低温对猪心肺复苏模型脑保护中电解质的影响  

Effects of mild hypothermia used for protecting neurological function on electrolytes changes in swine model of ventricular fibrillation after cardiopulmonary resuscitation

作　　者：赵红[1] 李春盛[2] 丁宁[1] 

机构地区：[1]首都医科大学附属北京同仁医院急诊科,北京100730 [2]首都医科大学附属北京朝阳医院急诊科

出　　处：《中华急诊医学杂志》2014年第6期625-629,共5页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金（30972863）

摘　　要：目的：通过猪心肺复苏（cardiopulmonary resuscitation，CPR）模型，观察复苏后72 h内血流动力学参数和电解质的动态变化，以及低温治疗（hypothermia therapy）12 h对各指标的影响，为亚低温（Mild hypothermia，MTH）在脑复苏中的临床推广应用提供更为确凿有力的依据。方法制作了标准的猪心室颤动（ventricular fibrillation，VF）8 min模型，复苏成功动物采用随机数字表法分成常温组和 MTH 组，MTH 组在自主循环恢复（restoration of spontaneous circulation， ROSC）后立即以1℃/h速率给予血管内降温，核心温度达33℃后维持12 h，继之以0.5℃/h速率被动复温至38℃。复苏成功后24 h和72 h以双盲法用神经功能缺损评分（neurological deficit score，NDS）对猪神经功能状态进行评分，且分别动态观察两组在心脏停搏前、复苏成功后0.5 h、复苏成功后6 h、复苏成功后12 h、复苏成功后24 h和复苏成功后72 h血清钾和钠离子水平。结果ROSC成功率为84.2％，MTH 组24 h 和72 h 存活率分别为75％和62.5％，常温组分别为37.5％和25％，两组相比较差异具有统计学意义（P＜0.01）。MTH组和常温组血流动力学参数（心率、平均动脉压、心排量、肺动脉楔压、中心静脉压）差异无统计学意义（P＞0.05），MTH组在复苏后24 h血清钾明显低于常温组（3.41＆#177;0.11）（P＜0.01），各个检测时间点两组者血清钠差异无统计学意义，总体趋势比较两组血清钠和血清钾差异无统计学意义（P＞0.05）。MTH组的NDS在24 h和72 h分别为112.5（98.75～126.25）和61（50～75），常温组分别为230（225～235）和207.5（165～250），低温组的NDS均显著低于常温组（P＜0.01）。结论低温对血清钾钠的影响不大，可以明显改善神经功能预后，因此低温治疗在临床推广应用具有可行性。Objective To study the changes of hemodynamic parameters and electrolytes observed within 72 hours of hypothermic therapy in porcine model of cardiac ventricular fibrillation after cardiopulmonary resuscitation （CPR ） in order to provide clinical basis for safe application of mild hypothermia.Methods After typical ventricular fibrillation （VF）for 8 minutes,the survival animals were randomly （random number）divided into two groups,namely normothermia group and hypothermia group. Upon restoration of spontaneous circulation （ROSC ）,swine of the hypothermic group was treated by endovascular cooling device at a rate of 1 ℃/h until 33 ℃ and it was maintained for 12 h,then rewarming was initiated passively at a rate of 0.5 ℃/h until 38 ℃.The neurologic deficit scores （NDS）of swine were used to evaluate neurological function at 24 h and 72 h after recovery.Serum levels of potassium and sodium were measured at 0.5 h,6 h,12 h,24 h and 72 h after recovery.Results ROSC （restoration of spontaneous circulation）rate was 84.2%.The hypothermia group had higher survival rates at 24 h （75%） and 72 h （62.5%）compared to the normothermia group （37.5% and 25%,respectively）,（P〈0.01 ）. There were no significant differences in hemodynamic variables （HR,MAP,CO,PAWP and CVP）between the two groups （P〈0.05 ）,Serum potassium of the hypothermia group was lower obviously at 24 h after recovery （3.41 ±0.11）（P〈0.01）,and there were no significant differences in serum sodium at all the intervals,and there were no significant differences in underlying trend of electrolytes changes over time （P〉0.05）.The mean NDSs at 24 h and 72 h after recovery was 112.5 （98.75 -126.25）and 61 （50-75）, respectively,in the hypothermic group,and 230 （225 -235）and 207.5 （165 -250）,respectively,in the normothermia group （P 〈0.01 ）.Conclusions Hypothermia has little influence on serum levels of potassium and sodium,and mild hypothermia following resuscitation improves neurolog

关 键 词：心肺复苏 心室颤动 心脏骤停 低温疗法 血管内降温 血流动力学 自主循环恢复 神经功能缺损评分 

分 类 号：R459.7[医药卫生—急诊医学]