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
2013年
1期
9-12
,共4页
心搏骤停%心肺复苏%高血压灌注%1H-磁共振波谱
心搏驟停%心肺複囌%高血壓灌註%1H-磁共振波譜
심박취정%심폐복소%고혈압관주%1H-자공진파보
Cardiac arrest%Cardiopulmonary resuscitation%Hypertensive perfusion%1H-magnetic resonance spectroscopy
目的用1H-磁共振波谱成像(1H-MRS)技术对去甲肾上腺素(NE)诱导的高血压灌注状态下猪头部进行扫描,观察心搏骤停(CA)动物自主循环恢复(ROSC)后脑代谢的变化.方法12只北京长白猪复制CA心室纤颤(VF)模型4 min后,给予标准心肺复苏(CPR),在ROSC后将动物按照随机数字表法分为高血压灌注组〔立即给予NE,使平均动脉压(MAP)维持在VF前的130%,维持高血压灌注状态4 h〕和正常灌注组(给予适量NE,维持MAP在VF前水平).观察ROSC后不同时间点两组动物血流动力学参数的变化,并于VF前和ROSC后1 h、3 h用1H-MRS技术进行头部扫描,观察两组动物脑部代谢物的动态变化.结果12只猪中有2只因复苏失败而死亡,存活10只,其中高血压灌注组5只,正常灌注组5只.高血压灌注组心率(HR,次/min)于ROSC后30 min、MAP(mm Hg,1 mm Hg=0.133 kPa)和连续心排血量(CO,L/min)于ROSC后1 h即较正常灌注组明显升高(ROSC后30 min HR:167±8比140±15,ROSC后1 h MAP:131±9比108±10,CO:4.9±0.1比3.4±0.5,P<0.05或P<0.01).高血压灌注组ROSC后1 h N-乙酰-天门冬氨酸(NAA,mmol/L)、胆碱(Cho,mmol/L)、肌酸(Cr,mmol/L)、Cho/Cr 比值即均较正常灌注组明显升高(1 h NAA:0.837±0.042比0.594±0.032,Cho:0.827±0.046比0.563±0.030,Cr:0.726±0.076比0.547±0.073,Cho/Cr比值:1.144±0.060比1.038±0.080,P<0.05或P<0.01),ROSC后3 h NAA/Cr比值明显升高(0.877±0.050比0.770±0.040,P<0.01).结论高血压灌注有利于增加脑血流量,降低脑内有害代谢产物,促进神经功能的恢复.1H-MRS技术可对脑代谢物实施动态监测,可对干预措施进行动态评价,为研究各种治疗手段的时间窗提供重要依据.
目的用1H-磁共振波譜成像(1H-MRS)技術對去甲腎上腺素(NE)誘導的高血壓灌註狀態下豬頭部進行掃描,觀察心搏驟停(CA)動物自主循環恢複(ROSC)後腦代謝的變化.方法12隻北京長白豬複製CA心室纖顫(VF)模型4 min後,給予標準心肺複囌(CPR),在ROSC後將動物按照隨機數字錶法分為高血壓灌註組〔立即給予NE,使平均動脈壓(MAP)維持在VF前的130%,維持高血壓灌註狀態4 h〕和正常灌註組(給予適量NE,維持MAP在VF前水平).觀察ROSC後不同時間點兩組動物血流動力學參數的變化,併于VF前和ROSC後1 h、3 h用1H-MRS技術進行頭部掃描,觀察兩組動物腦部代謝物的動態變化.結果12隻豬中有2隻因複囌失敗而死亡,存活10隻,其中高血壓灌註組5隻,正常灌註組5隻.高血壓灌註組心率(HR,次/min)于ROSC後30 min、MAP(mm Hg,1 mm Hg=0.133 kPa)和連續心排血量(CO,L/min)于ROSC後1 h即較正常灌註組明顯升高(ROSC後30 min HR:167±8比140±15,ROSC後1 h MAP:131±9比108±10,CO:4.9±0.1比3.4±0.5,P<0.05或P<0.01).高血壓灌註組ROSC後1 h N-乙酰-天門鼕氨痠(NAA,mmol/L)、膽堿(Cho,mmol/L)、肌痠(Cr,mmol/L)、Cho/Cr 比值即均較正常灌註組明顯升高(1 h NAA:0.837±0.042比0.594±0.032,Cho:0.827±0.046比0.563±0.030,Cr:0.726±0.076比0.547±0.073,Cho/Cr比值:1.144±0.060比1.038±0.080,P<0.05或P<0.01),ROSC後3 h NAA/Cr比值明顯升高(0.877±0.050比0.770±0.040,P<0.01).結論高血壓灌註有利于增加腦血流量,降低腦內有害代謝產物,促進神經功能的恢複.1H-MRS技術可對腦代謝物實施動態鑑測,可對榦預措施進行動態評價,為研究各種治療手段的時間窗提供重要依據.
