山莨菪碱对心脏停搏大鼠复苏中微循环的影响

Effects of anisodamine on microcirculation of the asystole rats during the cardiopulmonary resuscitation

目的 观察复苏早期给予山莨菪碱(Ani)对心脏停搏(CA)大鼠肠系膜微循环和肠壁组织血流量变化的影响.方法 采用电击法制备大鼠CA模型,将实验动物随机分为4组,每组15只.待大鼠CA后4 min行呼吸机辅助呼吸、胸外按压.静脉补液复苏.对照组仅给予生理盐水;肾上腺素组(Epi组)注射Epi200 μg/kg;Epi+低剂量Ani组(低剂量Ani组)注射Epi 200 μg/kg+Ani 5 mg/kg;Epi+高剂量Ani组(高剂量Ani组)注射Epi 200 μg/kg+Ani 10 mg/kg.观察大鼠肠系膜微动、静脉血管再通率和再通血管管径及肠壁血流量.结果 微动、静脉再通率:高剂量Ani组(66.6%,60.0%)>低剂量Ani组(60.0%,53.3%)>对照组(40.0%,40.0%)>Epi组(26.7%,20.0%),Epi组与两个Ani组间差异均有统计学意义(P均<0.05).微动、静脉血管管径:自主循环恢复(ROSC)30 rain和60 min时高剂量Ani组>低剂量Ani组>对照组>Epi组.其中30 min时高、低剂量Ani组与Epi组比较差异有统计学意义(P均<0.05);60 min时低剂量Ani组微静脉血管管径与Epi组比较差异无统计学意义;高、低剂量Ani组间比较差异均无统计学意义.高、低剂量Ani组大鼠ROSC 15 min肠壁组织血液灌注量明显高于对照组和Epi组.随时问延长明显增高.持续至ROSC 60 min.结论 复苏早期给予Ani干预可改善组织微循环状态,从而提高ROSC率和复苏成功率.

Objective To study the effects of anisodamine (Ani) on microcirculation and reperfusion volume of intestine wall in Wistar rats during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). Methods Healthy Wistar rats subjected to CA and resuscitation were randomly divided into four groups, 15 rats in each group. After a 4-minute-non-intervention interval, CPR was started. After CPR for 4 minutes the animals in control group received normal saline, group epinephrine (Epi) received Epi (bolus dose of 200 μg/kg), Epi plus low dosage Ani (Ld Ani) group received Epi plus Ani (bolus dose of 200 μg/kg Epi followed by Ani of 5 mg/kg), and Epi plus high dosage Ani (Hd Ani) group received Epi plus Ani (bolus dose of 200 μg/kg Epi followed by Ani of 10 mg/kg). The reeanalization rate of mesenteric arterioles and venules, caliber of the recanalizatted mesentery arteriole and venule, and the reperfusion volume of intestine wall were observed in vivo in rats with restoration of spontaneous circulation (ROSC). Results As the rate of recanalization of mesenteric arteriols and venules was compared, group Hd Ani (66. 6%, 60. 0%)>group Ld Ani (60. 0%, 53.3%)>group control (40. 0%, 40. 0%)>group Epi (26. 7%, 20. 0%), and group Ld Ani and group Hd Ani was much better than group Epi(all P<0. 05). When the caliber of arteriols and venules was compared, group Hd Ani>group Ld Ani>group control>group Epi 30 minutes and 60 minutes after ROSC. Thirty minutes after ROSC, the caliber of arterioles and venules was much larger in group Ld Ani and group Hd Ani than that in group Epi (all P<0. 05). Sixty minutes after ROSC, there was no statistical difference in the caliber of venules between group Ld Ani and group Epi, so as between group Ld Ani and group Hd Ani. Reperfusion volume of intestine wall in group Ld Ani and group Hd Ani was higher than that in groups control and Epi 15 minutes after ROSC, and it kept on to he better up to 60 minutes after ROSC. Conclusion Administration of Ani at earlier period of resuscitation could improve microcirculation of the tissue and raise ROSC rate and successful rate of resuscitation.