弥散张量成像技术对亚低温治疗猪复苏后脑损伤的效果评价  

Effect Evaluation of Diffusion Tensor Imaging to Mild Hypothermia Therapy in Pig Brain Injury after Cardiac Arrest

作　　者：唐子人[1] 李春盛[1] 彭朋[2] 蒋涛[2] 赵红[1] 龚平[1] 花嵘[1] 

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,北京市100020 [2]首都医科大学附属北京朝阳医院放射科,北京市100020

出　　处：《中国病案》2014年第5期68-71,共4页Chinese Medical Record

基　　金：北京市中医药科技发展资金项目(JJ2013-16)

摘　　要：目的通过弥散张量成像(DTI)技术研究心肺复苏成功后72小时内脑功能、脑损伤的动态变化趋势和亚低温的脑保护作用。方法五指山猪32只,致颤8分钟后按标准心肺复苏操作,复苏成功28只,随机分为低温组14只和常温组14只。低温组在自主循环恢复后给予血管内降温,将核心体温以最快速度降至33℃,维持低温12小时后被动复温(0.5℃/h)至37℃,常温组不干预温度,两组动态监测血流动力学变化,于基础状态,ROSC后6h,12h,24h,72h行脑组织DTI检测。统计学处理采用Student t检验、重复测量方差分析及Kaplan-Meier生存分析。结果低温组72小时成活率优于常温组(78.6%vs.50%,P<0.123),72小时神经功能缺损评分显著优于常温组(43.83分vs.110.57分,P=0.001)。DTI结果显示:两组表观弥散系数值与部分各向异性数值在复苏后均出现了明显的降低,低温组较常温组降低幅度小。结论亚低温疗法一定程度上可以提高复苏成功率,减轻脑损伤,对脑复苏具有重要的保护作用;DTI技术可以对复苏后脑损伤进行动态监测,对干预措施进行动态评价。Objective To explore the brain function within 72 hours after cardiopulmonary resuscitation,the dynamic change trend after brain injury and the brain protect function of mild hypothermia therapy with the application of diffusion tensor imaging（DTI） technology.Methods Ventricular fibrillation was induced in 32 inbred wuzhishan miniature pigs,standard CPR was performed after 8 minutes of untreated ventricular fibrillation and 28 cases were recovered successfully.Then the 28 cases were randomly assigned to normothermia group（n=14） and hypothermia group（n=14）.The hypothermia group immediately received endovascular cooling to regulate temperature to 33°C,which was maintained for 12 hours,followed by passive rewarming at 0.5°C/h to 37°C,while the normothermia group received no intervention.The two groups were scanned the DTI at baseline,6h,12h,24h,and 72h after ROSC.The statistical analysis used Student t test,One-way repeated-measures and Kaplan-Meier survival analysis.Results Compared with the normothermia group,the hypothermia group exhibited a higher 72 h survival rate（78.6% vs.50%,P〈0.123）,superior neurological deficit scores（43.83 vs.110.57,P=0.001）.The average diffusion coefficient value and fractional anisotropy in both groups decreased after ROSC and a smaller decrease in the hypothermia group.Conclusions Mild hypothermia therapy could increase the successfully ROSC rate and alleviate brain injury,which had important protect function to the recovery of brain.DTI could effectively reflect the dynamic trend of cerebral injury after ROSC and conduct dynamic evaluation to the intervention measures.

关 键 词：心脏骤停 心肺复苏 亚低温治疗 弥散张量成像 表观弥散系数 部分各向异性 

分 类 号：R742[医药卫生—神经病学与精神病学]