中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
Chinese Journal of Emergency Medicine
2015年
10期
1135-1140
,共6页
徐杰丰%叶森%王茉莉%袁海鸿%李子龙
徐傑豐%葉森%王茉莉%袁海鴻%李子龍
서걸봉%협삼%왕말리%원해홍%리자룡
心脏骤停%心肺复苏%心室颤动%心脏骤停后综合征%动物模型
心髒驟停%心肺複囌%心室顫動%心髒驟停後綜閤徵%動物模型
심장취정%심폐복소%심실전동%심장취정후종합정%동물모형
Cardiac arrest%Cardiopulmonary resuscitation%Ventricular fibrillation%Post-cardiac arrest syndrome%Animal model
目的 应用电刺激法诱导室颤,建立10 min的长时程猪心脏骤停模型,评估该模型的稳定性及其在心脏骤停后综合征研究中的应用价值.方法 国产健康白猪14头,体质量(38±3)kg,室颤10 min,心肺复苏5 min,复苏后观察72 h.心肺复苏期间,记录每只动物的复苏情况.复苏后72 h内,定期评估动物心肺脑功能、机体炎症反应、组织灌注及存活情况.结果 11头猪恢复自主循环,复苏成功率与72 h存活率均为78.6％.复苏后,所有动物出现明显的心功能不全,表现为每搏输出量与全心射血分数下降,血清肌钙蛋白Ⅰ与N-末端脑钠肽前体水平升高,与基础值相比差异具有统计学意义(均P＜0.01).复苏后的血管外肺水指数与肺血管通透性指数明显升高,氧合指数明显下降,与基础值相比均差异有统计学意义(均P＜0.01),提示存在急性肺损伤.复苏后机体出现全身炎症反应与组织灌注不足,监测血清肿瘤坏死因子-α、白介素-6与血乳酸水平显著高于基础值(均P＜0.01).复苏后的72 h观察中,所有动物出现严重的神经功能缺损,监测血清神经元特异性烯醇化酶与S-100B蛋白水平显著高于基础值,比较差异均具有统计学意义(均P＜0.01).结论 电刺激诱导的长时程猪室颤心脏骤停模型稳定,复苏成功率高,重要脏器损伤明显,存活时间长,是一个较为理想的心脏骤停后综合征研究模型.
目的 應用電刺激法誘導室顫,建立10 min的長時程豬心髒驟停模型,評估該模型的穩定性及其在心髒驟停後綜閤徵研究中的應用價值.方法 國產健康白豬14頭,體質量(38±3)kg,室顫10 min,心肺複囌5 min,複囌後觀察72 h.心肺複囌期間,記錄每隻動物的複囌情況.複囌後72 h內,定期評估動物心肺腦功能、機體炎癥反應、組織灌註及存活情況.結果 11頭豬恢複自主循環,複囌成功率與72 h存活率均為78.6％.複囌後,所有動物齣現明顯的心功能不全,錶現為每搏輸齣量與全心射血分數下降,血清肌鈣蛋白Ⅰ與N-末耑腦鈉肽前體水平升高,與基礎值相比差異具有統計學意義(均P＜0.01).複囌後的血管外肺水指數與肺血管通透性指數明顯升高,氧閤指數明顯下降,與基礎值相比均差異有統計學意義(均P＜0.01),提示存在急性肺損傷.複囌後機體齣現全身炎癥反應與組織灌註不足,鑑測血清腫瘤壞死因子-α、白介素-6與血乳痠水平顯著高于基礎值(均P＜0.01).複囌後的72 h觀察中,所有動物齣現嚴重的神經功能缺損,鑑測血清神經元特異性烯醇化酶與S-100B蛋白水平顯著高于基礎值,比較差異均具有統計學意義(均P＜0.01).結論 電刺激誘導的長時程豬室顫心髒驟停模型穩定,複囌成功率高,重要髒器損傷明顯,存活時間長,是一箇較為理想的心髒驟停後綜閤徵研究模型.
목적 응용전자격법유도실전,건립10 min적장시정저심장취정모형,평고해모형적은정성급기재심장취정후종합정연구중적응용개치.방법 국산건강백저14두,체질량(38±3)kg,실전10 min,심폐복소5 min,복소후관찰72 h.심폐복소기간,기록매지동물적복소정황.복소후72 h내,정기평고동물심폐뇌공능、궤체염증반응、조직관주급존활정황.결과 11두저회복자주순배,복소성공솔여72 h존활솔균위78.6％.복소후,소유동물출현명현적심공능불전,표현위매박수출량여전심사혈분수하강,혈청기개단백Ⅰ여N-말단뇌납태전체수평승고,여기출치상비차이구유통계학의의(균P＜0.01).복소후적혈관외폐수지수여폐혈관통투성지수명현승고,양합지수명현하강,여기출치상비균차이유통계학의의(균P＜0.01),제시존재급성폐손상.복소후궤체출현전신염증반응여조직관주불족,감측혈청종류배사인자-α、백개소-6여혈유산수평현저고우기출치(균P＜0.01).복소후적72 h관찰중,소유동물출현엄중적신경공능결손,감측혈청신경원특이성희순화매여S-100B단백수평현저고우기출치,비교차이균구유통계학의의(균P＜0.01).결론 전자격유도적장시정저실전심장취정모형은정,복소성공솔고,중요장기손상명현,존활시간장,시일개교위이상적심장취정후종합정연구모형.
Objective To establish a swine model of 10 min prolonged cardiac arrest (CA) induced by electrically triggered ventricular fibrillation,and then evaluate the quality of the model and the value in the establishment of post-cardiac arrest syndrome.Methods Fourteen domestic healthy swine weighing 38 ±3 kg were selected for study.Ventricular fibrillation was induced for 10 min,and then cardiopulmonary resuscitation (CPR) was initiated and continued for 5 min.The resuscitated animals were observed for 72 h after resuscitation.The resuscitation outcomes and survival rate were recorded.The functions of heart,lung and brain,and systemic inflammatory response and tissue perfusion were regularly evaluated for 72 h post-resuscitation.Results Eleven of the fourteen swine obtained restoration of spontaneous circulation (ROSC),and the rate of successful resuscitation and 72 h survival were both 78.6％.Significantly worse post-resuscitation myocardial function was found in all animals compared to the value prior to CA and the myocardial function was evaluated by decreased stroke volume and global ejection fraction,and increased levels of serum cardiac troponin-Ⅰ and n-terminal pro brain natriuretic peptide.Postresuscitation extra-vascular lung water index and pulmonary vascular permeability index were significantly increased accompanied with significantly decreased oxygenation index compared with the values before CA,indicating the occurrence of acute lung injury.In addition,post-resuscitation systemic inflammatory response and tissue low perfusion evidenced by significantly higher levels of serum tumor necrosis factor-α and interleukin-6 and arterial blood lactate were observed.Consequently,severe neurological deficit with significantly higher levels of serum neuron-specific enolase and S-100B was observed following 72 h postresuscitation.Conclusions This swine model of prolonged cardiac arrest induced by electrically triggered ventricular fibrillation was a well established model with high success rate of resuscitation,significant vital organ injury and relatively long duration of survival;it is an excellent model for the study of post-cardiac arrest syndrome.
