经皮电刺激心肌建立兔心脏骤停后综合征模型

Rabbit models of post-cardiac arrest syndrome induced by transcutaneous electrical stimulation on the myocardium

目的 建立一种简便的兔心脏骤停后综合征（post-cardiac arrest syndrome,PCAS）模型.方法 在厦门大学动物实验中心进行,选择25只新西兰白兔,两根针灸针作为电极经皮刺入心肌,持续电刺激3 min而诱发心脏骤停（cardiac arrest,CA）.CA 6 min后进行心肺复苏,于CA前、自主循环恢复（restoration of spontaneous circulation,ROSC）即刻、及ROSC后24、48、72 h测量心率、体温、血压,血气分析,检测外周血中白细胞计数、丙氨酸转氨酶、肌酐、血糖、肌钙蛋白Ⅰ、钠利尿肽;ROSC 72 h时麻醉后处死家兔观察各脏器超微结构改变.结果 本组兔ROSC率22/25,ROSC 24 h时存活率20/22,全部表现出全身炎症反应综合征、心肌损伤及功能障碍.ROSC 48 h时存活率为15/22,此时全部家兔出现多器官功能障碍综合征（multiple organ dysfunction syndrome,MODS）;ROSC 72 h时有11只MODS兔存活.肿瘤坏死因子-α在ROSC 24 h达峰值;降钙素原于ROSC 24 h后迅速升高.结论 经皮电刺激心肌诱发家兔CA模型成功模拟了家兔PCAS的典型病理生理演变过程,创伤小,复苏成功率高,存活时间较长,是一个较为理想的PCAS研究模型.

Objective To establish a simple and convenient model of post-cardiac arrest syndrome （PCAS） in rabbits.Methods The experiment site in Xiamen university animal experiment center.Twenty five New Zealand rabbits were selected,male and female unlimited.Two acupuncture needles connected to the anode and cathode of a stimulator were transcutaneously inserted into the myocardium as electrode.The stimulating current was steered to the myocardium and maintained for 3 minutes to induce cardiac arrest （CA）.Cardiopulmonary resuscitation （CPR） was performed at 6 minutes after a period of nonintervention.The levels of white blood cell （WBC）,alanine aminotransferase （ALT）,creatinine （Cr）,troponin Ⅰ （Tn Ⅰ）,brain natriuretic peptide （BNP）,partial pressure of oxygen （PaO2）,partial pressure of carbon dioxide （PaCO2） in arterial blood and the heart rate,body temperature,blood pressure were measured before CA and 0,24,48,72 hours after ROSC.Rabbits were sacrificed and microstructure injury was observed using electric microscope after ROSC 72 h.Comparisons among two groups were studied by using IndependentSamples t Test.Statistical comparisons within groups were analyzed by using paired t-test.Results The rate of ROSC in rabbits was 22/25.Twenty rabbits were survived in systemic inflammatory response syndrome （SIRS） and myocardial injury and dysfunction at 24 h after ROSC.Eleven rabbits were survived in post-resuscitation multiple organ dysfunction syndrome （PR-MODS） at 72 h after ROSC.TNF-α level peaked at 24 h after ROSC,and then decreased gradually.The procalcitonin （PCT） concentration significantly increased after ROSC 24 h.Conclusions The model of CA in rabbits induced by transcutaneous electrical myocardial stimulation required low-intensity current and showed typical pathophysiological process of PCAS,the model had high success rate and long survival time.The model appeared typical brain injury,myocardial dysfunction,ischemia-reperfusion injury.It may be an ideal animal model for investigation on PCAS.