西地那非对室颤猪心肌儿茶酚胺水平的影响  

The influence of sildenaffl on myocardial catecholamine level in a swine model of ventricular fibrillation

作　　者：袁伟[1] 武军元[1] 王国兴[2] 张茜[1] 李春盛[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 [2]首都医科大学附属北京友谊医院急诊科,北京100050

出　　处：《中华急诊医学杂志》2017年第1期37-43,共7页Chinese Journal of Emergency Medicine

摘　　要：目的通过分析室颤猪模型复苏前后血流动力学变化与心肌组织液中儿茶酚胺与乳酸水平的变化，研究西地那非预处理对复苏后心功能的保护作用。方法将北京长白猪24头随机（随机数字法）分为3组进行致颤：盐水组，西地那非组与假手术组。西地那非组于致颤前40rain将西地那非0．5mg／kg用0．9％氯化钠溶液配制成40mL溶液一次性灌胃；盐水组则给予同等量的0．9％氯化钠溶液40mL灌胃；假手术组：不予任何干预。在8min的无干预室颤后，对盐水组和西地那非组进行开胸心肺复苏。分别于基础时及自主循环恢复后4min、1h、6h测定并记录血流动力学数据。利用微透析探针留取室颤中及复苏后各时间段的心肌组织液，对其中的多巴胺、去甲肾上腺素、肾上腺素与乳酸水平进行检测分析。自主循环恢复后24h留取心肌病理样本，分析心肌细胞与细胞内线粒体变化。结果除基础状态外，西地那非组心肌组织液中多巴胺、去甲肾上腺素、肾上腺素与乳酸水平均低于盐水组（P〈0．05或P〈0．01）。西地那非组累积除颤能量低于盐水组（P〈0．05）。西地那非组复苏后血流动力学指标与心肌组织病理改变均优于盐水组（P〈0．05）。盐水组心肌组织与线粒体的病理变化较西地那非组更严重。结论西地那非预处理可以有效地减低室颤猪模型心肌组织中儿茶酚胺与乳酸的水平，进而起到保护心肌的作用，有利于改善复苏后的心功能。Objective To reveal the changes of catecholamine and lactate levels in myocardial interstitial fluid during cardiopulmonary resuscitation in order to prove the protective effects of sildenafil pretreatment on post-resuscitation myocardial function in swine model of ventricular fibrillation （VF）. Methods Twenty-four swine were randomly （random number） divided into three groups： saline group, sildenafil group and shame operation group. Sildenafil in dose of 0. 5 mg/kg dissolved in 40 mL of saline was given to swine once intraperitoneally 40 rain prior to VF in sildenafil group. The equivalent volume of saline （0. 9% NaCl） alone was administered instead in saline groups. There was no treatment in shame operation group. After ventricular fibrillation untreated for 8 min, open-chest eardiopulmonary resuscitation was initiated. The hemodynamic variables were recorded at baseline, 4 min, 1 h and 6 h after restoration of spontaneous circulation （ROSC）. The interstitial fluid from the left ventricle wall was collected by using the microdialysis tubes at given intervals, in which the levels of dopamine, norepinephrine, epinephrine, and lactate were measured. The samples for pathological examination were taken at 24 hours after ROSC. Results The levels of catecholamine and lactate in the sildenafil group were lower than those in saline group at all different intervals （ P 〈 0.05 or P 〈 0. 01 ）. The cumulative defibrillation energy was lower in the sildenafil group than that in the saline group （ P 〈 0. 05 ）. The hemodynamic changes and myocardial histological damage in sildenafil group were milder than those in saline group （ P 〈 0. 05 ）. The pathologic changes of myocardium and mitochondria in saline group were more severe than those in sildenafil group. Conclusions Sildenafil pretreatment prior to VF can effectively reduce endogenous catecholamine secretion and lactate levels in myocardial tissue, protecting the myocardium and improving post-resuscitation myocardial function.

关 键 词：西地那非 心肺复苏 微透析 儿茶酚胺 乳酸 血流动力学 

分 类 号：R541.75[医药卫生—心血管疾病]