选择性α_2-肾上腺素能受体激动剂对家兔心肺复苏后心脏功能影响的实验研究
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摘要
目的:复苏后心功能不全是成功现场心肺复苏后导致高死亡率的主要原因。本实验目的在于明确选择性α_2肾上腺素能受体激动α-甲基去甲肾上腺素(Alphα-methylnorepinephrine,α-MNE)对复苏后家兔心功能的影响,探索更有效的复苏药物。
方法:通过体外致颤法建立家兔心肺复苏模型。18只清洁级家兔随机分为三组,A组:手术对照组,仅行麻醉、手术、气管插管,但不致颤;B组:肾上腺素组,在复苏时使用标准剂量肾上腺素(30ug/kg);C组:α-MNE组,在复苏时使用α-MNE(100ug/kg)。动态观察致颤前15min、复苏后30、60、120、180及240min左室舒张末压(LVEDP)、左室内压上升和下降最大速率(peak±dp/dt)、血清B型利钠肽(BNP)及心肌肌钙蛋白(cTnT)浓度变化。复苏后240min处死家兔取心肌组织进行光镜检查。
结果:(1)与A组比较,其余两组复苏成功后LVEDP和BNP明显升高(P均<0.01),peak±dp/dt显著下降(P均<0.01);(2)C组与同时相B组比较,LVEDP和BNP升高幅度明显降低(P均<0.05),peak±dp/dt降低程度减轻(P<0.05);(3)致颤前各组cTnT值差异无统计学意义(P>0.05),复苏成功后B、C二组各时间段cTnT值均明显高于对照组及基线水平(P<0.05),但C组升高幅度小于B组(P<0.05),尤以60min时明显(P<0.01),240min时达高峰。心肌组织形态学变化也进一步揭示B组损害较C组重。
结论:在对室颤导致的心脏骤停进行复苏时,α-甲基去甲肾上腺素可以改善心肺复苏后心功能不全,并可降低复苏早期BNP及cTnT浓度,减轻心肌组织形态学损伤,对复苏后心脏有保护作用。
Objective:Postresuscitation myocardial dysfunction contributes to the high fatality rate following successful resuscitation.The purpose of this animal research was to observe the effects of selectiveα_2-adrenergic receptor agonist alpha-methylnorepinephrine (α-MNE) on postresuscitation cardiac function in the rabbit cardiopulmonary resuscitation.
Methods:After setting up rabbit model of cardiopulmonary resuscitation,18 rabbits were randomly divided into three groups, group A:operation-control group,only anesthesia,surgery, endotracheal intubation,but was not induced ventricular fibrillation; group B:epinephrine group,administration of the standard dose of epinephrine(30ug/kg) during CPR;group C:α-MNE group, administration ofα-MNE(100ug/kg) during CPR.The left ventricular end-diastolic pressure(LVEDP) and peak first derivative of left ventricular pressure(±dp/dt) were observed.Collecting blood samples at certain time points to measure the concentration of B-type natriuretic peptide(BNP) and cardiac troponin T(cTnT).At 240~(th) minute after successful resuscitation,killed animals and took myocardium to do light microscopy detection.
Results:Compared with group A,the BNP and LVEDP of the remaining two groups gradually increased respectively(P＜0.01),±dp/dt decreased(P＜0.01).Increases of BNP and LVEDP in Group C were less than in Group B(P＜0.05,P＜0.05),whereas±dp/dt in group C were higher than in group B(P＜0.05) at the same stage. Compared with group A,the cTnT of the remaining two groups increased respectively(P＜0.01),and at 240~(th) minutes reached the peak.Increase of cTnT in group C were less than in Group B(P＜0.05)at the same stage,especially at 60~(th) minutes.group B and group C were detected myocardial injury under a light microscope, but the myocardial damage of group C were lighter than group B.
Conclusion:A-MNE administered immediately during resuscitation improved postresuscitation myocardial dysfunction.It reduced the concentration of BNP and cTnT and alleviated cardiac pathological damage at the early stage of cardiopulmonary resuscitation after CPR from cardiac arrest.
