尼可地尔后适应对猪心脏骤停后心脑肾缺血再灌注损伤的保护作用

Protective effects of post-conditioning with nicorandil on myocardial,cerebral and renal ischemia-reperfusion injury following cardiac arrest in swine

目的探讨猪心脏骤停模型中尼可地尔后适应对心脑肾缺血再灌注损伤的作用。方法 22头长白猪随机分为假手术组(n=4)和复苏组(n=18)。复苏组在手术后给予电刺激诱导室颤,4 min后行心肺复苏术。假手术组给予手术而不诱发室颤。复苏组16头长白猪复苏成功并随机分为盐水对照组(n=8)和尼可地尔组(n=8),尼可地尔组即刻经中央静脉注射尼可地尔(150μg/kg),随后以3μg/(kg·min)静滴至再灌注结束;盐水对照组给予同剂量生理盐水。致颤前和自主循环恢复后5 min、30 min、3 h、6 h采取静脉血以测定心肌肌钙蛋白I(c Tn I)水平。自主循环恢复后6 h速取其左心室心尖、大脑顶叶皮层和左肾上极组织行普通病理学及透射电镜检查。结果自主循环恢复后,与假手术组相比,复苏组c Tn I水平显著升高(P<0.05);与盐水对照组相比,尼可地尔组c Tn I水平显著降低(P<0.05),复苏后心脑肾组织学损伤减轻。结论尼可地尔后适应可减轻猪心脏骤停后心脑肾缺血再灌注损伤。

Objective To explore the effects of post-conditioning w ith nicorandil on myocardial,cerebral and renal ischemia-reperfusion injury follow ing cardiac arrest in a porcine. Methods A total of 22 landrace pigs w ere randomized into the sham group（ n = 4） and resuscitation group（ n = 18）. The resuscitation group received ventricular fibrillation induced by electrical stimulation for 4 min and then cardiopulmonary resuscitation. The sham group received surgery only.The resuscitation group w as subdivided into saline control group（ n = 8） and nicorandil（ n = 8） group. The nicorandil group w as given central intravenous injection of nicorandil（150 μg/kg） at onset of restoration of spontaneous circulation（ ROSC）,follow ed by 3 μg/（ kg·min） intravenous drip until the end of reperfusion. The saline control group w as given the same dosage of saline. At baseline,5 min,30 min,3 h and 6 h after ROSC,blood samples w ere collected to examine the level of cardiac troponin I（ c Tn I）. At 6 h after ROSC,the cardiac apex,parietal-cerebral cortex and upper pole of left kidney w ere removed for microstructure and ultrastracture studies. Results The c Tn I level w as significantlyincreased in the resuscitation group than in the sham group after ROSC（ P〈0. 05）. The c Tn I level w as significantly decreased in the nicorandil group than in the saline control group（ P〈0. 05）. Histopathologic injury w as relieved in the nicorandil group. Conclusion Post-conditioning w ith nicorandil can relieve myocardial,cerebral and renal ischemiareperfusion injury follow ing cardiac arrest in swine.