硝酸异山梨酯改善猪心肺复苏后的心功能障碍

Improvement of cardiac function after cardiopulmonary resuscitation by using isosorbide mononitrate in porcine models

目的研究硝酸异山梨酯（isosorbidemononitrate，IM）对室颤型心脏骤停猪自主循环恢复（returnofspontaneouscirculation，ROSC）后的心功能障碍的影响。方法实验于首都医科大学附属北京朝阳医院实验中心进行。20头五指山小型猪随机（随机数字法）分成IM组（n=10）和对照组（n=10），通过程控刺激方法制作室颤型心脏骤停模型，制模成功后8min后行CPR。IM组在ROSC即刻给予IM[2μg/（kg·min）]6h；对照组则给予等量生理盐水。比较两组实验动物ROSC后24h内血流动力学及ROSC后72h心脏超声和心肌超微结构变化。结果IM组和对照组ROSC几率相同；IM组平均动脉压（mmHg，1mmHg：0．133kPa）在ROSC后6h（88．5±5．6VS．87．8±6．0，P=0．790）与24h（89．3±3．8伽．86．9±5．0，P=0．245）较对照组差异无统计学意义；IM组心输出量（L／rnin）在ROSC6h（2．40±0．17掷．1．60±0．14，P〈0．01）及24h（2．49±0．12vs．2．09±0．16，P〈0．01）较对照组显著升高；复苏后72hIM组左心室收缩功能较对照组显著改善，射血分数显著高于对照组（0．67±0．08vs0．56±0．09，P=0．044）；ROSC72hIM组心肌超微结构损伤较对照组减轻。结论硝酸异山梨酯可以改善室颤引起的猪心搏骤停复苏后的心功能障碍。

Objective To determine the protective effect of isosorbidemononitrate （IM） on myocardial injury after restoration of spontaneous circulation （ ROSC ） in swine models of cardiac arrest induced by ventricular fibrillation. Methods The experiment was carried out in Animal Lab of Beijing Chao-Yang Hospital, Capital Medical University. Ventricular fibrillation was induced and untreated for 8 min in twenty WhuZhiShan piglets. CPR was performed until ROSC occurred. The animals were randomized （random number） into two groups： IM group （n = 10） and control group （n = 10） . IM [2 μg/ （kg- min） ] or the equivalent volume in saline was administered respectively for 6 h after ROSC. Hemodynamics and post-resuscitation cardiac function were monitored until 24 h after ROSC. Echocardiography and transmission electron microscopy were useed at 72 h after ROSC. Results There was no significant difference in survival rate between the two groups. No significant differences in mean arterial pressures （mmHg） at ROSC 6 h （88.5 ±5.6 vs. 87. 8 ±6. 0, P =0. 790） and ROSC 24 h （89. 3 ±3.8 vs. 86. 9± 5.0, P = 0. 245 ） between the two groups were found. Cardiac outputs （L/rain） were signifieantly increased at ROSC6 h （2.40±0.17vs. 1.60±0.14, P〈0.01） andROSC24h （2.49±0.17vs. 2. 09±0.21, P 〈 0. 01 ） ; and ejection fraetion at ROSC 72 h （0. 67 ±0. 08 vs. 0. 56 ± 0.09, P = 0. 044） was improvedtoo, and significant differences were found between the two groups. The ultra-structural myocardial injury was ameliorated in the MI group at 72 b after CPR observed by using electron microscopy. Conclusions IM can ameliorate post-resuscitation cardiac dysfunction in porcine models of cardiac arrest induced by ventricular fibrillation.