窒息心脏骤停动物模型中碳酸氢钠对复苏的影响  

Effects of sodium bicarbonate on resuscitation in swine model of asphyxia cardiac arrest

作　　者：吴彩军[1] 李春盛[1] 杨军[1] 郭志军[1] 张奕[1] 

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,北京100020

出　　处：《中华急诊医学杂志》2015年第4期403-407,共5页Chinese Journal of Emergency Medicine

摘　　要：目的 研究碳酸氢钠（sodium bicarbonate,SB）在窒息心脏骤停（asphyxiation cardiac arrest,ACA）动物模型中对复苏预后的影响.方法 32只五指山幼猪随机（随机数方法）平均分成SB组（n=16）和对照组（n=16）,通过在呼吸末堵塞气管插管方法制作窒息型的心脏骤停模型,在成功制作心脏骤停模型后8 min后行标准心肺复苏.SB组在复苏即刻予以SB（1.0 mEq/kg稀释到40 mL）静脉推注,对照组予以40 mL生理盐水静脉推注.比较两组实验动物的自主循环恢复（return of spontaneous circulation,ROSC）率,复苏前和复苏后6h内血压,心排血量（cardiac output,CO）血液pH值,血清钠离子浓度变化.在基础状态以及复苏后6h利用正电子发射型计算机断层显像（positron emission tomography,PET）测定左心室心肌代谢最大标准化摄取值（themaximum standardized uptake value,SUVmax）.结果 SB组复苏成功率（10/16）较对照组复苏成功率（8/16）高,6h生存时间均值SB组较对照组长（3.63±0.76） hvs.（2.45±0.70）h,但差异均无统计学意义;两组实验动物在复苏前后血清钠离子比较差异无统计学意义;复苏后6h两组左心室心肌代谢SUVmax比较：SB组较对照组要高（1.32±0.20）vs.（1.10±0.14）,P=0.035.结论 窒息心脏骤停在复苏过程中使用SB可能会增加复苏成功率以及改善复苏后心肌代谢,且没有发生高钠血症.Objective To study the effects of sodium bicarbonate （SB） on resuscitation in swine model of asphyxiation cardiac arrest （CA）.Methods Thirty-two healthy miniature pigs were randomized （ramdom number） into two groups,the SB group （n =16） and the control group （n =16）.Animals in both groups underwent endotracheal tube clamping to induce CA.Once induced,CA left untreated for a period of 8 minutes.At the beginning of initiation of cardiopulmonary resuscitation （CPR）,SB （1.0 mEq/kg,diluted to 40 mL） was injected in central venous in SB group and isopyknic normal saline solution was injected in control group.Two minutes following initiation of CPR,defibrillation was attempted until return of spontaneous circulation （ROSC） was achieved or animals died.To assess the SB effects on myocardial metabolism,positron emission tomography （PET） was performed at baseline and 6 after ROSC.To analyze 18F-FDG myocardial uptake identified in PET,the maximum standardized uptake value （SUV） was measured.Results ROSC was 10/16 successful in SB group and only 8/16 successful in control group.The average survival time of SB group was （3.63 ± 0.76） h and that of control group was （2.45 0.70） h.Myocardial metabolism imaging using PET demonstrated that myocardial metabolism injuries in control group were more severe than in SB group at 6 h after ROSC and SUVmax was more higher in SB group than in control group （6 hrs after ROSC：1.32 ± 0.20 vs.1.10 ± 0.14,P =0.035）.Conclusions In swine model of asphyxiation CA,SB improve the myocardial metabolism and might raise the possibility of ROSC and have no hypernatronemia.

关 键 词：窒息 心脏骤停 碳酸氢钠 心肌代谢 正电子发射型计算机断层显像 高钠血症 自主循环恢复 复苏 

分 类 号：R541.78[医药卫生—心血管疾病] R-332[医药卫生—内科学]