CAJ | 학술논문

目的评价咪达唑仑对新生猪缺氧缺血性脑损伤的影响.方法雄性新生猪24头,日龄3～7 d,体重1.8～3.0 kg,随机分为3组(n=8):假手术组(S组)、缺氧缺血性脑损伤+盐水组(HI-S组)和缺氧缺血性脑损伤+咪达唑仑组(HI-M组).HI-S组和HI-M组采用窒息性心跳骤停后心肺复苏的方法制备缺氧缺血性脑损伤模型.自主循环恢复(ROSC)后3 h,各组均静脉输注芬太尼10～30 μg·kg-1·h-1和泮库溴铵0.1～0.2 mg·kg-1·h-1,HI-M组同时静脉输注咪达唑仑0.05 mg·kg-1·h-1至ROSC后24 h,HI-S组和S组静脉输注等容量生理盐水.于模型制备前(基础状态)、低氧37 min、吸入空气5 min、窒息5 min、ROSC后6、12和24 h时取动脉血样行血气分析,并记录各时点MAP;于ROSC后48、72、96及240 h时行神经行为学评分(NVS),于ROSC后240 h时取脑组织,计数纹状体(壳状核和尾状核)存活神经元,计算存活神经元密度.结果与S组和基础值比较,HI-S组和HI-M组低氧窒息期间动脉血氧分压降低,窒息5 min时动脉血二氧化碳分压升高,pH值和MAP降低(P<0.05),HI-M组和HI-S组各时点上述指标比较差异无统计学意义(P>0.05).与S组比较,HI-S组和HI-M组壳状核和尾状核存活神经元密度降低(P<0.01),ROSC后48996 h时NBS评分升高(P<0.05);与HI-S组比较,HI-M组壳状核和尾状核存活神经元密度明显增加,ROSC后72和96 h时NBS评分降低(P<0.05).结论心肺复苏早期应用咪达唑仑可减轻新生猪缺氧缺血性脑损伤.
목적 평개미체서륜대신생저결양결혈성뇌손상적영향.방법 웅성신생저24두,일령3～7 d,체중1.8～3.0 kg,수궤분위3조(n=8):가수술조(S조)、결양결혈성뇌손상+염수조(HI-S조)화결양결혈성뇌손상+미체서륜조(HI-M조).HI-S조화HI-M조채용질식성심도취정후심폐복소적방법 제비결양결혈성뇌손상모형.자주순배회복(ROSC)후3 h,각조균정맥수주분태니10～30 μg·kg-1·h-1화반고추안0.1～0.2 mg·kg-1·h-1,HI-M조동시정맥수주미체서륜0.05 mg·kg-1·h-1지ROSC후24 h,HI-S조화S조정맥수주등용량생리염수.우모형제비전(기출상태)、저양37 min、흡입공기5 min、질식5 min、ROSC후6、12화24 h시취동맥혈양행혈기분석,병기록각시점MAP;우ROSC후48、72、96급240 h시행신경행위학평분(NVS),우ROSC후240 h시취뇌조직,계수문상체(각상핵화미상핵)존활신경원,계산존활신경원밀도.결과 여S조화기출치비교,HI-S조화HI-M조저양질식기간동맥혈양분압강저,질식5 min시동맥혈이양화탄분압승고,pH치화MAP강저(P<0.05),HI-M조화HI-S조각시점상술지표비교차이무통계학의의(P>0.05).여S조비교,HI-S조화HI-M조각상핵화미상핵존활신경원밀도강저(P<0.01),ROSC후48996 h시NBS평분승고(P<0.05);여HI-S조비교,HI-M조각상핵화미상핵존활신경원밀도명현증가,ROSC후72화96 h시NBS평분강저(P<0.05).결론 심폐복소조기응용미체서륜가감경신생저결양결혈성뇌손상.
Objective To investigate the effects of midazolam on hypoxic-ischemic (HI) brain injury in neonatal piglets.Methods Twenty-four newborn male piglets 3-7 days old weighing 1.8-3,0 kg were randomly divided into 3 groups ( n = 8 each): sham group (group S), HI + normal saline group (group HI-S) and HI + midasolam group (group HI-M). The animals of group HI-S and HI-M were subjected to 7 min of hypoxia, producing asphyxic cardiac arrest, followed by cardiopulmonary resuscitation. At 3 h after restoration of spontaneous circulation (ROSC), animals received i.v. infusion of fentanyl at a rate of 10-30 μg·kg-1·h-1 and pancuroniumat a rate of 0.1-0.2 mg·kg-1·h-1 from 3 h after ROSC to 24 h after ROSC to maintain the anesthesia. In addition, midazolam at a rate of 0.05 mg·kg-1·h-1 wee infused simultaneously until 24 h after ROSC in HI-M group, while the equal volume of normal saline was infused instead in group HI-S and S. Arterial blood samples were taken before hypoxia (baseline), and at 37 min of hypoxia, 5 min of air inspiration, 5 min of asphyxia and 6, 12, and 24 h after ROSC for blood gas analysis, and MAP was monitored at the each time point. Neurological behavior was assessed and scored (NBS) at 48, 72, 96 and 240 h after ROSC. Brains were removed at 10 h after ROSC, the remaining viable neurons in putamen and candate nucleus were counted and the density of viable neurons was determined using light microscopic examination. Results PaO2 was significantly decreased during hypoxia-eephyxia, and PaCO2 was significantly increased, while pH value and MAP were significantly decreased at 5 min of asphyxia in group HI-S and HI-M compared with group S and the baseline (P < 0.05).There were no significant differences in MAP and arterial blood gas analysis at the each time point between group HI-S and HI-M ( P > 0.05). The density of viable neurons in putamen and caudate nucleus was significantly lower, and NBS at 48-96 h after BOSC significantly higher in group HI-S and HI-M than in group S ( P < 0.05). The density of viable neurons in putamen and caudate nucleus was significantly higher and NBS at 72 and 96 h after ROSC significantly lower in group HI-M than in group HI-S ( P < 0.05). Conclusion Midazolam used at the early stage of cardiopulmonary resuscitation can attenuate HI brain injury in neonatal piglets.