失血性心脏骤停兔模型构建及其应用研究

发布时间：2018-01-13 01:37

本文关键词：失血性心脏骤停兔模型构建及其应用研究　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的为了更好地模拟严重失血致心脏骤停的病理生理过程及其治疗经过,并对心肺复苏与液体复苏在失血性心脏骤停中的应用,本课题组实验构建失血性心脏骤停兔模型并对其进行探索。研究方法(1)选择27只新西兰兔分为假手术组(A组,不做处理)、未控制组(B,单纯放血)、复苏组(C组,放血与复苏)。B、C组经动静脉放血约放出50%的全身血量,达到心脏骤停后维持状态15min,随后采用乳酸林格液和全血回输复苏。各时相点采动脉血测血气分析并统计输液量、失血量及6h存活率,处死后进行肾脏和心肌组织病理切片;(2)选择12只新西兰兔分为单纯液体复苏(A组)和液体复苏组+CPR组(B组),构建失血性心脏骤停模型后按相应方式复苏,各时相点采动脉血测血气分析并统计输液量、失血量、复苏率及6h存活率,处死后行肾脏和心肌组织病理切片。研究结果(1)建模成功时B、C组血压显著降低,C组MAP下降至(14.5±5.3)mmHg。复苏30 min C组MAP为(69.75±14.37)mmHg。在复苏5 min时C组pH值、PaC02、Hct、Na+、C1-、Hb、实际碳酸氢盐(AB)、标准碳酸氢盐(SB)、实际碱剩余(ABE)、标准碱剩余(SBE)显著降低,K+、乳酸水平显著升高(与Omin比较:P均0.01);在复苏25 min,仅K+恢复0 min水平,而AB、SB、SBE、ABE与乳酸均低于0 min水平(P均0.05);肌细胞HE染色示:C两组心肌细胞界限不清、排列紊乱的现象较B组轻,心肌组织细胞缺氧受损改变较轻,心肌细胞水肿、坏死较轻,细胞间隙稍增宽。肾脏HE染色示:B、C组肾小管上皮细胞均存在玻璃样改变和坏死,大量炎性细胞浸润,C组亦可见更明显空泡状变性。(2)复苏5min、复苏10min、复苏15min、和复苏30min时间点两组对比均有差异(P＜0.01),复苏60min时A组MAP为(84.6±4.34)mmHg,B组MAP数值为(87.8±5.26),两者比较无统计学差异(P0.05)。血气结果中,复苏5min时A组PaC02数值为(41.76±1.28),B组为(50.72±6.03),两者对比有统计学差异(P＜0.05),余Hct、Na+、C1-、乳酸、Hb、AB、SB、ABE、SBE K+均无差异(P均0.05)。两组各有一只兔子未复苏成功,抢救成功率为83.7%,其中A、B组各有2只兔子并未坚持到所规定的6h时间限定,其6h最终存活率为60%。研究结论(1)通过动静脉联合放血构建的模型稳定性和可重复性高,适用于失血性心脏骤停的研究;(2)CPR联合液体复苏抢救与单纯液体复苏抢救在抢救成功率和生存率上在6h观察期内并无差异,唯一的优势是联合CPR能以更快的速度达到ROSC。
[Abstract]:Objective to simulate the pathophysiological process and treatment of cardiac arrest caused by severe blood loss, and to evaluate the application of cardiopulmonary resuscitation and fluid resuscitation in hemorrhagic cardiac arrest. In this study, we constructed a rabbit model of hemorrhagic cardiac arrest and explored it. Methods: 27 New Zealand rabbits were divided into sham-operation group (group A) and control group (group B). Bloodletting alone, resuscitation group C, bloodletting and resuscitation group C bleeding and resuscitation group released about 50% whole body blood volume through arteriovenous bleeding, reaching the state of 15 minutes after cardiac arrest. Ringer lactate solution and whole blood transfusion were used for resuscitation. Arterial blood gas was collected at each time point to analyze the transfusion volume, blood loss and 6 h survival rate. The renal and myocardial tissue sections were taken after death. (2) 12 New Zealand rabbits were divided into two groups: fluid resuscitation group (A) and fluid resuscitation group (CPR) group (group B). The hemorrhagic cardiac arrest model was established and resuscitated according to the corresponding mode. Arterial blood samples were collected at different time points for blood gas analysis and blood transfusion, blood loss, resuscitation rate and 6 h survival rate. Pathological sections of kidney and myocardium were taken after death. The blood pressure in group C was significantly decreased. The MAP of group C decreased to 14.5 卤5.3 mm Hg.The MAP of group C was 69.75 卤14.37 for 30 min of resuscitation. The pH value of group C was 5 min after resuscitation. PaC02HctNa-C1-Hb, actual bicarbonate, standard bicarbonate, standard bicarbonate SBE, actual alkali residual abe, standard base residual SBE) decreased significantly. K, lactic acid level increased significantly (compared with Omin, 0. 01%, P = 0. 01); After 25 minutes of resuscitation, only K recovered to 0 min level, while ABN SBE and lactic acid were both lower than 0 min level (P 0.05). The results of HE staining showed that the boundary of cardiomyocytes in the two groups was not clear, the phenomenon of arrangement disorder was lighter than that in group B, the changes of hypoxia injury of myocardial tissue cells were lighter, the myocardial cells were edema and necrosis. The renal HE staining showed that there were glass like changes and necrosis in tubular epithelial cells in group C, and a large number of inflammatory cells were infiltrated. In group C, there were more obvious vacuolar denaturation at 5 min, resuscitation at 10 min, resuscitation at 15 min, and 30 min resuscitation (P < 0.01). At 60 minutes after resuscitation, the MAP of group A was 84.6 卤4.34mm HgCU B, the MAP value of group B was 87.8 卤5.26). There was no statistical difference between the two groups (P 0.05). The PaC02 value of group A was 41.76 卤1.28 and that of group B was 50.72 卤6.03 at 5 minutes after resuscitation. There was a significant difference between the two groups (P < 0.05), and there was no significant difference between the two groups (P < 0.05), and there was a significant difference between the two groups (P < 0.05). There was no difference in SBE K between two groups (P < 0.05). One rabbit in each group was not resuscitated and the successful rate of rescue was 83.7% (A). Two rabbits in group B did not adhere to the prescribed time limit of 6 hours, and the final survival rate was 60 hours. Conclusion 1) the model constructed by combined arteriovenous bleeding has high stability and reproducibility. Suitable for the study of hemorrhagic cardiac arrest; There was no difference in the survival rate and survival rate between CPR combined with fluid resuscitation and pure fluid resuscitation during the 6-hour observation period. The only advantage is that the combined CPR can reach Ros faster.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7;R-332

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