浅低温联合富氢液对大鼠心脏停搏复苏后脑损伤的影响  

Effect of mild hypothermia combined with hydrogen-rich saline on cerebral injury after cardiac arrest and resuscitation in rats

作　　者：高宇 孙正琴 王强 段满林[3] 徐建国[3] Gao Yu;Sun Zhengqin;Wang Qiang;Duan Manlin;Xu Jianguo(Department of Anesthesiology,Zhongda Hospital Southeast University,Nanjing 210009,China;Department of Anesthesiology,Nanjing Meishan Hospital,Nanjing 210012,China;Department of Anesthesiology,Jinling Hospital,School of Medicine,Nanjing University,Nanjing 210018,China)

机构地区：[1]东南大学附属中大医院麻醉科,南京210009 [2]南京梅山医院麻醉科,210012 [3]南京大学医学院附属医院麻醉科,210018

出　　处：《中华麻醉学杂志》2019年第5期556-560,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价浅低温联合富氢液对大鼠心脏停搏复苏后脑损伤的影响。方法雄性SD大鼠165只,7~8周龄,体重280~320 g,采用随机数字表法分为5组(n=33):假手术组(S组)、心脏停搏复苏组(CA-R组)、富氢液组(H2组)、浅低温组(MH组)和浅低温联合富氢液组(MH+H2组)。CA-R组、H2组、MH组和MH+H2组采用经食管心脏起搏诱发心脏骤停后心肺复苏法建立大鼠脑损伤模型。H2组和MH+H2组于自主循环恢复(ROSC)即刻腹腔注射富氢液5 ml/kg,其余各组腹腔注射等容量生理盐水。MH组和MH+H2组于ROSC即刻行体表降温,体温于15 min内降至32~34℃,并维持4 h。于ROSC后24 h时,每组取15只大鼠,行神经功能评分(NDS);于ROSC后24 h每组处死18只大鼠,取脑组织,HE染色后观察海马CA1区病理学结果,并行锥体细胞计数;Western blot法检测葡萄糖调节蛋白78(GRP78)、C/EBP同源蛋白(CHOP)、caspase-12、caspase-3、Bcl-2和Bax的表达水平。结果与S组比较,其余4组NDS降低,锥体细胞计数减少,海马CA1区GRP78、CHOP、caspase-12、caspase-3和Bax的表达上调,Bcl-2表达下调(P<0.05)。与CA-R组比较,H2组、MH组和MH+H2组NDS升高,锥体细胞计数增多,海马CA1区GRP78和Bcl-2的表达上调,CHOP、caspase-12、caspase-3和Bax的表达下调(P<0.05)。与H2或MH组比较,MH+H2组NDS升高,椎体细胞计数增多,海马CA1区caspase-3和Bax的表达下调,Bcl-2表达上调(P<0.05),GRP78、CHOP和caspase-12的表达差异无统计学意义(P>0.05)。结论与单独应用浅低温或富氢液相比,浅低温联合富氢液减轻大鼠心脏停搏复苏后脑损伤的效应增强。Objective To evaluate the effect of mild hypothermia combined with hydrogen-rich saline on cerebral injury after cardiac arrest and resuscitation in rats.Methods Healthy male Sprague-Dawley rats,aged 7-8 weeks,weighing 280-320 g,were divided into 5 groups(n=33 each)using a random number table method:sham operation group(group S),cardiac arrest and resuscitation group(group CA-R),hydrogen-rich saline group(group H2),mild hypothermia group(group MH),and mild hypothermia plus hydrogen-rich saline group(group MH+H2).Cardiac arrest was induced with transoesophageal cardiac pacing followed by cardiopulmonary resuscitation to establish the cerebral injury model.Hydrogen-rich saline 5 ml/kg was intraperitoneally injected immediately after return of spontaneous circulation(ROSC)in H2 and MH+H2 groups,while the equal volume of normal saline was given instead in the other groups.The body temperature of rats was cooled down to 32-34℃within 15 min starting from the time point immediately after ROSC and maintained for 4 h in MH and MH+H2 groups.Fifteen rats were selected at 24 h after ROSC to assess the neurological function score(NDS).Eighteen rats in each group were sacrificed at 24 h after ROSC,and brains were removed for microscopic examination of the pathological changes in hippocampal CA1 region after hematoxylin and eosin staining and for determination of pyramidal cell count and expression of glucose-regulated protein 78(GRP78),C/EBP-homologous protein(CHOP),caspase-12,caspase-3,Bcl-2 and Bax in hippocampal CA1 region(by Western blot).Results Compared with group S,the NDS was significantly decreased,the pyramidal cell count was reduced,the expression of GRP78,CHOP,caspase-12,caspase-3 and Bax was up-regulated,and the expression of Bcl-2 was down-regulated in the other four groups(P<0.05).Compared with group CA-R,the NDS and pyramidal cell count were significantly increased,the expression of GRP78 and Bcl-2 was up-regulated,and the expression of CHOP,caspase-12,caspase-3 and Bax was down-regulated in H2,MH and MH+H2 g

关 键 词：低温 人工 氢 心脏停搏 心肺复苏术 再灌注损伤 脑 

分 类 号：R73[医药卫生—肿瘤]