犬心肺复苏前后红细胞流变学变化的特征

Features of erythrocyte rheological alterations in dog before and after cardiopulmonary resuscitation

目的:从非失血因素导致的心跳骤停复苏前后红细胞流变学变化入手,对影响后期脑复苏及重要器官保护的其中一个因素进行研究。方法:实验选用健康杂种家犬8只,体质量11～20.5kg。将狗麻醉后,于右胸及左心尖的皮下电极以交流电(50～80V)刺激,诱发室颤至循环停止。8min后开始机械通气及心肺复苏,复苏成功行常规后续支持治疗。心跳骤停前5min,心跳骤停中第5秒,心肺复苏后30,60,90,120min于股静脉采集血液标本测定红细胞聚集指数(RBCaggregationindex,RAI),红细胞变形指数(RBCdeformationindex,RDI),红细胞刚性指数(RBCrigidityindex,RRI),全血高切黏度(high-shearbloodviscosity,HBV),全血低切黏度(low-shearbloodviscosity,LBV),卡松黏度,卡松屈服应力(Cassonyieldstress,CYS)。结果:心跳骤停中5min,复苏后30min与复苏前RAI比较,差异无显著性意义(P>0.05);复苏后60min,90min与复苏前比较,差异有显著性意义(t=2.97,2.42,P<0.05);复苏后120min与复苏前比较,差异有非常显著性意义(t=3.46,P<0.01)。心跳骤停中5min与复苏后120minRDI(0.96±0.09,0.91±0.13)和复苏前(0.88±0.07)比较,差异无显著性意义(P>0.05);复苏后90min(1.01±0.12)与复苏前比较,差异有显著性意义(t=2.57,P<0.05);复苏后30min(1.05±0.13)。

AIM: To investigate one of the factors that influences the protection of the late brain resuscitation and important organs by analyzing the cytorheological changes of red blood cells (RBC) before and after resuscitation from cardiac arrest(CA) caused by non-blood loss factor. METHODS: Eight healthy hybrid dogs, weighting 11 to 20.5 kg, were used in the study. The dogs were stimulated with alternating current (50 to 80 V) at the sibintegumental electrode of right thorax and left apex to induce ventricular fibrillation(VF) till the stop of ventilation after anesthesia. Eight minutes later, mechanical ventilation and cardiopulmonary resuscitation(CPR) were performed at the same time, and followed by routine sustain therapy after success of CPR. Blood samples was collected via femoral vein 5 minutes before and 5 minutes during CA, 30, 60, 90 and 120 minutes after CPR respectively to determine the RBC aggregation index(RAI), RBC deformation index (RDI), RBC rigidity index (RRI), high-shear blood viscosity(HBV), low-shear blood viscosity(LBV), Casson viscosity (CV) and Casson yield stress (CYS). RESULTS: Compared with before CPR, the RAI 5 minutes during CA and 30 minutes after CPR were not significantly different (P >0.05), while there were significant differences 60 and 90 minutes after CPR(t=2.97, 2.42, P< 0.05), and very significantly difference 120 minutes after CPR (t=3.46, P< 0.01). The RDI 5 minutes during CA and 120 minutes after CPR(0.96±0.09, 0.91±0.13) were not significantly different from that before CPR (0.88±0.07) (P >0.05); Compared with before CPR, the RDI 90 minutes after CPR (1.01±0.12) was significantly different (t=2.57, P< 0.05), while those 30 and 60 minutes after CPR (1.05 ±0.13, 1.07±0.15) were very significantly different (t=3.07, 3.08, P< 0.01). There were very significant differences in RRI 5 minutes during CA, 30, 60, 90 and 120 minutes after CPR (t=4.67, 6.19, 5.06, 10.37, 7.75,P< 0.01). The LBV and CYS 5 minutes during CA, 5 and 30 minutes after CPR had insignificant differences from that before CPR (P >0.05); while those 60 and 90 minutes after CPR were significantly different from that before CPR (P< 0.05); and there were very significant difference between 120 minutes after CPR and before CPR (t=5.62, 6.48, 7.02, 6.48, P< 0.01). CONCLUSION: After CPR in non-blood loss CA of dog, RAI, RDI, RRI are all significantly increased as compared with those before CPR, while the indexes of LBV and CYS, which reflect the macroscopic hemorheological characteristics, are also obviously increased.