吸入氢气对窒息大鼠复苏后心脑功能的保护作用研究

发布时间：2018-04-03 15:41

  本文选题：氢气　切入点：亚低温　出处：《第三军医大学》2016年硕士论文

【摘要】：心脏骤停复苏后患者死亡的主要原因是复苏后心、脑损伤。近年来,院外心脏骤停数据报道中,不可除颤节律患者所占的比例越来越大,并且预后较差。治疗性亚低温作为目前研究唯一有效的治疗措施被写进复苏指南,但因其带来的副作用及对不可除颤患者保护效果不显著引起争议。在心室颤动心脏骤停动物模型中,氢气被证明具有脑保护作用并且可以显著改善复苏后存活,然而,氢气对于心、脑的保护作用在不可除颤节律模型中未被研究。本研究运用动物实验以及组织病理生物学、生化学的分析方法,证明氢气对无脉电活动大鼠复苏后的心、脑损伤有改善作用,主要研究内容和实验结果如下:一、建立窒息法致心脏骤停大鼠复苏后心肌损伤及神经功能损伤的疾病模型,探讨吸入2%氢气对心肺复苏大鼠心、脑损伤及存活率的改善作用,并与传统亚低温治疗方式进行比较。方法:健康SD大鼠72只,维持窒息心脏骤停未处理五分钟,随后给予心肺复苏及机械通气,动物自主循环恢复后随机分为三组:常温机械通气2%氮气+98%氧气(对照组);亚低温(33℃)机械通气2%氮气+98%氧气(低温组);常温机械通气2%氢气+98%氧气(氢气组)。混合气体机械吸入1小时,降温方法为恢复自主循环后体表物理降温,十分钟左右将核心温度将至亚低温范围(32℃-34摄氏度),且维持33℃亚低温两小时,之后两小时复温至基础体温,复苏后连续监测4小时且持续观察96小时。对各组大鼠进行生存率评价和形态学观察,每24小时进行神经功能缺陷评分,分析各组大鼠在不同时间点的超声数据,用ELISA方法测定各组大鼠不同时间点的心肌损伤指标c TnT及脑功能损伤指标s-100B。结果:各组动物在基础状态均无差异,所有动物均复苏成功,低温组复苏早期血清中cTn T与s-100b的含量均显著低于对照组(p0.05),氢气组复苏后左心室射血分数显著提高(p0.05),其神经功能缺损评分显著改善(p0.05);96小时生存率分别为:氢气组75.0%(p=0.004 vs.对照组;p=0.039 vs.低温组),低温组45.8%(p=0.376 vs.对照组),对照组33.3%。方法:健康大鼠36只随机分为三组:(1)假手术组:仅麻醉,气管插管及动静脉插管手术;(2)对照组:复苏后机械通入1小时2%氮气+98%氧气,观测终点为4小时;(3)实验组:复苏后机械通入1小时2%氢气+98%氧气,观测终点为4小时。观察终点处死取材,做血液生化与病理生化检测。结果:与对照组相比,实验组复苏后四小时血清炎症因子IL-6,IL-8,IgG及凋亡因子TFAR19均显著减少,差异有统计学意义(p0.05)。本研究证明,在窒息致大鼠心脏骤停模型中,吸入小剂量氢气比低温更能有效的减轻心脑功能损伤及改善复苏后存活,初步探讨氢气的保护作用与其抗炎症抗凋亡反应有关。二、初步探讨吸入氢气对复苏后心、脑保护作用机制。
[Abstract]:The main cause of death after cardiac arrest resuscitation is cardiac and brain injury after resuscitation.In recent years, the proportion of patients with undefibrillation rhythm is increasing, and the prognosis is poor.Therapeutic mild hypothermia, as the only effective treatment in current studies, has been included in the resuscitation guidelines, but its side effects and protective effects on patients with undefibrillation are not controversial.In ventricular fibrillation and cardiac arrest animal models, hydrogen has been shown to have a brain protective effect and can significantly improve survival after resuscitation. However, the protective effect of hydrogen on heart and brain is not studied in the undefibrillation rhythm model.In this study, animal experiments, histopathological and biochemical methods were used to prove that hydrogen can improve cardiac and brain injury after resuscitation in rats with no pulse electrical activity. The main contents and experimental results are as follows: 1.To establish the model of myocardial injury and nerve function injury after resuscitation in rats with cardiac arrest induced by asphyxia, to investigate the effects of inhaling 2% hydrogen on the improvement of heart and brain injury and survival rate in rats with cardiopulmonary resuscitation, and to compare it with the traditional mild hypothermia therapy.Methods: 72 healthy SD rats were given cardiopulmonary resuscitation and mechanical ventilation.After mechanical inhalation of mixed gases for 1 hour, the cooling method is physical cooling of body surface after recovery of spontaneous circulation, the core temperature will reach 32 鈩，

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