不同时相亚低温治疗对心室纤颤兔脑功能的影响  

Effect of different therapeutic time windows of mild hypothermia on neurological protection from ventricular fibrillation in rabbit models

作　　者：牛宏涛 杨小华[2] 曹雯[1] 何囡囡 罗延年[1] 李培杰[1] 

机构地区：[1]兰州大学第二医院内科ICU,兰州730000 [2]兰州大学第二医院麻醉科,兰州730000

出　　处：《中华急诊医学杂志》2018年第1期44-50,共7页Chinese Journal of Emergency Medicine

基　　金：甘肃省卫生行业科研计划项目（GSWSKY-2015-62）

摘　　要：目的 探究不同时相行亚低温（mild hypothermia, MH） 治疗对心室纤颤（ventricular fibrillation , VF） 兔脑功能的影响。方法 本实验在兰州大学医学院实验室进行。45 只健康雄性日 本大耳白兔随机（随机数字法）分为常温复苏组（normothermic resuscitation group, NR）、CA 前亚 低温组（mild hypothermia pre-cardiac arrest group, HP）、复苏后30 min 亚低温组（mild hypothermia resuscitation 30 min group, HRe30）， 复苏后90 min 亚低温组（mild hypothermia resuscitation 90 min group, HRe90），常温假手术组（normothermic sham group, NS）和亚低温假手术组（hypothermia sham group, HS），采用体外电击法建立心搏骤停（cardiac arrest, CA）心肺复苏（CPR）兔模型，应用体表 降温法诱导亚低温，并维持至实验结束。所有动物于诱发CA 前15 min、自主循环恢复（restoration of spontaneous circulation, ROSC）后30、60、120、360 和600 min 分别测定心率（HR）、左室舒张期 末压（LVDEP）、左室内压上升或下降最大速率（peak±dp/dtmax）和平均动脉压（MAP）等血流动力 学指标，并留取动脉血待测血清神经元特异性烯醇化酶（NSE）和硫氧还蛋白（Trx）浓度。实验终 点时处死动物，留取全脑组织标本，利用原位末端缺口标记法（TUNEL）光镜下观察海马CA1 区细 胞凋亡情况并统计凋亡指数（AI）。多组间比较采用单因素方差分析，以P〈0.05 为差异有统计学意义。 结果 ①血流动力学：观察期间NR 组HR（次/min）于复苏后30、60、120、360、600 min 均高于 HP、HRe30 和HRe90 组；HP 组LVEDP 复苏后30 min 明显低于NR、HRe30 和HRe90 组，于复苏 后30 min、120 min明显高于NR、HRe30和HRe90组。HP组-dp/dtmax（ mmHg/s）于复苏后30、60、 120、360、600 min 明显高于NR 组。②血清学指标：HP 组NSE（μg/L）于复苏后360 min、600 min 低于NR、HRe30 和HRe90 组；NR 组Trx（ng/L）于Objective To investigate the effects of mild hypothermia neurological outcome after ventricular fibrillation （VF） in rabbits. Methods Zealand rabbits were induced VF by direct current of electricity. The rabbits on post-resuscitation Forty-ftve adult New were randomly（randomnumber） divided into following groups： normothermic resuscitation group （NR）, mild hypothermia pre- arrest group （HP）, mild hypothermia resuscitation 30 min group （HRe30）, mild hypothermia resuscitation 90 min group （HRe90）, normothermic sham group （NS）, and hypothermia sham group （HS）. The rabbits of NR group were observed for 600 min in room temperature after restoration of spontaneous circulation （ROSC）. The mild hypothenrlia was induced by surface cooling, and maintained for 600 min after the aimed low temperature reached. The arterial blood samples were collected for determining neuron-specific enolase （NSE） and thioredoxin （Trx） and the mean arterial pressure （MAP）, left ventrieular end-diastolic pressure （LVEDP） and left ventricular pressure raise and fall rate （＋dp/dtm^x） were observed at 15 min before CA, and 30 min, 60 min, 120 min, 360 min and 600 min after ROSC. After the animals were sacrificed at 600 min after ROSC, the whole brain of animals was harvested and observed under light microscope to calculate the apoptotic index of the hippocampal CA1 neurons by using TUNEL method. One-way ANOVA was used to determine the statistical significance between two groups, a two-tailed value of P〈0.05 was considered statistically significant. Results （1） Hemodynamically compared with normal temperature groups, FIR was lower in hypothermia groups. Compared with NR, HRe30, and HRe90 group, LVEDP was higher in HP group at 30 min after ROSC（3.4±0.8 vs. 4.6±1.0, 4.1±0.5, 4.3±0.2, F=9.85, P=0.019）.In HP group, the level of ＋dp/dtm,x was higher than that in NR, HRe30 and HRe90 groups at 30 min and 120 min after ROSC. In HP group, the level of -dp/dtmax was higher than that o

关 键 词：心脏骤停后综合征 亚低温治疗 心室纤颤 硫氧还蛋白 脑保护 兔 

分 类 号：R541.7[医药卫生—心血管疾病]