肝素预抗凝对窒息性心跳骤停大鼠心肺脑复苏效果的影响

目的 评价肝素预抗凝对窒息性心脏停搏大鼠心肺脑复苏效果的影响。方法 SD雄性大鼠70只，8-9周龄，体重350-450 g，随机分为4组：正常对照组（组Ⅰ，n=10）、假手术组（组Ⅱ， n=10）、心跳骤停-复苏组（组Ⅲ，n=25）和预抗凝组（组Ⅳ，n=25），组Ⅳ窒息前静脉注射肝素50 IU／100 g。组Ⅲ、组Ⅳ窒息导致大鼠心脏停搏后5 min开始心肺复苏术。于窒息前（基础值）、复苏成功后即刻、10、30、60min时记录大鼠平均动脉压（MAP）、心率（HR）、直肠温度（RT）和呼气末二氧化碳分压（PETCO2）。记录大鼠心脏停搏、心肺复苏及气管导管拔除的时间。于麻醉前、复苏成功后2、24、48、72 h对大鼠神经系统损伤进行行为学评分（ND评分）。光学显微镜下对复苏成功后72 h大鼠海马、皮层、丘脑、小脑以及壳-尾核进行组织病理损伤评分（HD评分）。结果 MAP、HR、BT和PETCO2基础值组间相比差异无统计学意义（P〉0．05）。与组Ⅲ相比，组Ⅳ复苏成功后即刻MAP明显升高，心脏停搏时间延长，复苏时间以及气管导管拔除时间明显缩短（P〈0．01），心肺复苏成功率及72 h存活率明显升高（P〈0．05），ND和HD评分明显降低（P〈0．05）。结论 肝素预抗凝可明显提高窒息性心跳骤停大鼠心肺复苏的效果，减轻复苏后脑组织损伤，改善心肺脑复苏的转归。

Effect of prophylactic anticoagulation with heparin on the efficacy of cardiopulmonary-cerebral resuscitation in rats following cardiac arrest induced by asphyxia

Objective To evaluate the effect of prophylactic anticoagulation with heparin on efficacy of cardiopulmonary-cerebral resuscitation in rats following asphyxia-induced cardiac arrest . Methods Male Sprague-Dawley rats aged 8-9 week weighing 350-450 g were randomly divided into 4 groups: normal control group (group I , n = 10), sham operation group (group II , n = 10) , cardiac arrest-resuscitation group (group III , n = 25), and prophylactic anticoagulation group ( group IV , n = 25) . The rats in group III and group IV underwent asphyxia to induce cardiac arrest, and in group IV heparin 50 IU/100 g was administered IV for anticoagulation before asphyxia. Group III and group IV received standard cardiopulmonary resuscitation(CPR) 5 min after cardiac arrest. The mean arterial pressure( MAP),heart rate(HR),rectal temperature(RT) and partial pressure of carbon dioxide in end expiratory gas(PETCO2 )were recorded before asphyxia (baseline), immediately after restoration of spontaneous circulation(ROSC), 10, 30,60 min after ROSC. Survival rate at 72 h after ROSC and the time intervals of cardiac arrest (from asphyxia to cardiac arrest), CPR (from start to ROSC) and extubation (from stopping mechanical ventilation to extubation) were recorded. Neurological deficit ( ND) scores were evaluated before anesthesia, at 2 h,24 h,48 h,and 72 h after ROSC (0 = best, 100% = worst) .The histopathological damage (HD) scores of the five brain regions (hippocampus, cortex, thalamus, cerebellum, caudate-putamen) were determined at 72 h after ROSC. Results There were not significant differences in baseline values of MAP, HR, RT and PET CO2 among groups. Compared with those in group III , MAP was significantly increased immediately after ROSC, time interval of cardiac arrest was prolonged, time intervals of CPR and extubation were shorten, achievement ratio of CPR and survival rate at 72 h after ROSC were increased and ND and HD scores were decreased significantly in group IV ( P < 0.05) . Conclusion Prophylactic anticoagulation with heparin has beneficial effects in enhancing the achievement of CPR, reducing the histopathological damage of cerebral neurons and improving the turnover of cardiopulmonary-cerebral resuscitation in rat following asphyxia-induced cardiac arrest.