七氟醚后处理减轻心脏骤停大鼠脑损伤的实验研究

Anesthetic post-conditioning at the initiation of CPR attenuates cerebral injuries in a rat model of cardiac arrest

目的 明确七氟醚后处理是否可以减轻心脏骤停（cardiac arrest,CA）大鼠造成的脑损伤.方法 窒息法建立CA大鼠模型.40只雄性Wistar大鼠随机（随机数字法）分为七氟醚（APoC）组、对照（CON）组.APoC组在心肺复苏（cardio-pulmonary resuscitation,CPR）时即予以1MAC七氟醚吸入,CON组进行常规CPR.各组大鼠在自主循环恢复（restoration of spontaneous circulation,ROSC）后记录血压、心率,并于造模前、ROSC 1 h及ROSC 4 h行心脏超声测定心功能;于ROSC 24 h、ROSC 72 h进行神经功能评分（NDS）测定;于ROSC 72 h过量麻醉处死,分别通过TUNEL及Nissl染色测海马CA1区凋亡及存活细胞.结果 ROSC后两组大鼠平均动脉压、心率的比较差异无统计学意义（P＞0.05）;ROSC 4 h APoC组左室后壁肥厚轻于CON组（P＜0.05）,舒张末左室容量大于CON组（P＜0.01）;APoC组海马CA1区凋亡细胞数少于CON组（P＜0.05）,存活神经元多于CON组（P ＜0.05）;ROSC 24 h及72 h APoC组神经功能评分均高于CON组（P＜0.05）.结论 七氟醚后处理可以减轻CA大鼠造成的脑损伤.

Objective In this study,we hypothesized that anesthetic post-conditioning with sevoflurane at the initiation of cardio-pulmonary resuscitation （CPR） will attenuate cerebral injuries in the model of cardiac arrest.Methods The cardiac arrest model was established through asphyxia.Forty male Wistar rats were assigned to two groups randomly.Rats in the sevoflurane （anesthetic post-conditioning,APoC） group inhaled 1 MAC of sevoflurane during CPR.Rats in the control （CON） group did not receive inhaled sevoflurane during CPR.After return of spontaneous circulation （ROSC）,the mean arterial pressure （MAP） and heart rate （HR） was recorded.Before cardiac arrest （baseline） as well as ROSC 1 h and ROSC 4 h,cardiac function was measured.Neurologic deficit scores （NDS） was assessed at 24 and 72 hours after ROSC.At 72 hours after ROSC,coronal brain sections were analyzed by counting TUNEL positive （i.e,apoptotic） cells and Nissl positive （i.e,viable） cells.Results There was no statistical difference in MAP and HR between the two groups.Rats in the APoC group had a thinner LVPW （P ＜ 0.05） and a higher EDV （P ＜ 0.01） compared to the CON group.The apoptotic cells were less and the viable neurons were more in the APoC group compared with CON group （P ＜ 0.05）.The NDS was higher in the APoC group at ROSC 24 h and ROSC 72 h （P ＜ 0.05）.Conclusion Volatile anesthetic sevoflurane,when administered at initiation of CPR,improves NDS associated with reducing neuronal damage.