肝素钠和小剂量高渗盐水对心肺复苏后兔小肠微循环灌注障碍的影响

Effect of heparin and small-dose hypertonic saline on the intestinal microcirculation perfusion after cardiopulmonary resuscitation in rabbits

目的:研究心肺复苏期间肝素钠和小剂量高渗盐水治疗对自主循环恢复后兔小肠微循环灌注的影响。方法:23只家兔开胸交流电致心室颤动,心室颤动5min后行胸内心肺复苏,心肺复苏过程中随机滴注生理盐水(NS组)2mL/(kg.10min)或生理盐水2mL/(kg.10min)加普通肝素钠60u/kg(H组)或7.5%NaCL2mL/(kg.10min)+普通肝素钠60u/kg(HSH组),另有3只家兔作为假手术组,只进行外科手术操作,不给予致颤和心肺复苏。自主循环恢复后30min注入10%异硫氰酸荧光素钠-白蛋白0.3mL/kg标记全身血液,循环2min后处死动物取回肠末段,观察微循环灌注情况。结果:NS组中8只动物,6只完成实验;H组和HSH组各6只,各有5只完成实验。各组动物的生理学参数差异无统计学意义(P>0.05)。兔经历5min心跳骤停和心肺复苏后,在自主循环恢复后仍有严重的微循环灌注障碍,NS组的小肠微循环灌注面积为(22.78±4.21)%;H组为(29.73±1.21)%,和NS组相比二者差异有统计学意义(P<0.01);HSH组为(68.36±7.43)%,和其他2组相比差异均有统计学意义(P<0.05);而3只假手术组的动物显示了均匀一致的微循环灌注。结论:心肺复苏期间给予肝素钠和小剂量高渗盐水治疗可以改善复苏后兔小肠微循环灌注障碍。

Objective To evaluate the effect of heparin and small-dose hypertonic saline on the intestinal microcirculation perfusion after cardiopulmonary resuscitation in rabbits.Methods Twenty-three New Zealand rabbits were anesthetized with embutal,and cardiac arrest was induced by electrical ventricular fibrillation.Cardiopulmonary resuscitation was initiated 5 minutes after ventricular fibrillation,and animals randomly received 2 mL/kg of either 0.9% Nacl（NS）,0.9% Nacl combined with heparin 60 u/kg（H）or 7.5% Nacl combined with heparin 60 u/kg（HSH）.Other 3 rabbits were served as sham group,which did not receive ventricular fibrillation or cardiopulmonary resuscitation.The microcirculation perfusion was marked by injection of 10% fluorescent isothiocyanate-albumin 0.3 mL/kg after restoration of spontaneous circulation 30 minutes and the animals were decapitated 2 minutes later.The end of ileum was observed.Results In group NS（n=8）,6 animals survived to the end of the experiment,and 5 animals of both group H（n=6）and group HSH（n=6）.There were no statistic differences in physiological variables in all groups（P0.05）.The area of intestine microcirculation perfusion was（22.78±4.21）% in group NS,（29.73±1.21）% in group H,（68.36±7.43）% in group HSH（P0.01,P0.05）.The three sham operated animals showed homogeneous microcirculation perfusion.Conclusion The administration of heparin and small-dose of hypertonic saline during the cardiopulmonary resuscitation could improve microcirculation perfusion of intestine in rabbits.