목적용1H-자공진파보성상(1H-MRS)기술대거갑신상선소(NE)유도적고혈압관주상태하저두부진행소묘,관찰심박취정(CA)동물자주순배회복(ROSC)후뇌대사적변화.방법12지북경장백저복제CA심실섬전(VF)모형4 min후,급여표준심폐복소(CPR),재ROSC후장동물안조수궤수자표법분위고혈압관주조〔립즉급여NE,사평균동맥압(MAP)유지재VF전적130%,유지고혈압관주상태4 h〕화정상관주조(급여괄량NE,유지MAP재VF전수평).관찰ROSC후불동시간점량조동물혈류동역학삼수적변화,병우VF전화ROSC후1 h、3 h용1H-MRS기술진행두부소묘,관찰량조동물뇌부대사물적동태변화.결과12지저중유2지인복소실패이사망,존활10지,기중고혈압관주조5지,정상관주조5지.고혈압관주조심솔(HR,차/min)우ROSC후30 min、MAP(mm Hg,1 mm Hg=0.133 kPa)화련속심배혈량(CO,L/min)우ROSC후1 h즉교정상관주조명현승고(ROSC후30 min HR:167±8비140±15,ROSC후1 h MAP:131±9비108±10,CO:4.9±0.1비3.4±0.5,P<0.05혹P<0.01).고혈압관주조ROSC후1 h N-을선-천문동안산(NAA,mmol/L)、담감(Cho,mmol/L)、기산(Cr,mmol/L)、Cho/Cr 비치즉균교정상관주조명현승고(1 h NAA:0.837±0.042비0.594±0.032,Cho:0.827±0.046비0.563±0.030,Cr:0.726±0.076비0.547±0.073,Cho/Cr비치:1.144±0.060비1.038±0.080,P<0.05혹P<0.01),ROSC후3 h NAA/Cr비치명현승고(0.877±0.050비0.770±0.040,P<0.01).결론고혈압관주유리우증가뇌혈류량,강저뇌내유해대사산물,촉진신경공능적회복.1H-MRS기술가대뇌대사물실시동태감측,가대간예조시진행동태평개,위연구각충치료수단적시간창제공중요의거.
Objective To observe the changes of cerebral metabolism after the animal's recovery of voluntary blood circulation from cardiac arrest(CA),after norepinephrine-induced hypertension perfusion by 1H-magnetic resonance spectroscopy(1H-MRS)was performed to scan the head region . Methods After the 12 Landrace Beijing white pig models of CA and ventricular fibrillation(VF)were established for 4 minutes,the standard cardiopulmonary resuscitation(CPR)was applied for them. After the recovery of voluntary blood circulation(ROSC),the animals were randomly divided into two groups:hypertensive and normal reperfusion groups. In the hypertensive reperfusion group, NE was applied immediately to maintain the mean arterial pressure(MAP)for 4 hours at the level of 130%before VF;in the normal reperfusion group,appropriate NE was applied to maintain the MAP for 4 hours at the same level before VF. One hour and 3 hours after successful recovery of voluntary blood circulation,the changes of blood flow dynamic parameters were observed in the two animal groups,and before VF and after recovery of circulation at the above time points,1H-MRS technique was used to scan the head region to observe the dynamic changes of cerebral metabolites in the two animal groups. Results Finally,there were 2 pigs died of recovery failure,and 10 pigs survived including 5 in the hypertensive reperfusion group and 5 in the normal reperfusion group. In the hypertensive reperfusion group, the heart rate(HR,bpm)after recovery of circulation for 30 minutes and the MAP(mm Hg,1 mm Hg=0.133 kPa)and continuous cardiac output(CO,L/min)after the recovery for 1 hour were significantly higher than those in the normal reperfusion group(30 minutes after ROSC HR:167±8 vs. 140±15,1 hour after ROSC MAP:131±9 vs. 108±10, CO:4.9±0.1 vs. 3.4±0.5,P<0.05 or P<0.01). One hour after ROSC,N-acetyl-L-aspartic acid(NAA,mmol/L), choline(Cho,mmol/L),creatine(Cr,mmol/L)and the Cho/Cr ratio in hypertensive reperfusion group were significantly higher than those of the normal reperfusion group(1 hour NAA:0.837±0.042 vs. 0.594±0.032,Cho:0.827±0.046 vs. 0.563±0.030,Cr:0.726±0.076 vs. 0.547±0.073,Cho/Cr ratio:1.144±0.060 vs. 1.038±0.080,P<0.05 or P<0.01), and 3 hours after ROSC,the NAA/Cr ratio was obviously elevated in the hypertensive reperfusion group(0.877±0.050 vs. 0.770±0.040,P<0.01). Conclusions Hypertensive reperfusion is beneficial to the increase of cerebral blood flow, decreases the harmful metabolites in the brain and promotes the recovery of neural functions. 1H-MRS technique can be used to monitor the dynamic changes of cerebral metabolites,evaluate the interventional means for CPR dynamically and provide important basis in the investigation of various therapeutic measures at time points.
