CAJ | 학술논문

目的观察外源性磷酸肌酸(CP)对大鼠心肺复苏(CPR)后脑损伤的影响.方法成年雄性SD大鼠160只,随机(随机数字法)分为4组:假手术对照组(A组)、常规复苏组(B组)、小剂量CP组(C组)、大剂量CP组(D组),各组再分别按自主循环恢复(ROSC)后(B、C、D组)或气管切开后(A组)0.5、3、6、12、24h时间点分为5亚组(n=8).B、C、D组采用窒息法建立大鼠CPR模型,ROSC后即刻C组静注CP0.5 g/kg,D组静注CP 1.0 g/kg.A组仅施行麻醉、气管切开、血管穿刺等操作,不行窒息及复苏.各亚组在相应时间点取材大脑额叶.采用高效液相色谱法( HPLC)测定脑组织三磷酸腺苷(ATP)、二磷酸腺苷(ADP)、一磷酸腺苷(AMP)含量,并计算总腺苷酸(TAN)及能倚(EC)值；采用吸光度法测定脑组织Na+ -K+ -ATP酶、Ca2+ - Mg2+ - ATP酶活性；HE染色观察光镜下大脑皮层病理变化.应用SPSS 16.0软件包进行数据统计,组间比较采用方差分析.结果与A组比较,B组C组各时间点ATP、TAN、EC、Na+-K+-ATPase、Ca2+ -Mg2+ -ATPase均降低(P＜0.05或P＜0.01),D组0.5、3、6、12 h时间点的ATP、TAN、EC、Na+ -K+ -ATPase、Ca2 -Mg2 -ATPase均降低(P＜0.05或P＜0.01),B组各时间点AMP均升高(P＜0.01),C组D组0.5h和3h时间点的AMP升高(P＜0.01)；与B组比较,C组D组6、12、24h时间点的ATP、TAN、EC、Na+ -K+ -ATP酶、Ca2+ -Mg2+ -ATP酶均升高(P＜0.05或P＜0.01),C组D组6、12、24h时间点的AMP均降低(P＜0.05或P＜0.01)；与C组比较,D组6、12、24h时间点的TAN、Na+ -K+ -ATPase、Ca2 -Mg2 -ATPase以及24h的ATP均升高(P＜0.05或P＜0.01).大脑皮层病理变化B组严重,C组D组较轻.结论心肺复苏后存在脑能量代谢障碍,CP可以增加CPR后脑组织中的ATP含量,提高Na+ -K+ -ATPase和Ca2 -Mg2+ -ATPase的活性,减轻脑组织病理损伤,具有脑保护作用,在大剂量给药时作用更明显.
목적 관찰외원성린산기산(CP)대대서심폐복소(CPR)후뇌손상적영향.방법 성년웅성SD대서160지,수궤(수궤수자법)분위4조:가수술대조조(A조)、상규복소조(B조)、소제량CP조(C조)、대제량CP조(D조),각조재분별안자주순배회복(ROSC)후(B、C、D조)혹기관절개후(A조)0.5、3、6、12、24h시간점분위5아조(n=8).B、C、D조채용질식법건립대서CPR모형,ROSC후즉각C조정주CP0.5 g/kg,D조정주CP 1.0 g/kg.A조부시행마취、기관절개、혈관천자등조작,불행질식급복소.각아조재상응시간점취재대뇌액협.채용고효액상색보법( HPLC)측정뇌조직삼린산선감(ATP)、이린산선감(ADP)、일린산선감(AMP)함량,병계산총선감산(TAN)급능의(EC)치；채용흡광도법측정뇌조직Na+ -K+ -ATP매、Ca2+ - Mg2+ - ATP매활성；HE염색관찰광경하대뇌피층병리변화.응용SPSS 16.0연건포진행수거통계,조간비교채용방차분석.결과 여A조비교,B조C조각시간점ATP、TAN、EC、Na+-K+-ATPase、Ca2+ -Mg2+ -ATPase균강저(P＜0.05혹P＜0.01),D조0.5、3、6、12 h시간점적ATP、TAN、EC、Na+ -K+ -ATPase、Ca2 -Mg2 -ATPase균강저(P＜0.05혹P＜0.01),B조각시간점AMP균승고(P＜0.01),C조D조0.5h화3h시간점적AMP승고(P＜0.01)；여B조비교,C조D조6、12、24h시간점적ATP、TAN、EC、Na+ -K+ -ATP매、Ca2+ -Mg2+ -ATP매균승고(P＜0.05혹P＜0.01),C조D조6、12、24h시간점적AMP균강저(P＜0.05혹P＜0.01)；여C조비교,D조6、12、24h시간점적TAN、Na+ -K+ -ATPase、Ca2 -Mg2 -ATPase이급24h적ATP균승고(P＜0.05혹P＜0.01).대뇌피층병리변화B조엄중,C조D조교경.결론 심폐복소후존재뇌능량대사장애,CP가이증가CPR후뇌조직중적ATP함량,제고Na+ -K+ -ATPase화Ca2 -Mg2+ -ATPase적활성,감경뇌조직병리손상,구유뇌보호작용,재대제량급약시작용경명현.
