血管内降温治疗对复苏后综合征的保护作用及机制研究  

Protective effects of endovascular cooling treatment on post-resuscitation syndrome and its mechanism

作　　者：邹洋洋 陈立旻 华天凤[1] 杨旻[1] Zou Yangyang;Chen Limin;Hua Tianfeng;Yang Min(Second Department of Intensive Care Unit,the Second Affiliated Hospital of Anhui Medical University,Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine,Hefei 230601,Anhui,China)

机构地区：[1]安徽医科大学第二附属医院重症医学二科、心肺复苏与危重病实验室,安徽合肥230601

出　　处：《中华危重病急救医学》2018年第9期888-893,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金（81601661）;安徽省自然科学基金（1608085MH195）;安徽省博士后研究人员科研项同（20168140）

摘　　要：目的探讨血管内降温治疗对心脏停搏（CA）家猪复苏后综合征（PRS）的保护作用及机制。方法选择健康雄性家猪15只，诱颤后维持心室纤颤（VF）8 min，然后进行标准心肺复苏（CPR）。将复苏成功动物按随机数字表法分为两组。常温组维持动物核心体温在（38.0±0.5）℃并持续12 h；亚低温组复苏成功后5 min启动亚低温治疗，应用体温控制系统快速血管内降温至（33.0±1.0）℃并维持到复苏后6 h，然后以0.7℃/h的速度缓慢复温至（38.0±0.5）℃。持续监测动物心率（HR）、平均动脉压（MAP）、心排血量（CO）等血流动力学参数；分别于VF前和复苏后1、2、4、6、12、24 h取右侧股静脉血，采用酶联免疫吸附试验（ELISA）检测血清E-选择素、可溶性血栓调节蛋白（sTM）及白细胞介素-1β（IL-1β）水平。观察家猪复苏后24 h存活情况，对存活家猪进行神经功能缺损程度评分（NDS）；然后处死家猪取脑、心、肺组织，苏木素-伊红（HE）染色后，光镜下观察组织病理学改变。结果15只家猪经8 min VF后成功复苏14只，常温组和亚低温组各7只，复苏成功率为93.3%。两组动物体重、核心体温、血流动力学指标、血乳酸等基础生理学参数及CPR时间和除颤次数差异均无统计学意义。常温组动物核心体温均控制在（38.0±0.5）℃；亚低温组在复苏后1 h降至预定低温范围（33.0±1.0）℃，维持到6 h后缓慢升温达到基础体温（38.0±0.5）℃。与VF前比较，两组动物在复苏后HR明显增快，而MAP及CO降低，之后逐渐恢复正常；两组各时间点间血流动力学参数比较差异均无统计学意义。与VF前比较，两组动物复苏后1 h血清E-选择素、sTM水平即明显升高，6 h达峰值后逐渐下降；IL-1β随时间延长呈持续升高趋势。常温组与亚低温组VF前E-选择素（μg/L：1.34±0.52比1.60±0.61）、sTM（μg/L：19.13±0.34比19.24ObjectiveTo investigate the protective function of endovascular cooling method on post-resuscitation syndrome （PRS） in porcine cardiac arrest （CA） model and its mechanism.MethodsVentricular fibrillation （VF） was electrically induced and untreated for 8 minutes in 15 healthy male porcines, cardiopulmonary resuscitation （CPR） was then initiated. All successful recovery animals were randomly divided into two groups by random number table. In normal temperature group, the core temperature was maintained at （38.0±0.5） ℃ for 12 hours. In mild hypothermia group, the mild hypothermia treatment was initiated at 5 minutes after successful resuscitation, the treatment of rapid endovascular cooling was performed to reach the target cooling temperature of （33.0±1.0） ℃, and then maintained until 6 hours after resuscitation. Rewarming was implemented at the rate of 0.7 / until the body temperature reached （38.0±0.5） ℃. Hemodynamic parameters including heart rate （HR）, mean arterial blood pressure （MAP）, cardiac output （CO） were continually monitored. Right femoral vein blood was collected before VF and 1, 2, 4, 6, 12 and 24 hours after resuscitation, respectively, and the serum concentrations of E-selectin, soluble thrombomodulin （sTM）, and interleukin-1β （IL-1β） were determined with enzyme linked immunosorbent assay （ELISA）. The survival of porcines at 24 hours after resuscitation was observed, and the neurological deficit score （NDS） was calculated for the surviving porcines. All animals were sacrificed, and brain, heart and lung tissues were collected, after hematoxylin and eosin （HE） staining, the histopathology changes were evaluated under a light microscopy.ResultsAfter 8-minute VF, 14 porcines were resuscitated successfully, 7 porcines in normal temperature group and 7 in mild hypothermia group respectively, with the resuscitation success rate of 93.3%. There was no significant difference in body weigh, core temperature, hemodynamics, or blood lactate

关 键 词：心肺复苏 血管内降温 复苏后综合征 血管内皮细胞损伤 

分 类 号：R459.7[医药卫生—急诊医学]