氨基胍联合肾上腺素对心脏骤停自主循环恢复及心功能影响的实验研究  

Effects of aminoguanidine combined epinephrine on return of spontaneous circulation and heart function of cardiac arrest

作　　者：张彤哲[1] 陈红纲[3] 杨蓉佳[3] 潘政[1] 张蓓[1] 付晓燕[4] 李培杰[2] 马莉[1] 李培武[1] 

机构地区：[1]兰州大学第二医院急诊科,甘肃兰州730030 [2]兰州大学第二医院内科ICU [3]甘肃省人民医院急诊科,甘萧兰州730000 [4]兰州大学第一医院门诊部,甘肃兰州730000

出　　处：《中国急救医学》2013年第11期969-972,共4页Chinese Journal of Critical Care Medicine

基　　金：兰州大学中央高校基本科研业务费专项资金资助项目（Lzujbey-2012-201）

摘　　要：目的 研究选择性诱导型一氧化氮（NO）合酶抑制剂氨基胍（AG）联合肾上腺素（EPI）对心脏骤停自主循环恢复（ROSC）、心肺复苏（CPR）期间心功能及复苏成功率的影响.方法 将45只家兔建立心脏骤停模型,行胸外按压、机械通气,随机分为三组（每组n=15）：EPI（0.02 mg/kg）组、AG（20 mg/kg）＋ EPI（0.02 mg/kg）组及对照（生理盐水2 mL）组.持续按压5min后行电除颤.动态监测平均动脉压（MAP）、冠状动脉灌注压（CPP）、左室压最大上升及下降速率（±dP/dtmax）及血NO变化.结果 AG＋ EPI组和EPI组ROSC率分别为13/15、10/15,高于对照组6/15（P =0.028）；AG＋ EPI组4h复苏成功率12/15,高于EPI组（4/15,P=0.003）和对照组（3/15,P=0.001）.胸外按压期间AG＋ EPI组CPP第2～5 min及MAP第4～5 min均高于EPI组（P =0.001～0.000）；第4～5min＋ dP/dtmax及第3～5 min-dP/dtmax均高于EPI组（P=0.001～0.000）.ROSC后AG＋ EPI组第15～240 min MAP显著高于EPI组（P =0.001～0.000）；左室＋ dP/dtmax第15～240 min及-dP/dtmax第15、30、120、240 min也显著高于EPI组（P=0.001 ～0.000）.结论 AG联合EPI能增加CPR期间CPP,改善心脏舒缩功能,提高自主循环恢复；防止EPI复苏后早期心功能障碍的发生,提高CPR成功率.Objective To observe the changes of the restoration of spontaneous circulation （ROSC） after cardiac arrest, heart function during cardiopulmonary resuscitation （CPR） and the success rate of CPR treated with epinephrine （EPI） combined aminognanidine （AG）. Methods 45 domestic rabbits were divided into 3 groups （ n = 15 ） to receive either 0.02 mg/kg EPI, 0.02 mg/kg EPI ＋ 20 mg/kg AG or 2 mL saline placebo. After 5 rain chest compression rabbits were received defibrillation. Successfully resuscitated rabbits were observed for 4hrs. Hemodynamics variables and cardiac functions were monitoring with instrumentation. Results The rate of ROSC in AG ＋ EPI and EPI groups was significantly higher than that in control group （P =0. 028 ）. 12/15 AG ＋ EPI rabbits survived versus 4/15 EPI （P =0. 003） and 3/15 control rabbits （P = 0. 001 ） in early 4 hours after ROSC. During chest compression, the coronary perfusion pressure （CPP） of 2 - 5 min and mean arterial pressure （MAP） of 4 - 5 rain in AG ＋ EPI groups were higher than in EPI group （ P = 0. 001 - 0. 000 ） ; Left ventricular ＋ dP/dtmax of 4 - 5 min and - dP/dtmax of 3 N 5 min were higher than EPI group （P =0.001 - 0.000）. After ROSC MAP in AG ＋ EPI group of 15 - 240 min were higher than in EPI group （ P = 0.001 - 0. 000 ） ; Left ventricular ＋ dP/dtmax of 15 - 240 min and - dP/dtmax of 15, 30, 120, 240 min were significantly higher than those of EPI group （ P =0. 001 - 0. 000）. Conclusion AG combined with EPI can improve coronary perfusion pressure CPP, left ventricular systolic and diastolic function during CPR and subsequently increase ROSC and success rate of resuscitation.

关 键 词：心脏骤停 心肺复苏(CPR) 一氧化氮 氨基胍(AG) 肾上腺素(EPI) 

分 类 号：R977.1[医药卫生—药品]