七氟醚在兔心脏停搏自主循环恢复后亚低温治疗中的应用  

Application of sevoflurane in mild hypothermia therapy for cardiac arrest restoration of spontaneous circulation in rabbits

作　　者：毛慧[1] 南勇 陈环[2] 李声琴 李恒杰[2] MAO Hui;NAN Yong;CHEN Huan;LI Shengqin;LI Hengjie(Department of Anesthesiology,Zhejiang Provincial People's Hospital,People's Hospital of Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院,杭州医学院附属人民医院麻醉科,杭州310014 [2]浙江省人民医院,杭州医学院附属人民医院急诊科,杭州310014

出　　处：《浙江医学》2021年第19期2054-2057,2095,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2020KY028、2021KY074)。

摘　　要：目的探讨七氟醚在保证兔心脏停搏(CA)自主循环恢复(ROSC)后亚低温治疗中的应用效果。方法将雄性新西兰兔30只按随机数字表法分为对照组(Con组)、静脉药物亚低温组(IV组)和七氟醚亚低温组(Sevo组),每组10只。3组均建立心室颤动引起的CA模型,Con组在ROSC后不实施亚低温,IV组在ROSC后实施亚低温治疗的同时静脉泵注瑞芬太尼0.2μg/(kg·h)+丙泊酚4 mg/(kg·h),Se vo组ROSC后实施亚低温治疗的同时吸入2.4%七氟醚,目标温度34℃并维持12 h。亚低温治疗期间以床边寒颤评分(BSAS)评估寒颤发生情况,以脑电双频指数(BIS)监测麻醉深度;记录3组兔达到目标温度的时间、自主呼吸恢复时间、拔管时间;分别于ROSC 24、48、72 h进行神经功能缺损(NDS)评分;3组兔分别于造模前、ROSC 2 min、24 h、72 h检测血清神经元特异性烯醇化酶(NSE)和S-100钙结合蛋白β(S-100β)水平。结果亚低温实施过程中,Se vo组和IV组的BSAS比较差异均无统计学意义(均P>0.05),Sevo组BIS均短于IV组(均P<0.05);Sevo组自主呼吸恢复时间、拔管时间短于IV组(均P<0.05);Sevo组与IV组不同时点NDS评分均高于Con组(均P<0.05)。ROSC 24 h,Sevo组NDS评分高于IV组(P<0.05),ROSC 48 h和72 h两组NDS评分比较差异均无统计学意义(均P>0.05);ROSC 24、72 h,Se vo组和IV组血清NSE、S-100β水平均低于Con组(均P<0.05),Se vo组与IV组比较差异均无统计学意义(均P>0.05)。结论七氟醚可以保证CA兔ROSC后亚低温治疗的顺利实施,缩短自主呼吸恢复时间和拔管时间。Objective To investigate the application of sevoflurane in mild hypothermia therapy after cardiac arrest(CA)restoration of spontaneous circulation(ROSC)in rabbits.Methods Thirty male New Zealand rabbits were randomly divided into three groups:control group(n=10),intravenous injection mild hypothermia group(IV group,n=10)and sevoflurane mild hypothermia group(Sevo group,n=10).The ventricular fibrillation-induced CA was induced in last two groups,mild hypothermia was implemented by injection of propofol and remifentanyl after ROSC in the IV group,while mild hypothermia was implemented by inhalation of sevoflurane after ROSC in the Sevo group.The target temperature was 34℃and maintained for 12 h.During mild hypothermia,bedside shivering score(BSAS)was used to evaluate the occurrence of shivering,bispectral index(BIS)was used to monitor the depth of anesthesia.The time to reach the target temperature,to recovery of spontaneous respiration,to remove endotracheal intubation were recorded.neural function defect score(NDS)score was evaluated 24 h,48 h and 72 h after ROSC.Serum NSE and S-100β were measured at baseline,2 min,24 h and 72 h after ROSC.Results There was no significant difference in BSAS scores between Sevo group and IV group(P>0.05),the depth of anesthesia in Sevo group was lower than that in IV group(all P<0.05).The recovery time of spontaneous respiration and removal of endotracheal intubation in Sevo group were shorter than those in IV group(all P<0.05).NDS scores in Sevo group and IV group were higher than those in control group(all P<0.05).The NDS score of Sevo group was higher than that of IV group at 24 h after ROSC(P<0.05),and there was no significant difference in NDS score between the two groups at 48 h and 72 h after ROSC(all P>0.05).The serum NSE and S-100βlevels of Sevo group and IV group were lower than those of control group at 24 h and 72 h after ROSC(all P<0.05),while there was no significant difference between Sevo group and IV group(all P>0.05).Con-clusion Sevoflurane can support the im

关 键 词：心脏停搏 亚低温 七氟醚 镇静 自主循环恢复 

分 类 号：R541.78[医药卫生—心血管疾病]