方法:通过体外致颤法建立家兔心肺复苏模型。18只清洁级家兔随机分为三组,A组:手术对照组,仅行麻醉、手术、气管插管,但不致颤;B组:肾上腺素组,在复苏时使用标准剂量肾上腺素(30ug/kg);C组:α-MNE组,在复苏时使用α-MNE(100ug/kg)。动态观察致颤前15min、复苏后30、60、120、180及240min左室舒张末压(LVEDP)、左室内压上升和下降最大速率(peak±dp/dt)、血清B型利钠肽(BNP)及心肌肌钙蛋白(cTnT)浓度变化。复苏后240min处死家兔取心肌组织进行光镜检查。
结果:(1)与A组比较,其余两组复苏成功后LVEDP和BNP明显升高(P均<0.01),peak±dp/dt显著下降(P均<0.01);(2)C组与同时相B组比较,LVEDP和BNP升高幅度明显降低(P均<0.05),peak±dp/dt降低程度减轻(P<0.05);(3)致颤前各组cTnT值差异无统计学意义(P>0.05),复苏成功后B、C二组各时间段cTnT值均明显高于对照组及基线水平(P<0.05),但C组升高幅度小于B组(P<0.05),尤以60min时明显(P<0.01),240min时达高峰。心肌组织形态学变化也进一步揭示B组损害较C组重。
结论:在对室颤导致的心脏骤停进行复苏时,α-甲基去甲肾上腺素可以改善心肺复苏后心功能不全,并可降低复苏早期BNP及cTnT浓度,减轻心肌组织形态学损伤,对复苏后心脏有保护作用。
Objective:Postresuscitation myocardial dysfunction contributes to the high fatality rate following successful resuscitation.The purpose of this animal research was to observe the effects of selectiveα_2-adrenergic receptor agonist alpha-methylnorepinephrine (α-MNE) on postresuscitation cardiac function in the rabbit cardiopulmonary resuscitation.
Methods:After setting up rabbit model of cardiopulmonary resuscitation,18 rabbits were randomly divided into three groups, group A:operation-control group,only anesthesia,surgery, endotracheal intubation,but was not induced ventricular fibrillation; group B:epinephrine group,administration of the standard dose of epinephrine(30ug/kg) during CPR;group C:α-MNE group, administration ofα-MNE(100ug/kg) during CPR.The left ventricular end-diastolic pressure(LVEDP) and peak first derivative of left ventricular pressure(±dp/dt) were observed.Collecting blood samples at certain time points to measure the concentration of B-type natriuretic peptide(BNP) and cardiac troponin T(cTnT).At 240~(th) minute after successful resuscitation,killed animals and took myocardium to do light microscopy detection.
Results:Compared with group A,the BNP and LVEDP of the remaining two groups gradually increased respectively(P＜0.01),±dp/dt decreased(P＜0.01).Increases of BNP and LVEDP in Group C were less than in Group B(P＜0.05,P＜0.05),whereas±dp/dt in group C were higher than in group B(P＜0.05) at the same stage. Compared with group A,the cTnT of the remaining two groups increased respectively(P＜0.01),and at 240~(th) minutes reached the peak.Increase of cTnT in group C were less than in Group B(P＜0.05)at the same stage,especially at 60~(th) minutes.group B and group C were detected myocardial injury under a light microscope, but the myocardial damage of group C were lighter than group B.
Conclusion:A-MNE administered immediately during resuscitation improved postresuscitation myocardial dysfunction.It reduced the concentration of BNP and cTnT and alleviated cardiac pathological damage at the early stage of cardiopulmonary resuscitation after CPR from cardiac arrest.
引文
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5.Haas T,Voelekel WG,Wenzel V,et al.Revisiting the cardiac versus thoracic pump mechanism during cardiopulmonary resuscitation[J].Resuscnation,2003,58(1):113-116.
6.Fraseone RJ,Bitz D,Lurie K.Combination of active compression decompression cardiopulmonary resuscitation and the inspiratory impedance threshold device:state of the art[J].Curropin Crit Care,2004,10(3):193-201.
7.高瑞,奚万山,陈伟宏等.大剂量肾上腺素对心肺复苏大鼠心肌超微结构的影响[J].中国危重病急救医学1998,11(10):648-652.
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13.李丹.心肺复苏研究进展[J].人民军医,2005,48(3):175-177.
14.陈永强.心肺复苏指南概要[J].中华护理杂志.2002,37(7):555-558.
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20 李义明,种群生存力分析：准确性和保护应用,生物多样性,2003,11(4)：340～350．
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2.王其新.现代临床急救进展[M].北京:人民军医出版社,2003:1-20
3.2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J].Circulation.2005,12(24Suppl):Ⅳ 1-203.
4.Berg R,Hilwig RW,Ewy GA,et al.Precountershock cardiopulmonary resuscitation improves initial response to defibrillation from prolonged ventricular fibrillation:A randomized,controlled swine study[J].Crit Care Med,2004,32(6):1352-1357.
