亚低温联合μ-阿片受体激动剂对家兔心肺复苏后心功能的保护作用

发布时间：2018-07-25 17:25

【摘要】：目的研究亚低温联合μ-阿片受体激动剂对家兔心肺复苏后心功能的保护作用,并探讨其可能的机制。方法体外致颤法建立家兔心肺复苏模型,随机分为常规复苏组(B组)、亚低温复苏组(C组)、瑞芬太尼复苏组(D组)、亚低温联合瑞芬太尼复苏组(E组),并设对照组(A组,仅行麻醉、手术、气管插管,但不致颤)。测定各组不同时间点左室舒张末压(LVEDP)、左室内压上升和下降最大速率(peak±dp/dt)及血清COX2、H-FABP浓度,并于复苏后4h处死动物,观察心肌细胞ICAM-1的表达情况以评价心功能的变化。结果 1与A组比较,其余4组LVEDP与peak±dp/dt在复苏成功30min差异有统计学意义(P0.01);C、D、E组与B组比较,分别在复苏成功120、60min时差异有统计学意义(P0.05),但E组LVEDP升高幅度以及peak±dp/dt下降幅度均小于C、D组(P0.05);C、D两组差异无统计学意义。2与A组比较,其余4组血清H-FABP与COX-2值明显升高(P0.01);C、D、E组较B组明显降低,但E组下降幅度最为明显(P0.05);3A组心肌细胞未见ICAM-1表达阳性细胞,B组可见大量阳性细胞,C、D组较B组阳性细胞减少,差异有统计学意义(P0.05);E组较C、D组阳性细胞明显减少,差异有统计学意义(P0.05)。结论亚低温治疗及瑞芬太尼干预均可改善心肺复苏后心功能不全,两者联用可提高疗效,具有协同功效。该疗效可能是通过延长亚低温治疗时间窗,更加有效地发挥瑞芬太尼和亚低温的自由基清除及抑制炎症反应作用而达到心肌保护作用。
[Abstract]:Objective to study the protective effect of mild hypothermia combined with 渭 -opioid receptor agonist on cardiac function after cardiopulmonary resuscitation in rabbits and its possible mechanism. Methods Rabbits with cardiopulmonary resuscitation were randomly divided into conventional resuscitation group (group B), mild hypothermia resuscitation group (group C), remifentanil resuscitation group (group D), mild hypothermia and remifentanil resuscitation group (group E). Surgery, tracheal intubation, but no tremor). Left ventricular end-diastolic pressure (LVEDP), left ventricular pressure (peak 卤dp/dt) and serum COX2H-FABP concentration were measured at different time points. The animals were killed at 4 h after resuscitation. The expression of ICAM-1 in cardiac myocytes was observed to evaluate the changes of cardiac function. Results 1Compared with group A, the other four groups of LVEDP and peak 卤dp/dt had significant difference in 30min of successful resuscitation (P0.01). The difference was statistically significant at 120 minutes after successful resuscitation (P0.05), but the increase of LVEDP and the decrease of peak 卤dp/dt in group E were lower than those in group C (P0.05). There was no significant difference between group C and group A. The levels of serum H-FABP and COX-2 in the other four groups were significantly higher than those in group B (P0.01), but the decrease was the most obvious in group E (P0.05). There were no significant positive cells in group B (P > 0.05). A large number of positive cells were found in group D than in group B, and there was no significant decrease in positive cells in group C (P 0.05). The difference was statistically significant (P0.05). The number of positive cells in E group was significantly lower than that in CMA D group, and the difference was statistically significant (P0.05). Conclusion mild hypothermia therapy and remifentanil intervention can improve cardiac dysfunction after cardiopulmonary resuscitation. This effect may be achieved by prolonging the time window of mild hypothermia therapy, exerting free radical scavenging and inhibiting inflammatory response of remifentanil and mild hypothermia more effectively.
【作者单位】：兰州大学附属第二医院ICU;
【基金】：甘肃省科技厅资助项目甘肃省技术研究与开发专项计划资助项目(No.1105TCYA011)~~
【分类号】：R459.7

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