摘要
目的：研究集束化治疗[α－去甲基肾上腺素（α－MNE）、κ－阿片受体激动剂（U50488H）、瑞芬太尼及亚低温]对家兔心脏骤停后综合征（post－cardiac arrest syndrome， PCAS）早期心脑功能及血流动力学的优化作用，同时探索二氢辣椒素（ DHC）药物诱导亚低温的可行性及其可能作用机制。方法50只健康成年家兔麻醉置管前随机（随机数字法）分为五组（每组10只）：手术对照组（ A组）、肾上腺素组（ epinephrine ，E）（ B组）、α－MNE＋U50488 H组（ C组）、α－MNE＋U50488 H＋亚低温＋瑞芬太尼组（ D组）、α－MNE＋U50488 H＋DHC＋瑞芬太尼组（ E组）。体外电击建立家兔心肺复苏模型，于诱发室颤前15 min，复苏后30、60、120、240、360 min动态监测血流动力学指标，检测血清肌钙蛋白（ cTnI ）、神经元特异性烯醇化酶（ NSE ）浓度变化。结果①复苏后，除A组外其余四组家兔MAP、peak＋dp／dt、peak－dp／dt均不同程度下降，LVEDP均不同程度升高（P均＜0．05）；D、E组家兔各时间点参数比较差异无统计学意义（P均＞0．05）；D、E组与B组比较，MAP在复苏后60、120、240、360 min比较差异均有统计学意义（P均＜0．05）， peak＋dp／dt、peak－dp／dt、LVEDP在复苏后30、60、120、240、360 min比较差异均有统计学意义（ P均＜0畅05）；D、E组与C组比较，MAP、peak＋dp／dt、peak－dp／dt及LVEDP于复苏后60、120、240、360 min比较差异均有统计学意义（P均＜0．05）。②复苏后，除A组外其余四组家兔cTnI、NSE浓度均不同程度升高（ P均＜0．05）；D、E两组家兔各时间点cTnI、NSE浓度比较差异无统计学意义（P均＞0．05）；D、E组与B组比较，cTnI、NSE浓度在复苏后各时间点比较差异均有统计学意义（P均＜0．05）；D、E组与C组比较，cTnI、NSE浓度于复苏后60、120、240、360 min比较差异均有统计学意义（P均＜0�
Objective To investigate the myocardial and brain function protection and hemodynamic stability effects of the bundle of care which formed by selective α2 -adrenergic receptor agonist alpha -methylnorepinephrine （α-MNE）, κ-opioid receptor agonist U50488H, remifentani and transient receptor potential vanilloid type 1 （ TRPV1 ） agonist dihydrocapsaicin （ DHC ） drug -induced mild hypothermia at early stage of post -cardiac arrest syndrome （ PCAS） in rabbits.Methods Fifty rabbits were randomly divided into 5 groups , A group： operation control group , only anesthesia and tubes inserted without performing ventricular fibrillation （ VF ）; B group： epinephrine group , injecting epinephrine（30 μg/kg） during CPR;C group：injectingα-MNE（100 μg/kg） and U50488H （1.5 mg/kg ） during CPR; D group： the similar to C group during cardiopulmonary resuscitation （CPR）, but when achieved return of spontaneous circulation （ROSC）, surface cooling（ice, 100 g/100 mg） was given to quickly cool rabbit to 32℃-35℃（anal temperature） lasting to the end.Meanwhile, large dose of remifentani [6.0 μg/（kg· min）] was continuously pumped intravenously; E group： the similar to C group during CPR too, but after ROSC, DHC [1.0 mg/（kg· h）] and remifentani [6.0μg/（ kg· min） ] were continuously intravenous pumped in order to obtain drug -induced mild hypothermia . Blood samples were collected at before VF , 30, 60, 120, 240, 360 min after CPR, and the levels of troponin I （ cTnI） and neuron -specific enolase （ NSE） were measured, in addition, hemodynamic parameters were also recorded at above time points .Statistical analysis was performed by using SPSS software.Results ①After CPR, compared with group A, MAP, peak -dp/dt, peak ＋dp/dt at the time points were significantly lower（P〈0.05）, and LVEDP was significantly increased（P〈0.05）in other four groups , but there were no differences between D and E groups （ P〉0.05 ） .MAP in D and E groups were si
出处
《中国急救医学》
CAS
CSCD
北大核心
2014年第12期1127-1132,共6页
Chinese Journal of Critical Care Medicine
基金
甘肃省自然科学基金资助项目