5.Haas T,Voelekel WG,Wenzel V,et al.Revisiting the cardiac versus thoracic pump mechanism during cardiopulmonary resuscitation[J].Resuscnation,2003,58(1):113-116.
6.Fraseone RJ,Bitz D,Lurie K.Combination of active compression decompression cardiopulmonary resuscitation and the inspiratory impedance threshold device:state of the art[J].Curropin Crit Care,2004,10(3):193-201.
7.高瑞,奚万山,陈伟宏等.大剂量肾上腺素对心肺复苏大鼠心肌超微结构的影响[J].中国危重病急救医学1998,11(10):648-652.
8.Pellis T,Weil MH,Tang WC,et al.Evidence favoring the use ofα_2-selective vasopressor agent for Cardiopulmonary Resuscitation[J].Circulation.2003,108(21):2716-2721.
9.刘玉群.成人心肺复苏的护理现状[J].中国实用护理杂志,2005,21(7):73-75.
10.Dick,Wolfgong F.The carotid pulse check revisited:what if there is no pulse[J]?Critical care Medicine,2000,28(11):183-185.
11.李培杰,董晨明.心肺复苏新知[J].临床急诊杂志,2001,2(1):43.
12.樊寻梅,谢曹.心肺复苏的最新进展—第六届WOLF CREEK会议纪要[J].中华急诊医学杂志,2001,10(6):404-405.
13.李丹.心肺复苏研究进展[J].人民军医,2005,48(3):175-177.
14.陈永强.心肺复苏指南概要[J].中华护理杂志.2002,37(7):555-558.
15.Auderheide TP , Pirrallo RG, Yannopoulos D , et al .Incomplete chest wall decompression : a clinical evaluation of CPR performance by EMS personnel and assessment of alternative manual chest compression- decompression techniques [J].Resuscitation, 2005 , 64 (3): 353- 362.
16.Yannopolous D , McKnite S , Aufderheide TP , et al .Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest [J].Resuscitation, 2005 ,64 (3): 363- 372.
17 .Wolcke BB , Mauer DK, Schoefmann MF.et al .Comparison of standard cardiopulmonary resuscitation versus the combination of active compression-decompression cardiopulmonary resuscitation and an inspiratory impedance threshold device for out-of-hospital cardiac arrest[J].Circulation , 2003,108 (18), 2201-2205.
18.Plaisance P , Lurie KG, Vicaut E , et al.Evaluation of an impedance threshold device in patients receiving active compression-decompression cardiopulmonary resuscitation for out of hospital cardiac arrest [J].Resuscitation, 2004 ,61 (3): 265-271.
19.Davies CS, Colquhoun MC,Boyle R,et al.A national programme for on-site defibrillation by lay people in selected high risk areas: initial results [J].Heart,2005,91(10):1299-1302.
20 李义明,种群生存力分析：准确性和保护应用,生物多样性,2003,11(4)：340～350．
21.Marsch SC,Tschan F,Semmer N,et al.Unnecessary interruptions of cardiac massage during simulated cariac arreses[J].Eur J Anaesthesiol, 2005, 22(11): 831-833.
22.Crile G,Dolly DH.Experimental research into resuscitation of dogs killed by anaesthetic and asphyxia[J].J Exp Med.1906,8:713-720.
23.Guidelines for cardiopulmonary resuscitation and emergency cardiac care[J].JAMA, 1992,268:2184-2241.
24.Koscove EM, Paradis NA.Successful resuscitation from cardiac arrest using high-dose epinephrine therapy.Report of two cases[J].JAMA.1988,259(20):3031-3034.
25.Gedeborg R,Silande HG,Ronne Engstrom,et al.Adverse effects of high doses epinephrine on cerebral blood flow during experimental cardiopul-monary resuscitation[J].Crit Care Med,2000,28(5):1423-1430.
26.The American Heart Association in collaboration with the International Liaison Committee on Resuscitation.Guidelines2000forcardiopulmonary resuscitation and emergency cardiovascular care[J].Circulation,2000,8(Suppl):I-129-I-135.
27.Tang WC,Weil MH,Sun S,et al.Epinephrine increases the severity of post-resuscitation myocardial dysfunction[J].Circulation 1995,92:3089-3093.
28.Kern KB.Postresuscitation myocardial dysfunction[J].Cardiol Clin 2002,20:89-101.
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