中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年
4期
241-244
,共4页
黄芪注射液%集束化治疗%心肺复苏%缺血/再灌注损伤,心肌
黃芪註射液%集束化治療%心肺複囌%缺血/再灌註損傷,心肌
황기주사액%집속화치료%심폐복소%결혈/재관주손상,심기
Huangqi injection%The combined treatment%Cardiopulmonary resuscitation%Ischemia/reperfusion injury,myocardial
目的：观察黄芪注射液联合集束化治疗对心搏骤停（CA）模型兔心肺复苏（CPR）后血流动力学指标、脑钠肽（BNP）变化的影响，探讨其心脏保护的作用机制。方法将24只新西兰大白兔按随机原则分为4组，每组6只。采用体外电击法复制家兔CPR模型（接通50 V交流电胸壁致颤）。手术对照组仅进行麻醉、各种导管置入体内、气管切开，但不致颤。肾上腺素组复苏时右颈静脉导管注入肾上腺素30μg/kg。亚低温组在胸外按压的同时经右颈静脉导管注入肾上腺素30μg/kg，耳缘静脉以1.0 mL · kg-1· min-1速度泵入4℃0.9%氯化钠注射液，同时配合体表降温，维持目标温度（32～34℃）4 h直至实验结束。集束化治疗组在亚低温组治疗的基础上经右颈静脉注入4 g/kg黄芪注射液。于诱发室颤前15 min和复苏后30、60、120、180、240 min动态监测左室舒张期末压（LVEDP）、左室内压上升和下降最大速率（±dp/dt max）、平均动脉压（MAP）等血流动力学指标，同时于诱发室颤前15 min和复苏后30、180、240 min动态检测BNP浓度。结果与手术对照组比较，肾上腺素组、亚低温组和集束化治疗组复苏成功后LVEDP和BNP均明显升高，±dp/dt max、MAP显著下降。复苏后集束化治疗组各时间点LVEDP、BNP水平均明显低于肾上腺素组和亚低温组，且随时间延长LVEDP有升高趋势、BNP则逐渐降低，于复苏后240 min达峰值和谷值〔LVEDP（mmHg，1 mmHg＝0.133 kPa）：6.56±0.21比12.57±0.33、9.54±0.24，BNP（ng/L）：199±19比286±14、251±29，均 P＜0.01〕；各时间点±dp/dt max、MAP水平均明显高于肾上腺素组和亚低温组，且随时间延长逐渐降低，于复苏后240 min达谷值〔+dp/dt max（mmHg/ms）：4229±353比2055±311、3224±158，-dp/dt max（mmHg/ms）：3587±168比1315±189、2357±245，MAP（mmHg）：82.02±1.81比44.15±1.17、56.79±1.60，均P＜0.01〕。结论黄芪注射液联合集束化治疗对CPR后家兔心脏有明显的保护作用，其机制可能与改善血流动力学、抑制BNP过表达有关。
目的：觀察黃芪註射液聯閤集束化治療對心搏驟停（CA）模型兔心肺複囌（CPR）後血流動力學指標、腦鈉肽（BNP）變化的影響，探討其心髒保護的作用機製。方法將24隻新西蘭大白兔按隨機原則分為4組，每組6隻。採用體外電擊法複製傢兔CPR模型（接通50 V交流電胸壁緻顫）。手術對照組僅進行痳醉、各種導管置入體內、氣管切開，但不緻顫。腎上腺素組複囌時右頸靜脈導管註入腎上腺素30μg/kg。亞低溫組在胸外按壓的同時經右頸靜脈導管註入腎上腺素30μg/kg，耳緣靜脈以1.0 mL · kg-1· min-1速度泵入4℃0.9%氯化鈉註射液，同時配閤體錶降溫，維持目標溫度（32～34℃）4 h直至實驗結束。集束化治療組在亞低溫組治療的基礎上經右頸靜脈註入4 g/kg黃芪註射液。于誘髮室顫前15 min和複囌後30、60、120、180、240 min動態鑑測左室舒張期末壓（LVEDP）、左室內壓上升和下降最大速率（±dp/dt max）、平均動脈壓（MAP）等血流動力學指標，同時于誘髮室顫前15 min和複囌後30、180、240 min動態檢測BNP濃度。結果與手術對照組比較，腎上腺素組、亞低溫組和集束化治療組複囌成功後LVEDP和BNP均明顯升高，±dp/dt max、MAP顯著下降。複囌後集束化治療組各時間點LVEDP、BNP水平均明顯低于腎上腺素組和亞低溫組，且隨時間延長LVEDP有升高趨勢、BNP則逐漸降低，于複囌後240 min達峰值和穀值〔LVEDP（mmHg，1 mmHg＝0.133 kPa）：6.56±0.21比12.57±0.33、9.54±0.24，BNP（ng/L）：199±19比286±14、251±29，均 P＜0.01〕；各時間點±dp/dt max、MAP水平均明顯高于腎上腺素組和亞低溫組，且隨時間延長逐漸降低，于複囌後240 min達穀值〔+dp/dt max（mmHg/ms）：4229±353比2055±311、3224±158，-dp/dt max（mmHg/ms）：3587±168比1315±189、2357±245，MAP（mmHg）：82.02±1.81比44.15±1.17、56.79±1.60，均P＜0.01〕。結論黃芪註射液聯閤集束化治療對CPR後傢兔心髒有明顯的保護作用，其機製可能與改善血流動力學、抑製BNP過錶達有關。
목적：관찰황기주사액연합집속화치료대심박취정（CA）모형토심폐복소（CPR）후혈류동역학지표、뇌납태（BNP）변화적영향，탐토기심장보호적작용궤제。방법장24지신서란대백토안수궤원칙분위4조，매조6지。채용체외전격법복제가토CPR모형（접통50 V교류전흉벽치전）。수술대조조부진행마취、각충도관치입체내、기관절개，단불치전。신상선소조복소시우경정맥도관주입신상선소30μg/kg。아저온조재흉외안압적동시경우경정맥도관주입신상선소30μg/kg，이연정맥이1.0 mL · kg-1· min-1속도빙입4℃0.9%록화납주사액，동시배합체표강온，유지목표온도（32～34℃）4 h직지실험결속。집속화치료조재아저온조치료적기출상경우경정맥주입4 g/kg황기주사액。우유발실전전15 min화복소후30、60、120、180、240 min동태감측좌실서장기말압（LVEDP）、좌실내압상승화하강최대속솔（±dp/dt max）、평균동맥압（MAP）등혈류동역학지표，동시우유발실전전15 min화복소후30、180、240 min동태검측BNP농도。결과여수술대조조비교，신상선소조、아저온조화집속화치료조복소성공후LVEDP화BNP균명현승고，±dp/dt max、MAP현저하강。복소후집속화치료조각시간점LVEDP、BNP수평균명현저우신상선소조화아저온조，차수시간연장LVEDP유승고추세、BNP칙축점강저，우복소후240 min체봉치화곡치〔LVEDP（mmHg，1 mmHg＝0.133 kPa）：6.56±0.21비12.57±0.33、9.54±0.24，BNP（ng/L）：199±19비286±14、251±29，균 P＜0.01〕；각시간점±dp/dt max、MAP수평균명현고우신상선소조화아저온조，차수시간연장축점강저，우복소후240 min체곡치〔+dp/dt max（mmHg/ms）：4229±353비2055±311、3224±158，-dp/dt max（mmHg/ms）：3587±168비1315±189、2357±245，MAP（mmHg）：82.02±1.81비44.15±1.17、56.79±1.60，균P＜0.01〕。결론황기주사액연합집속화치료대CPR후가토심장유명현적보호작용，기궤제가능여개선혈류동역학、억제BNP과표체유관。
