抗凝溶栓药物对家兔复苏时微循环的影响

目的探讨心脏骤停（CA）后心肺复苏（CPR）的基本生命支持（BLS）阶段组织微循环变化特点及抗凝溶栓药物对其影响。方法24只家兔随机分为实验组和对照组，每组12只。在交流电诱发CA后，对照组只进行BLS，实验组在此基础上给予尿激酶和肝素进行干预。分别于诱发CA前（0min）和CA后每隔3min测定兔耳的微循环血流量，在复苏30min时取心肌和肾脏组织进行形态学检查。结果对照组兔耳微循环血流量在CA发生后急剧下降（P〈0．05），在BLS阶段随时间的延长不断下降（P〈0．05）。实验组兔耳微循环血流量在CA发生后也急剧下降（P〈0．05），在BLS复苏9min后下降速度趋缓。两组相比微循环血流量变化明显不同（P〈0．05），两条变化曲线约在9min时相交，其后实验组的变化曲线趋于平坦，而对照组仍继续下降。对照组心肌和。肾脏组织的微循环内可观察到红细胞聚集，而实验组无此现象。结论CA后在CPR的BLS阶段微循环血流量下降，有血细胞聚集现象，给予溶栓、抗凝药物的干预可以改善BLS阶段组织的微循环血流灌注，防止微循环内微血栓形成。

Influence of anticoagulative and thrombolytic drugs on the microcirculation during basic life support in cardiopulmonary resuscitation: experiment with rabbits

Objective To explore the change of microcirculation after cardiac arrest （CA） and in the subsequent basic life support （BLS） phase in cardiopulmonary resuscitation （CPR） and to investigate the influences of anticoagulation and thrombolysis thereon. Methods Twenty-four healthy rabbits underwent alternating current stimulation so as to establish rabbit model of ventricular fibrillation. After CA was caused BLS was given to the rabbits. Then the rabbits were randomly divided into 2 equal groups： control group only receiving BLS, and experiment group given heparin, an anticoagulative drug, and urokinase, a thrombolytic drug by intravenous injection in addition to BLS. The dynamic change of microcirculatory blood flow of ear was recorded before CA and every 3 min after CA. Thirty minutes after CPR the rabbits were killed with specimens of heart and kidney taken out to undergo histomorphological examination. Results The blood flow of microcirculation in the rabbit ears reduced sharply after CA （P〈0.05）; and then decreased gradually in the BLS phase along with time （P〈0.05）; however, velocity of decrease tended to slow down since 9 min after the beginning of BLS in the experiment group. The 2 curves of mean microcirculation blood flow intersected 9 min after BLS and then the curve of the experiment group became more level compared to that of the control group. Erythrocyte aggregation could be seen in the heart and kidney specimens of the rabbits of the control group, however, not in the experiment group. Conclus ion Blood flow of microcirculation reduces sharply after CA, and there is red blood cell accumulation in the microcirculation of tissues. Intervention of anticoagulative and thrombolytic drugs improve the microcirculatory perfusion and prevent micro-thrombosis in the microcirculation.