黄芪注射液联合集束化治疗对心肺复苏后兔心脏保护作用的实验研究  

An experimental study on Huangqi injection associated with a combined treatment on protective effects of heart after cardiopulmonary resuscitation in rabbits

作　　者：梁建庆[1] 何建成[1] 

机构地区：[1]上海中医药大学基础医学院,上海201203

出　　处：《中国中西医结合急救杂志》2014年第4期241-244,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金资助项目（30873398）;上海市卫生系统优秀学科带头人培养计划（XBR2011070）;上海中医药大学研究生“创新能力培养”专项科研项目;基础医学院攀登计划（C0050101）

摘　　要：目的：观察黄芪注射液联合集束化治疗对心搏骤停（CA）模型兔心肺复苏（CPR）后血流动力学指标、脑钠肽（BNP）变化的影响，探讨其心脏保护的作用机制。方法将24只新西兰大白兔按随机原则分为4组，每组6只。采用体外电击法复制家兔CPR模型（接通50 V交流电胸壁致颤）。手术对照组仅进行麻醉、各种导管置入体内、气管切开，但不致颤。肾上腺素组复苏时右颈静脉导管注入肾上腺素30μg/kg。亚低温组在胸外按压的同时经右颈静脉导管注入肾上腺素30μg/kg，耳缘静脉以1.0 mL · kg^-1· min^-1速度泵入4℃0.9%氯化钠注射液，同时配合体表降温，维持目标温度（32～34℃）4 h直至实验结束。集束化治疗组在亚低温组治疗的基础上经右颈静脉注入4 g/kg黄芪注射液。于诱发室颤前15 min和复苏后30、60、120、180、240 min动态监测左室舒张期末压（LVEDP）、左室内压上升和下降最大速率（±dp/dt max）、平均动脉压（MAP）等血流动力学指标，同时于诱发室颤前15 min和复苏后30、180、240 min动态检测BNP浓度。结果与手术对照组比较，肾上腺素组、亚低温组和集束化治疗组复苏成功后LVEDP和BNP均明显升高，±dp/dt max、MAP显著下降。复苏后集束化治疗组各时间点LVEDP、BNP水平均明显低于肾上腺素组和亚低温组，且随时间延长LVEDP有升高趋势、BNP则逐渐降低，于复苏后240 min达峰值和谷值〔LVEDP（mmHg，1 mmHg＝0.133 kPa）：6.56±0.21比12.57±0.33、9.54±0.24，BNP（ng/L）：199±19比286±14、251±29，均 P＜0.01〕；各时间点±dp/dt max、MAP水平均明显高于肾上腺素组和亚低温组，且随时间延长逐渐降低，于复苏后240 min达谷值〔＋dp/dt max（mmHg/ms）：4229±353比2055±311、3224±158，-dp/dt max（mmHg/ms）：3587±168比1315±189、2357±245，MAP（mmHg）：82.02±1.81比44.15±1.17、56.79±1.60，均P＜0.01〕。结论黄芪注�Objective To observe the effects of Huangqi injection associated with a combined treatment on changes of hemodynamics indexes and brain natriuretic peptide （BNP） after cardiopulmonary resuscitation （CPR） in rabbit models with cardiac arrest （CA） to elucidate the mechanism of such cardiac protective effects. Methods Twenty-four New Zealand rabbits were randomly divided into four groups（each,n=6）. The CPR model in rabbits was reproduced by using extra-corporal electric shock method（put through 50 V alternating current to quiver on chest）. The animals in operation control group were given anesthesia,all kinds of catheter inserted into the body and tracheotomy,but no induction of ventricular fibrillation. In the epinephrine group,epinephrine （30 μg/kg）was injected into the right jugular vein by a catheter during CPR. In the sub-hypothermia group, epinephrine（30μg/kg）was injected into the right jugular vein via a catheter and 0.9%sodium chloride under 4℃at a rate of 1.0 mL · kg^-1 · min^-1 was pumped into the ear marginal vein simultaneously with the chest external compressions during CPR and the cooling of body surface sustaining at the target temperature （32-34℃） for 4 hours until the end of the experiment. In the combined treatment group,Huangqi injection（4 g/kg）was injected into the right jugular vein on the basis of treatment of sub-hypothermia group. Hemodynamics indexes such as left ventricular end-diastolic pressure（LVEDP）,the maximal rate of left ventricular pressure increase/decline（±dp/dt max）,and the mean arterial pressure（MAP）were dynamically monitored at 15 minutes before inducing ventricular fibrillation and at the early stage of post resuscitation for 30,60,120,180,240 minutes,and in the mean time the concentration of BNP was dynamically monitored at 15 minutes before inducing ventricular fibrillation and at the early stage of post resuscitation for 30,180,240 minutes. Results Compared with those of the operation control group,the levels of LVEDP

关 键 词：黄芪注射液 集束化治疗 心肺复苏 缺血/再灌注损伤 心肌 

分 类 号：R972[医药卫生—药品]