高渗高张溶液对心肺复苏后兔脑、心肌损伤及胃粘膜灌注水平的影响

目的 探讨高渗高张溶液(HHS)对心肺复苏后兔脑、心肌损伤及胃粘膜灌注水平的影响.方法 健康雄性兔,体重1.9～2.1 kg,采用窒息的方法制备兔心跳骤停模型,窒息10 min后开始心肺复苏.自主循环恢复后,随机分为2组(n=10):生理盐水对照组(NS组)静脉输注生理盐水4 ml/kg.HHS组静脉输注7.2%氯化钠和6%羟乙基淀粉200/0.54 ml/kg.于心跳骤停前测定心率、平均动脉压、冠脉灌注压、血红蛋白浓度、凝血功能指标、血清S-100蛋白、心肌肌钙蛋白Ⅰ(cTnI)浓度和胃粘膜pH值(pHi)的基础值,并于自主循环恢复后30、60、120、180和240 min时分别测定各项指标.结果 与基础值比较,自主循环恢复后,两组血清S-100蛋白和cTnI浓度均明显升高,pHi均先降低,后逐渐升高(P<0.01);与NS组比较,自主循环恢复后,HHS组血清S-100蛋白和cTnI浓度降低,pHi升高(P<0.01).结论 HHS可在一定程度上减轻心肺复苏后兔的脑及心肌损伤,改善胃粘膜的微循环灌注,从而有益于改善预后.

Effects of hypertonic- hyperoncotic solution given after cardiopulmonary resuscitation on brain and heart ischemia-reperfusion injury and gastric intramucosal perfusion in rabbits

Objective To investigate the effects of hypertonic- hyperoncotic solution ( HHS) given immediately after cardiopulmonary resuscitation ( CPR) on myocardial and brain injury and gastric mucosal microcirculation. Methods Twenty male rabbits weighing 1.9-2.1 kg were randomly divided into 2 groups ( n = 10 each): control group and HHS group. The animals were anesthetized with chloral hydrate 300 mg/kg iv, tracheotomized, intubated and mechanically ventilated (FiO_2 40% , V_T 10 ml/kg, RR 20 bpm). Femoral artery and vein were connulated for BP monitoring, blood gas analysis and fluid administration. Internal jugular, vein was cannulated for CVP monitoring. ECG was continuously monitored. Gastric intramucosal pH, blood coagulation and serum S-100 and cTnI concentrations were measured before (baseline) and at 30, 60, 120, 180 and 240 min after return of spontaneous circulation (ROSC) . Cardiac arrest was induced by occlusion of tracheal tube and confirmed by ECG (asystole, ventricular fibrillation) and sudden sharp drop in BP. After being suffocated for 10 min, basic life support ( BLS) and advanced cardiac life support (ACLS) were started. Upon ROSC the animals received 4 ml/kg of normal saline (NS) or 7.2% NaCl + 10% hydroxyethyl starch 200/0.5 (HHS) .Results The serum levels of cTnI and S-100 were significantly increased after ROSC as compared with baseline in both groups and were significantly lower in HHS group than in control group. The gastric intramucosal pH was significantly decreased after ROSC in both groups and was significantly higher in HHS group than in control group. Conclusion HHS given immediately after ROSC can ameliorate ischemia-reperfusion injury to heart and brain and improve gastric intramucosal microcirculatory perfusion.