摘要
目的观察轻度低温干预对心室纤颤（室颤）兔自主循环恢复（ROSC）后心脏功能、心肌结构和48h存活率的影响。方法将新西兰兔按随机数字表法分为4组，采用心外膜电刺激致颤4min行心肺复苏（CPR）复制动物CPR模型，ROSC后即分别给予常温[（39．0±0．5）℃，n=103和低温[（33．5±0．5）℃，n=103处理；同时设常温（n=8）和低温（n=8）对照。各组均监测4h血流动力学指标，观察48h存活情况；取心肌组织进行病理学观察，检测细胞凋亡[原位末端缺刻标记法（TUNEL）]；测定左室心尖组织ATP、ADP、AMP含量[高效液相色谱（HPLC）法]，并计算心肌能荷（EC）。结果①血流动力学：低温对照组和常温对照组比较，心率（HR）、左室压力下降最大速率（-dp／dtmax）在基线后各时间段均有下降；左室压力上升最大速率（＋dp／dtmax）和平均动脉压（MAP）在0．5h有显著差异，而在其他时段均无差异；左室舒张期末压（LVEDP）、左室收缩期末压（LVESP）和股动脉收缩压（SBP）、舒张压（DBP）在各时间段均无显著差异。②复苏后低温组与复苏后常温组比较，HR（次／min）和-dp／dtmax（mmHg／s）在ROSC后0．5、1、2、3、4h均有下降（HR：216．5±33．3比292．9±38．4，218．2±28．0比294．3±37．0，227．5±25．4比291．4±25．3，232．4±27．4比278．1±30．8，230．6±22．0比285．1±38．2；-dp／dtmax：1847．1±241．2比2383．3±470．9，1860．7±167．8比2154．6±319．5，1822．3±389．7比2239．7±379．0，1950．6±412．9比2229．6±392．4，1875．7±555．6比2396．7±420．1，均P〈0．05）；LVEDP、＋dp／dtmax、LVESP、股动脉血压（SBP、DBP、MAP）在ROSC后各时间点均无显著差异。③复苏后低温组48h心肌组织形态损害较复苏后常温组轻。④复苏后低温组心肌细胞凋亡指数（AI）低于复苏后常温组（26．39％比42．02％，P〈0．05）�
Objective To examine the impact of mild hypothermia on cardiac function, myocardial tissue integrity, and 48 hours mortality in a rabbits model of ventricular fibrillation after restoration of spontaneous circulation （ROSC）. Methods The rabbits were randomly divided into four groups： normothermic post ROSC （NTPR, n= 10）, mild hypothermia post ROSC （HTPR, n= 10）, normothermie control （NTC, n=8） and mild hypothermia control （HTC, n= 8）. Ventricular fibrillation was induced by trans-epicardium electric-shook with alternating current in all the animals and ROSC was achieved through administration of adrenaline （i. v. ） and artificial ventilation in group NTPR and HTPR. The body temperature of the animals was kept either at （39.0±0.5） ℃ （NTPR and NTC） or （33.5±0. 5） ℃ （HTPR and HTC） for 4 hours after surgery for hemodynamie indexe data collection 0.5, 1, 2, 3 and 4 hours after surgery, 48 hours later, the mortality in the animals was recorded, and myocardial tissue samples were collected from survivaed animals for morphological examination by light and electric microscopy and analysis of apoptosis by terminaldeoxynueleoitidyl transferase mediated nick end labeling （TUNEL） staining. The content of ATP, ADP and AMP in the tissue samples was measured by high performance liquid chromatography （HPLC） for the calculation of energy charges （EC）. Results （1）Hemodynamic indexes： as compared to the NTC group, HTC group exhibited significantly lower levels of heart rate （HR） and -dp/dt max in all the time points. No significant difference between the two groups in the levels of ＋dp/dt max and mean artery pressure （MAP） was found in all the time points but 0. 5 hour. There was no significant difference in the levels of left ventricular end-diastolic pressure （LVEDP）, left ventrieular end-systolic pressure （LVESP）, and femoral
artery blood pressure between the two groups. （2） In comparison with NTPR group, HTPR group exhibited significantly �
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2011年第12期743-748,共6页
Chinese Critical Care Medicine
基金
国家自然科学基金项目（30801480）
北京市科技新星项目（2008A090）
关键词
心室纤颤
自主循环恢复
低温
心功能不全
死亡率
Ventricular fibrillation
Restoration of spontaneous circulation
Hypothermia
Myocardial dysfunction
Mortality
