基于促进心肌能量代谢的复苏策略对家兔失血性心跳骤停效果的初步观察  

Preliminary observation on the effects of myocardial energy metabolism-promoted resuscitation strategy on hemorrhagic induced cardiac arrest in rabbits

作　　者：张琳[1,2] 于蕊 宗兆文 叶钊 钟鑫 贾益君 蒋仁庆 周小林 杨昊洋[1] 杜文琼 ZHANG Lin;YU Rui;YE Zhao;ZONG Zhaowen;ZHONG Xin;JIA Yijun;JIANG Renqing;ZHOU Xiaolin;YANG Haoyang;DU Wenqiong(State Key Laboratory of Trauma,Burns and Combined Injury,Department of Combat Casualties Care Training,Army Training Base for Health Care,Army Medical University(Third Military Medical University),Chongqing,400038;Department of Tactical Health Service,Noncommissioned Officer School of Army Medical University,Shijiazhuang,050083,Hebei Province;Department of Orthopedics,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学(第三军医大学)陆军卫勤训练基地战救技能训练教研室/创伤、烧伤与复合伤国家重点实验室,重庆400038 [2]陆军军医大学士官学校战术卫勤系,石家庄050083 [3]陆军军医大学(第三军医大学)第二附属医院骨科,重庆400037

出　　处：《陆军军医大学学报》2022年第16期1629-1635,共7页Journal of Army Medical University

基　　金：“十三五”全军后勤科研重大课题(ALJ19J001);陆军军医大学临床技术创新培育项目(2018JSLC0023);新桥医院临床重大创新特色技术项目(CX2019JS107)。

摘　　要：目的观察基于促进心肌能量代谢的复苏策略救治失血引发的创伤性心跳骤停(hemorrhage-induced traumatic cardiac arrest,HiTCA)的初步效果。方法将20只9月龄家兔(雌雄不拘)随机分为A组和B组(n=10),通过控制性失血法制备失血性心跳骤停模型,然后分别接受全血、全血+三磷酸腺苷+极化液治疗。用颈总动脉置管监测平均动脉压,全自动全血细胞计数仪检测血常规,自动凝血分析仪检测凝血象,全自动干式生化分析仪检测血生化,血气分析仪检测动脉血气,ELISA检测S100β蛋白,C反应蛋白(C-reaction protein,CRP)和Syndecan-1。结果2组家兔自主循环恢复率均为100%,2组动物24 h生存率分别为80%和100%;HiTCA后B组血糖、血钾明显低于A组(P<0.05);2组INR值均显著增加(P<0.05);HiTCA后4 h的各个时相点,B组乳酸、肌酐、尿素氮、谷丙转氨酶、谷草转氨酶、肌酸激酶同工酶-MB、CRP浓度和Syndecan-1浓度均低于A组(P<0.05),HiTCA后8 h和24 h两个时相点B组S100β浓度低于A组(P<0.05)。结论基于促进能量代谢的复苏策略可通过促进脏器能量代谢、改善凝血功能等来改善失血性心跳骤停后的脏器功能。Objective To observe the effects of myocardial energy metabolism-promoted resuscitation strategy on hemorrhagic induced cardiac arrest(HiTCA)in rabbits.Methods Twenty 9-month-old rabbits were randomly divided into 2 groups(n=10),and HiTCA model was prepared by controlled hemorrhage.Then the rabbits received whole blood infusion and whole blood infusion+adenosine triphosphate+polarization liquid,respectively.Mean arterial pressure was detected by common carotid artery intubation;Blood routine was examined by automatic blood cell count analyzer;Coagulogram was detected by automatic coagulation analyzer;Blood biochemical indexes was detected by automatic dry biochemical analyzer;Arterial blood gas was determined by arterial blood gas analyzer;S100β,C-reactive protein and Syndecan-1 were detected by ELISA.Results The rates of restoration of spontaneous circulation(ROSC)were 100%in both groups,and the 24 h survival rate of each group was 80%and 100%.After HiTCA blood glucose and blood potassium in group B were significantly lower than that of group A(P<0.05);INR values were significantly increased in both groups(P<0.05);Compared with group A,group B showed a lower level in lactic acid,creatinine,urea nitrogen,glutamic-pyruvic transaminase,glutamic-oxalacetic transaminase,creative kinase isoenzyme-MB,CRP and Syndecan-1(P<0.05)in every time point after 4 h of HiTCA.In the 2 time pointa(8 and 24 h after HiTCA),group B displayed a lower concentration level of S100β,compared with group A(P<0.05).Conclusion Resuscitation strategy based on promoting energy metabolism could improve organs function with hemorrhage induced cardiac arrest through improving energy metabolism of viscera and coagulation function.

关 键 词：创伤性心跳骤停 失血性心跳骤停 自主循环恢复率 三磷酸腺苷 极化治疗 

分 类 号：R318.03[医药卫生—生物医学工程] R605.971[医药卫生—基础医学] R654.1