Objective To study the effects of exogenous phosphocreatine (CP) on brain injury after cardiopulmonary resuscitation (CPR) in rats.Methods A total of 160 male adult SD rats were randomly ( random number) divided into 4 groups:sham-operation control group ( group A),CPR group ( group B),low-dose CP group ( group C),high-dose CP group ( group D),and each group was further divided into 5 subgroups (n =8) as per study at different intervals,0.5,3,6,12 and 24 h after restoration of spontaneous circulation (ROSC) in groups B,C and D or after tracheotomy in group A.Cardiac arrest (CA) was induced by using asphyxia to establish CPR model in group B,C and D.The CP0.5 g/kg used in group C or CP 1.0 g/kg used in group D was injected into femoral vein at beginning of ROSC.Rats in each subgroup were sacrificed and the tissues of frontal lobe of brain of rats were taken at different intervals.The levels of adenosine triphosphate (ATP),adenosine diphosphate (ADP) and adenosine monophosphate (AMP) in cerebral cortex were measured by high performance liquid chromatography (HPLC),and values of total adenine nucleotides ( TAN ) and energy charge ( EC ) were detected.The activities of Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase in cerebral cortex were assayed by spectrophotometric method. The pathological changes of cerebral cortex were observed under optical microscope.The experimental data were processed with analysis of variance by using SPSS 16.0 package. Results Compared with group A,the levels of ATP,TAN,EC,Na + -K + -ATPase,Ca2+ -Mg2+ -ATPase were lower ( P ＜ 0.05 or P ＜ 0.01 ) at each interval in groups B and C,and at intervals of 0.5,3,6,12 h in group D,and the levels of AMP were higher (P ＜ 0.01 ) at each interval in group B and at intervals of 0.5 h and 3 h in groups C and D.Compared with group B,the levels of ATP,TAN,EC,Na + -K + -ATPase,Ca2 + -Mg2+ -ATPase were higher ( P ＜ 0.05 or P ＜ 0.01 ),and the levels of AMP were lower ( P ＜ 0.05 or P ＜ 0.01 ) at intervals of 6,12 and 24 h in groups C and D.Compared with group C,the levels of ATP at interval of 24 h and TAN,Na +- K + -ATPase,Ca2 + -Mg2 + -ATPase at intervals of 6,12 and 24 h were higher in group D ( P ＜ 0.05 or P ＜ 0.01 ).There were severe pathological changes in cerebral cortex in group B,and mild changes in groups C and D. Conclusions There was obvious energy metabolism disorder after CPR in rats.Treatment with exogenous CP could increase the levels of ATP and activities of ATPase,alleviate pathological changes,especially in high-dose,and mitigate injury in cerebral cortex after CPR in rats.