亚低温减轻肾上腺素对心肺复苏中心肌损伤及改善生存的影响

The effect of mild hypothermia alleviating the cardiac injury induced by epinephrine during CPR

目的探讨亚低温治疗对肾上腺素在大鼠心肺复苏中心肌损伤及生存的影响。方法 32只雄性SD大鼠,建立心脏骤停/心肺复苏(CA/CPR)模型,随机分成4组(n=8):常温对照组(N)、常温肾上腺素组(N+E)、低温对照组(H)、低温肾上腺素组(H+E)。观察自主循环恢复情况、神经功能评分及存活情况。20只大鼠经造模后,随机分为N+E组和H+E组,在基础状态、复苏后0.5、1、2、4 h检测2组大鼠的血清心型脂肪酸结合蛋白,并在4 h处死大鼠取材观察心肌病理。结果 H+E组大鼠自主循环恢复率及72 h存活率明显高于N+E组及H组(P <0.05)。H+E组神经功能缺陷评分明显低于N+E组及H组(P <0.05)。H+E组大鼠脂肪酸结合蛋白明显低于N+E组(P <0.05),且复苏后4 h心肌病理损伤较N+E组明显减轻。结论肾上腺素和亚低温均能提高心脏骤停大鼠自主循环恢复成功率,但给予亚低温干预后,可明显改善肾上腺素复苏后早期心肌损伤,同时改善神经功能,延长存活时间。

Objective To investigatethe effect of mild hypothermia alleviating the cardiac injury induced by epinephrine during CPR.Methods Transoesophageal cardiac pacing was performed in order to elicit cardiac arrest for 5 minutes in SD male rats. 32 rats were divided into 4 groups randomly(n = 8):normothermic control group(N),normothermic epinephrine group(N + E),hypothermic control group(H),hypothermic epinephrine group(H + E). Chest compression was then initiated. Epinephrine(0.02 mg/kg)or saline was administrated at 1 min during cardiopulmonary resuscitation(CPR). The ROSC rate,neurological deficits score(NDS)and survival-were recorded. Serum heart-type fatty acid binding proteins(H-FABP)from normothermic epinephrine and hypo-thermic epinephrine groups were detected at 0.5 h,1 h,2 h and 4 h after resuscitation,and some rats were sacri-ficed at 4 h point to observe pathology.Results The ROSC rates of the four groups were H + E group 8/8,N + E group 7/8,H group 3/8 and N group 0/8,respectively. The NDS showed the lowest score in group H+E and the highest score in group N + E. The survival rate of 72 h in group H + E was significantly higher than that of other groups. The H-FABP of rats in the hypothermic epinephrine group was significantly lower than that in the normo-thermic epinephrine group after resuscitation(P < 0.05). The myocardium pathological injury of rats in the H + E group was less severe than that in the N + E group at 4 h after ROSC.Conclusion Both epinephrine and mild hypothermia can improve the success rate of resuscitation,and mild hypothermia can improve the myocardial injury and nerve prognosis caused by epinephrine.