亚低温治疗对心肺复苏后兔脑组织中基质金属蛋白酶9和神经元特异性烯醇化酶水平及脑复苏的影响  

Effect of subcryogenic therapy on matrix metalloproteinase-9,neuron-specific enolase and cerebral resuscitation in rabbit brain tissue after cardiopulmonary resuscitation

作　　者：祝雅 赵晖[1] 董莲莲[1] 金燕[1] Zhu Ya;Zhao Hui;Dong Lianlian;Jin Yan(Department of Emergency Medicine,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院急诊科,杭州310016

出　　处：《中华危重症医学杂志（电子版）》2021年第5期374-379,共6页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：浙江省医药卫生科技计划项目(2018KY496)。

摘　　要：目的探讨亚低温治疗对心肺复苏后兔脑缺血再灌注损伤和继发脑水肿的影响。方法建立兔心脏骤停模型,将恢复自主循环的40只家兔分为常温组和亚低温组,每组各20只。复苏后72 h,根据兔大脑神经功能评分表对每组各存活的18只家兔进行评分,然后开颅取左侧大脑组织用于制作病理切片,采用免疫组织化学染色法测定家兔左侧大脑组织中基质金属蛋白酶9(MMP-9)和神经元特异性烯醇化酶(NSE)的表达水平。比较两组家兔心脏骤停前(T0)、心肺复苏成功后开始亚低温时(心肺复苏后0 h即T1)、达到亚低温目标体温时(心肺复苏后2 h即T2)、复温前(心肺复苏后14 h即T3)、恢复常温后(心肺复苏后24 h即T4)的心率、平均动脉压及氧饱和度。结果常温组和亚低温组家兔T0、T1、T2、T3、T4时间点心率比较,差异有统计学意义(F=13.155,P=0.001),且亚低温组家兔T2[(185±14)次/min vs.(209±8)次/min]和T3[(182±12)次/min vs.(205±8)次/min]时间点心率均较同时间点常温组显著降低(P均<0.05)。心肺复苏72 h后,亚低温组家兔的神经功能缺陷评分[(35±23)分vs.(56±28)分]、MMP-9[(1603±573)μm2 vs.(3633±1571)μm2]及NSE[(2075±564)μm2 vs.(3532±988)μm2]阳性面积均较常温组显著降低(t=2.398、4.498、4.697,P=0.022、0.001、0.001)。结论亚低温治疗可降低心肺复苏后兔脑组织中MMP-9和NSE的表达水平,促进脑功能恢复。Objective To investigate the effect of subcryogenic therapy on rabbit cerebral ischemia and reperfusion injury and secondary cerebral edema after cardiopulmonary resuscitation.Methods A rabbit cardiac arrest model was established,and then 40 rabbits recovering the autonomous cycle were divided into a normal temperature group and a sub-low temperature group,with 20 rabbits in each group.After resuscitation for 72 h,18 surviving rabbits in each group were evaluated according to the brain neurological function rating scale.The left side of brain tissue was cut open to make pathological sections.The expression levels of matrix metalloproteinase-9(MMP-9)and neuron-specific enolase(NSE)in the left cerebral tissue of rabbits were determined by immunohistochemical staining.The heart rate,mean arterial pressure and oxygen saturation before cardiac arrest(T0),after successful cardiopulmonary resuscitation(0 h after cardiopulmonary resuscitation,T1),after reaching the target body temperature of mild hypothermia(2 h after cardiopulmonary resuscitation,T2),before rewarming(14 h after cardiopulmonary resuscitation,T3)and after returning to normal temperature(24 h after cardiopulmonary resuscitation,T4)were compared between these two groups.Results There was a significant difference in the heart rate between the normal temperature group and sub-low temperature group at T0,T1,T2,T3 and T4 time points(F=13.155,P=0.001).The heart rates at T2[(185±14)beats/min vs.(209±8)beats/min]and T3[(182±12)beats/min vs.(205±8)beats/min]time points in the sub-low temperature group were significantly lower than those at the same time point in the normal temperature group(both P<0.05).After 72 h of cardiopulmonary resuscitation,the neurological deficit score[(35±23)vs.(56±28)]and the positive area of MMP-9[(1603±573)μm2 vs.(3633±1571)μm2]and NSE[(2075±564)μm2 vs.(3532±988)μm2]in the sub-low temperature group were significantly lower than those in the normal temperature group(t=2.398,4.498,4.697;P=0.022,0.001,0.001).Conclusion Subcry

关 键 词：心肺复苏 亚低温治疗 基质金属蛋白酶9 神经元特异性烯醇化酶 

分 类 号：R459.7[医药卫生—急诊医学]