compared with that of the normal temperature group. Serum BUN （mmol/L）and Cr （μmol/L）at 2 hours and 4 hours of ROSC in the normal temperature group were higher than those before CA （BUN： 3.80 ± 0.79, 4.12 ±0.85 vs. 3.11 ±0.48; Cr： 94.43 ＋ 18.25, 94.15 ± 14.03 vs. 79.70 ± 16.03, all P〈0.05）, and the levels in hypothermia group showed no significant changes compared with those of normal temperature group. The activities of renal Na＋-K＋ATPase （ μmol·mg-1·h-1 ） and Ca2＋ATPase （ μmol·mg-1·h-1 ） at 24 hours after ROSC in the hypothermia group were lower than those in the norma

关 键 词：低温 心搏骤停 心肺复苏 肾脏 组织学 

分 类 号：R459.7[医药卫生—急诊医学]