高血压灌注对猪心肺复苏后胃肠组织超微结构和酶学的影响

The influence of hypertensive perfusion on ultrastructure of gastrointestinal tissue and enzymology of pigs after cardiopulmonary resuscitation

目的观察猪心肺复苏（CPR）后高血压灌注对胃肠组织超微结构和酶学的影响。方法采用直流电致实验猪心室纤颤（室颤）4min后行CPR。复苏成功的10只猪按随机数字表法分为对照组（n=5）和高血压灌注组（n=5），后者给予去甲肾上腺素升高血压，使平均动脉压（MAP）维持在室颤前基础状态的130％。于复苏前后测定血清二胺氧化酶（DAO）水平及胃肠组织ATP酶活性，并在光镜和电镜下观察组织结构。结果自主循环恢复（ROSC）后2h、4h高血压灌注组与对照组DAO水平均较室颤前明显升高（高血压灌注组：15．66±2．24、15．76±0．95比8．38±0．70，对照组：14．87±1．34、13．85±0．52比9．92±0．78，均P〈0．05）；而两组间均无差异。ROSC后24h高血压灌注组胃组织Na＋-K＋-ATP酶（μmol·mg-1·h-1）和Ca2＋-ATP酶（μmol·mg-1·h-1）明显高于对照组（Na＋-K＋-ATP酶：6．07±1．49比2．89±1．48，Ca2＋-ATP酶：7．67±1．86比3．07±150，均P〈0．05）；而两组间肠组织中ATP酶活性无明显差异。在光镜和电镜下观察高血压灌注组胃肠黏膜结构、线粒体损伤均轻于对照组。结论CPR后出现消化道功能受损、能量代谢异常、血清DAO水平升高、肠微绒毛破坏；高血压灌注能够改善能量代谢、减少黏膜损伤，对消化道具有保护作用。

Objective To study ultrastructure of gastrointestinal tissue and enzymology in pigs after cardiopulmonary resuscitation （CPR） in conditions of hypertensive perfusion. Methods Sixteen experimental pigs were induced ventricular fibrillation （VF） by direct current shock. CPR was conducted 4 minutes after VF, and 10 pigs were successfully resuscitated. These 10 pigs were divided into control group （n = 5 ） and hypertensive perfusion group （n = 5 ） through random number table method. Norepinephrine was administered to maintain the mean arterial pressure （MAP） at 130% of the baseline in the hypertensive perfusion group. Serum diamine oxidase （DAO） and gastrointestinal ATPase level were determined, and gastrointestinal mucosa damages were examined with light microscope, and mitoehondria injury was observed by electric microscope 24 hours after recovery of spontaneous circulation （ROSC）. Results The serum DAO level showed a significant increase at 2 hours and 4 hours after ROSC in hypertensive perfusion group and control group compared with baseline （hypertensive perfusion group： 15.66 ± 2.24, 15.76 ± 0.95 vs. 8.38 ±0.70, control group： 14.87 ± 1.34, 13.85 ±0.52 vs. 9.92 ±0.78, all P〈0.05）, but when the individual value was compared between two groups, no significant difference was found. The Na＋-K＋-ATPase （ μmol·mg-1·h-1 ） and Ca2＋-ATPase （ μmol·mg-1·h-1 ） of gastric tissue showed significant increase in the hypertensive perfusion group compared with the control group at 24 hours after ROSC （Na＋-K＋-ATPase： 6.07±1.49 vs. 2.89 ± 1.48, Ca2＋-ATPase： 7.67± 1.86 vs. 3.07 ± 1.50, both P〈0.05 ）. There was no significant difference in ATPase activity of intestinal tissue between the two groups. Gastrointestinal mucosa damages and mitochondrial injury in the hypertensive perfusion group were less obviously than in the control group. Conclusions Gastrointestinal function injury, abnormal energy metabolism, increased serum DAO levels, destruction of intestinal mierovilli were found after CPR. Hypertensive perfusion could improve cell energy metabolism, reduce the mueosal injury, and protect the digestive tract from injury due to CPR.