Objective To observe the effects of Huangqi injection associated with a combined treatment on changes of hemodynamics indexes and brain natriuretic peptide (BNP) after cardiopulmonary resuscitation (CPR) in rabbit models with cardiac arrest (CA) to elucidate the mechanism of such cardiac protective effects. Methods Twenty-four New Zealand rabbits were randomly divided into four groups(each,n=6). The CPR model in rabbits was reproduced by using extra-corporal electric shock method(put through 50 V alternating current to quiver on chest). The animals in operation control group were given anesthesia,all kinds of catheter inserted into the body and tracheotomy,but no induction of ventricular fibrillation. In the epinephrine group,epinephrine (30 μg/kg)was injected into the right jugular vein by a catheter during CPR. In the sub-hypothermia group, epinephrine(30μg/kg)was injected into the right jugular vein via a catheter and 0.9%sodium chloride under 4℃at a rate of 1.0 mL · kg-1 · min-1 was pumped into the ear marginal vein simultaneously with the chest external compressions during CPR and the cooling of body surface sustaining at the target temperature (32-34℃) for 4 hours until the end of the experiment. In the combined treatment group,Huangqi injection(4 g/kg)was injected into the right jugular vein on the basis of treatment of sub-hypothermia group. Hemodynamics indexes such as left ventricular end-diastolic pressure(LVEDP),the maximal rate of left ventricular pressure increase/decline(±dp/dt max),and the mean arterial pressure(MAP)were dynamically monitored at 15 minutes before inducing ventricular fibrillation and at the early stage of post resuscitation for 30,60,120,180,240 minutes,and in the mean time the concentration of BNP was dynamically monitored at 15 minutes before inducing ventricular fibrillation and at the early stage of post resuscitation for 30,180,240 minutes. Results Compared with those of the operation control group,the levels of LVEDP and BNP of epinephrine,sub-hypothermia and combined treatment groups were gradually increased obviously,while ±dp/dt max and MAP were decreased significantly after successful CPR. The levels of LVEDP and BNP at any time point in the combined treatment group were markedly less than those of the epinephrine and sub-hypothermia groups,and along with the time extension,the level of LVEDP had a tendency of elevation,and the level of BNP had a tendency of gradual decrease,reaching peak and valley values respectively at 240 minutes after CPR〔LVEDP (mmHg,1 mmHg=0.133 kPa):6.56±0.21 vs. 12.57±0.33,9.54±0.24,BNP(ng/L):199±19 vs. 286±14, 251±29,all P<0.01〕,at each time point,the ±dp/dt max and MAP levels were significantly higher than those in epinephrine and sub-hypothermia groups,and they were gradually decreased with the time prolongation,reaching valley values at 240 minutes after CPR〔+dp/dt max(mmHg/ms):4 229±353 vs. 2 055±311,3 224±158,-dp/dt max(mmHg/ms):3 587±168 vs. 1 315±189,2 357±245,MAP(mmHg):82.02±1.81 vs. 44.15±1.17, 56.79±1.60,all P<0.01〕. Conclusion Huangqi injection associated with a combined treatment has obvious protective effects on heart after CPR in rabbits,and the mechanism may be related to improvement of hemodynamics indexes and inhibition of excessive expression of BNP.
