CAJ | 학술논문

目的：通过灌注加权成像（PWI）技术研究心肺复苏（ROSC）成功后72h内脑功能、脑灌注的动态变化趋势和亚低温的脑保护作用。方法五指山猪30只，致颤8min后按标准心肺复苏，复苏成功28只，随机分为低温组（14只）和常温组（14只）。低温组在自主循环恢复后运用血管内降温法进行亚低温治疗（33℃低体温维持12h后以0.5℃/h被动复温），常温组不干预体温，动态监测血流动力学变化，于基础状态及ROSC后6、12、24、72h行脑组织PWI检查。结果低温组72h成活率（78.6%与42.9%，P<0.05）、72h神经功能缺损评分优于常温组（45.27分与119.50分，P=0.001），表明复苏后两组平均通过时间均延长，局部脑血流量、脑血容积下降；低温组平均通过时间、局部脑血流量数值变化较常温组幅度小，脑组织缺血程度较常温组轻。结论 ROSC后早期脑组织即出现严重的脑损伤，复苏后6h损伤最严重，PWI技术可以对复苏后脑组织循环和灌注进行动态监测，亚低温疗法一定程度上可提高复苏后生存率，改善脑功能恢复，具有较好的脑保护作用。
목적：통과관주가권성상（PWI）기술연구심폐복소（ROSC）성공후72h내뇌공능、뇌관주적동태변화추세화아저온적뇌보호작용。방법오지산저30지，치전8min후안표준심폐복소，복소성공28지，수궤분위저온조（14지）화상온조（14지）。저온조재자주순배회복후운용혈관내강온법진행아저온치료（33℃저체온유지12h후이0.5℃/h피동복온），상온조불간예체온，동태감측혈류동역학변화，우기출상태급ROSC후6、12、24、72h행뇌조직PWI검사。결과저온조72h성활솔（78.6%여42.9%，P<0.05）、72h신경공능결손평분우우상온조（45.27분여119.50분，P=0.001），표명복소후량조평균통과시간균연장，국부뇌혈류량、뇌혈용적하강；저온조평균통과시간、국부뇌혈류량수치변화교상온조폭도소，뇌조직결혈정도교상온조경。결론 ROSC후조기뇌조직즉출현엄중적뇌손상，복소후6h손상최엄중，PWI기술가이대복소후뇌조직순배화관주진행동태감측，아저온요법일정정도상가제고복소후생존솔，개선뇌공능회복，구유교호적뇌보호작용。
Objective To evaluate the effects of mild hypothermia therapy on cerebral function and perfusion as assessed by perfusion weighted imaging (PWI) during the first 72 hours after return of spontaneous circulation (ROSC) in a porcine model. Methods Ventricular fibrillation (VF) was induced in 30 Inbred Wuzhishan miniature pigs. After 8 min of untreated VF, standard CPR was performed and 28 animals got ROSC. The ROSC animals were randomly assigned to normothermia group (n=14) and hypothermia group (n=14). The hypothermia group immediately received endovascular cooling to regulate temperature to 33°C, which was maintained for 12 h, followed by passive rewarming at 0.5°C/h to 37°C. The two groups were scanned the perfusion weighted imaging at baseline, 6h, 12h, 24h, and 72 h after ROSC. Results Compared with the normothermia group, the hypothermia group exhibited a higher 72 h survival rate (78.6% vs. 42.9%, P<0.05), superior neurological deficit scores (45.27 vs. 119.50;P=0.001), a smaller changing in the PWI indexes (mean transition time, cerebral blood flow) and a relative slightly ischemia injury. Conclusions Cerebral microcirculation disturbance occurred at early stage after ROSC. Cerebral ischemic and anoxia were worst at 6 hours after ROSC and then recovered gradually. PWI could effectively reflect the dynamic trend of cerebral injury after ROSC. Hypothermia therapy could produce a protective effect on neurological function.