尿激酶对家兔心肺复苏后脑灌注的实验研究

Effect of urokinase on cerebral perfusion in rabbits after cardiopulmonary resuscitation

目的 探讨心肺复苏（CPR）时给予溶栓药物尿激酶对心搏骤停（CA）兔脑微循环灌注的影响.方法 将20只新西兰大白兔按随机数字表法分为药物溶栓组和常规CPR组,每组10只.采用注射氯化钾结合窒息法制备兔CA后,常规CPR组只进行CPR的基础生命支持,药物溶栓组在此基础上给予尿激酶20 kU/kg进行干预.于动物自主呼吸恢复30 min,通过双源螺旋CT进行脑灌注成像,观察两组基底节区相对全脑血流量（rCBF）、血容量（rCBV）、达峰时间（rTTP）,以此来证明尿激酶对兔脑微循环灌注的影响.结果药物溶栓组rCBF、rCBV均明显大于常规CPR组（rCBF：1.248±0.139比0.900±0.070,t=6.870,P=0.000；rCBV：1.206±0.117比0.969±0.067,t=6.156,P=0.000）,rTTP明显小于常规CPR组（0.950±0.037比1.015±0.026,t=3.777,P=0.004）,提示药物溶栓组脑微循环灌注明显优于常规CPR组.常规CPR组与药物溶栓组自主循环恢复时间、自主呼吸恢复时间、平均动脉压均无明显差异[自主循环恢复时间（s）：307.9±96.4比242.0±71.0,t=-1.741,P=0.099；自主呼吸恢复时间（min）：20.6±12.5比19.3±10.1,t=-0.256,P=0.801；平均动脉压（mm Hg,1 mm Hg=0.133 kPa）：65.5±6.2比69.0±6.7,t=1.217,P=0.239].结论在对CA兔进行CPR时应用尿激酶可改善脑微循环灌注.

Objective To investigate the effect of urokinase on cerebral microcirculatory perfusion after cardiopulmonary resuscitation （CPR） in rabbits after cardiac arrest （CA）.Methods Twenty New Zealand rabbits were assorted into drug thrombolysis group and routine CPR group by randomized digital method with 10 in each group.Potassium chloride injection combined with asphyxia was employed to establish the CA model.CPR and basic life-support were performed in routine CPR group.Following the above treatments,20 kU/kg urokinase was given in thrombolysis group.The relative cerebral blood flow （rCBF）,cerebral blood volume （rCBV） and top teep time （rTTP）were observed by dual-slice spiral CT cerebral perfusion imaging in order to investigate the effect of urokinase on cerebral microcirculatory perfusion in rabbits.Results rCBF and rCBV in thrombolysis group were significantly higher than those in routine CPR group （rCBF：1.248 ± 0.139 vs.0.900 ± 0.070,t=6.870,P=0.000; rCBV：1.206 ± 0.117vs.0.969 ± 0.067,t=6.156,P=0.000）,and rTTP in thrombolysis group was significantly shorter than that in routine CPR group （0.950 ± 0.037 vs.1.015 ± 0.026,t=3.777,P=0.004）.The cerebral perfusion in thrombolysis group was obviously better than routine CPR group.There were no significant differences in the time for restoration of spontaneous circulation （ROSC）,the time for restoration of spontaneous breathing or mean arterial pressure （MAP） between routine CPR group and thrombolysis group [time of ROSC （s）：307.9 ± 96.4 vs.242.0 ± 71.0,t =-1.741,P=0.099; time of restoration of spontaneous breathing （minutes）：20.6 ± 12.5 vs.19.3 ± 10.1,t=-0.256,P=0.801 ; MAP （mm Hg,1 mm Hg=0.133 kPa）：65.5 ±6.2 vs.69.0 ±6.7,t=1.217,P=0.239].Conclusion Thrombolytic therapy with urokinase in CPR could improve the cerebral microcirculatory perfusion in CA rabbits.