CAJ | 학술논문

目的：观察窒息大鼠心肺复苏术后血清肾素、血管紧张素Ⅱ（AngⅡ）以及心肌肾素、AT1、AT2 mRNA的表达情况。方法随机将42只SD大鼠分为正常对照组（A组）、假手术组（B组）、CPR组（C组）、CPR＋肾上腺素组（D组）四组，B、C、D三组均分为0h、6h两个亚组。A组未行有创操作，采血后处死取心肌组织；B、C、D三组均做动静脉穿刺，B组予普通上氧（3L／min），C组及D组给予气管切开、有创机械通气及心肺复苏。B、C、D三组于各亚组时间终点采血测血清肾素、AngⅡ表达水平，处死动物后留心肌标本检测心肌肾素、AT1R、AT2R的mRNA表达。B、C、D三组监测平均动脉压（MAP）、左室收缩峰压（LVSP）、左室舒张末期压力（LVEDP）、左室最大上升与下降速率（± LVdP／dtmax）。结果（1）心肺复苏术后6 h ，血清肾素及血管紧张素Ⅱ水平以及心肌肾素、AT1、AT2 mRNA表达上调，与A组比较差异有统计学意义（P＜0．01）；（2）复苏后6 h ，C组与B组比较，血清肾素、血管紧张素Ⅱ表达水平明显增高（P＜0．05），但心肌肾素、AT1、AT2 mRNA差异无统计学意义（P＞0．05）；（3）相关性分析结果提示，AngⅡ及AT1R mRNA与± dp／dtmax、LVSP呈正相关，与LVEDP呈负相关，差异均有统计学意义（P＜0．01）。结论心肺复苏可引起全身及心肌局部RAS系统激活；肾上腺素可促使血清肾素、血管紧张素Ⅱ及心肌肾素、AT1R、AT2R mRNA呈现过表达；ACE‐AngⅡ‐AT1轴的激活是复苏后心功能不全原因之一。
목적：관찰질식대서심폐복소술후혈청신소、혈관긴장소Ⅱ（AngⅡ）이급심기신소、AT1、AT2 mRNA적표체정황。방법수궤장42지SD대서분위정상대조조（A조）、가수술조（B조）、CPR조（C조）、CPR＋신상선소조（D조）사조，B、C、D삼조균분위0h、6h량개아조。A조미행유창조작，채혈후처사취심기조직；B、C、D삼조균주동정맥천자，B조여보통상양（3L／min），C조급D조급여기관절개、유창궤계통기급심폐복소。B、C、D삼조우각아조시간종점채혈측혈청신소、AngⅡ표체수평，처사동물후류심기표본검측심기신소、AT1R、AT2R적mRNA표체。B、C、D삼조감측평균동맥압（MAP）、좌실수축봉압（LVSP）、좌실서장말기압력（LVEDP）、좌실최대상승여하강속솔（± LVdP／dtmax）。결과（1）심폐복소술후6 h ，혈청신소급혈관긴장소Ⅱ수평이급심기신소、AT1、AT2 mRNA표체상조，여A조비교차이유통계학의의（P＜0．01）；（2）복소후6 h ，C조여B조비교，혈청신소、혈관긴장소Ⅱ표체수평명현증고（P＜0．05），단심기신소、AT1、AT2 mRNA차이무통계학의의（P＞0．05）；（3）상관성분석결과제시，AngⅡ급AT1R mRNA여± dp／dtmax、LVSP정정상관，여LVEDP정부상관，차이균유통계학의의（P＜0．01）。결론심폐복소가인기전신급심기국부RAS계통격활；신상선소가촉사혈청신소、혈관긴장소Ⅱ급심기신소、AT1R、AT2R mRNA정현과표체；ACE‐AngⅡ‐AT1축적격활시복소후심공능불전원인지일。
Objective To observe the serum renin ,angiotensin II(AngⅡ)and mRNA expression of myocardial re‐nin ,AT1 and AT2 after cardiopulmonary resuscitation (CPR) .Method 42 SD rats were randomly divided into 4 groups which were normal control group(group A ,n=6) ,the sham‐operation group(group B ,n=12) ,CRP group (group C ,n=12) ,and CPR + adrenaline group(group D ,n=12) .Group B ,C and D were all subdivided into sub‐group 0h(n=6)and subgroup 6h(n=6) .Group A was not given invasive operation .The rats were taken for blood and scarified for myocardial tissue .Group B ,C and D were given artery and vein puncture .Group B was given ordina‐ry oxygen(3L/min) .Group C and group D were given tracheotomy ,invasive mechanical ventilation and CPR .Group B ,C and D were taken blood for serum renin and AngⅡ at terminal time point of each subgroup .The animals were sacrificed for myocardial specimens to test mRNA expression of myocardial renin ,AT1R and AT2R .Group B ,C and D were monitored for mean arterial pressure(MAP) ,left ventricular systolic pressure(LVSP) ,left ventricular end‐di‐astolicpressure(LVEDP)and left ventricular maximum rising and falling rate(± LVdP/dtmax).Result 6h after CPR ,expression of serum renin ,AngⅡ ,and mRNA expression of cardiac renin ,AT1 and AT2 were increased ,which was of statistical significance compared to group A(P<0 .01) .6h after CPR ,compared to group B ,serum renin and AngⅡ were obviously increased in group C ,with statistical significance(P<0 .05) .But the mRNA expression of myocardial renin ,AT1 and AT2 were slightly increased ,but there were no statistical significance(P>0 .05) .Correla‐tion analysis was shown that mRNA of AngⅡ and AT1R was positively correlated to ± dp/dtmax and LVSP ,and negatively correlated to LVSP ,and there were statistical significantly differences(P<0 .01) .Conclusion CPR can ac‐tive systemic and myocardial RAS system .Adrenaline makes over‐expression of serum renin ,angiotensin Ⅱ and mR‐NA of cardiac renin ,AT1R and AT2R .Activation of ACE‐AngⅡ‐AT1 axis is one of the causes of cardiac insuffi‐ciency after CPR .