亚低温对心肺脑复苏后脑保护作用机制的临床研究

Exploring the Action Mechanism of Subhypothermia in Cerebral Protection After Cardiopulmonary Cerebral Resuscitation

目的探讨亚低温对心肺脑复苏后脑保护的作用机制及可行性。方法选择近2年来急诊科收治的心脏骤停后基础心肺复苏成功患者43例,随机分为 A、B 两组,A 组21例为对照组,B 组22例为亚低温组。两组患者基础心肺复苏用药及程序相同。B 组在复苏即刻加用电脑控制降温仪降低体温。A、B 两组均在复苏即刻、复苏第1、3、7 d,抽静脉血5 ml 送化验室检测丙二醛(MDA)、尿酸(UA)和血小板凝聚率(PAGT),于复苏第7天进行格拉斯哥结果分级(GOS)。结果亚低温组 GOS 分级显效率明显优于对照组(P<0.01);亚低温组治疗后 MDA、UA 浓度明显降低(P<0.01),而对照组治疗后变化不大(P>0.05);亚低温组治疗后 PAGT 明显下降(P<0.01),而对照组治疗后变化不大(P>0.05)。结论亚低温有明显改善心肺脑复苏神经功能的作用,是安全、有效、易于推广的心肺脑复苏的一种方法。

Objective To explore the action mechanism and practicality of subhypothermia in cardiopulmonary cerebral resuscitation. Methods 43 patients with sudden cardiac arrest from the emergency department were successfully treated by the cardiopulmonary cerebral resuscitation in recent 2 years. They were divided into 21patients in control group and 22 patients in subhypothermial treatment group. All patients in two groups were treated by same cerebral resuscit medicin and patients in group B were treated with lower temperature instrument controlled by computer after cardiopulmonary cerbral resusciation on 0,1,3,7days. 5 ml venous blood from the patients sent to the laboratory for test the MDA ,UA and PGTA. The Glasgow outcom scale （GOS） was carried out in the 7 days after resuscitation. Results The significantly effective rate in subhypothermial treatment group were apparently better than those in control group（ P 〈0.01 ） ;the MDA and UA after treatment were much lower then those before treatment in subhypothermia treatment group（ P 〈0.01 ） ; the GOS marks before and after treatment had little change in control group （ P 〉0.05）. The PACT after treatment were much lower than those before treatment in subhypothermial treatment group（ P 〈0.01 ） ,and those in control group had little change（ P 〉 0.05 ）. Conclusion The subhypothermia can largely improve nervoue function in cardiopulmonary cerebral resuscitation, which is safe ,effective and easily to be popularized.