【作者】 钟清玲；

【导师】 尹林；

【作者基本信息】 南昌大学 ， 急诊医学， 2007， 硕士

【摘要】 目的:研究肾上腺素采用电脑微量注射泵持续给药与间断人工静脉推注对室颤兔血流动力学及脑循环灌注的影响。方法:将实验兔22只随机抽取两只作为假手术组,只进行外科手术操作,不给予致颤和心肺复苏(CPR);其余20只随机分成两组,分别为肾上腺素持续给药组(实验组,A组)与间断给药组(对照组,B组)。采用开胸心外膜下电刺激法制备室颤动物模型,A组,首先20μg/kg人工推注一次,而后持续泵注10μg/kg/min 9min;B组20μg/kg每3min人工推注1次,共计4次。实验过程中测主动脉收缩压(ASP)、主动脉舒张压(AOD)、平均动脉压(MAP)、中心静脉压(CVP)、颅内压(ICP),计算冠状动脉灌注压(CoPP)、脑灌注压(CePP)及观察两组对室颤兔自主循环恢复(ROSC)率的影响。ROSC后30min注入10%的异硫氰酸荧光素-白蛋白标记全身血液(0.3g/kg),循环30min后将动物断头取脑。每只家兔切片三张,在100倍荧光显微镜下观察并拍照。用IMAGEJ1.36图像处理软件计算脑灌注区域,用百分数表示。结果:应用SPSS11.5统计软件进行统计分析,显示实验组的ASP、AOD、MAP、CoPP、CePP均高于对照组(室颤前均无差异),两组CoPP、CePP显示均有差异(p<0.05)。实验组10例复苏成功8例,对照组10例复苏成功6例,采用Fisher确切概率法统计分析,结果两组ROSC率无差异(p=0.628,p>0.05)。A组中的脑灌注面积为62.35±3.51%、B组31.92±3.86%,两组差异显著(P<0.01),而两只假手术组的动物显示了均匀一致的脑循环灌注。结论:肾上腺素持续给药与间断给药相比有更佳的血流动力学效果及脑循环灌注,因此,采用电脑微量泵持续给药优于传统的肾上腺素给药方式。更多还原

【Abstract】 Objective:To study the effects of continuously administered epinephrine(Epi) with computer micro pump, compared to intermittent bolus doses, on hemodynamic and cerebral circulation perfusion in ventricular fibrillation rabbits during cardiopulmonary resuscitation (CPR) .Methods:Two of 22 rabbits were served as sham operated group ,which were not induced ventricular fibrillation and implemented of CPR .Other animals were randomized into two groups. A group was received an initial bolus of 20μg/kg epinephrine followed by an infusion of 10μg/kg/min epinephrine for 9 minutes. B group was received a bolus of 20μg/kg epinephrine every other 3 minutes, to amount to 4 times. Ventricular fibrillation was induced with epicardium electric current shock in 20 anaesthetised rabbits. aortic systolic pressure(ASP) ,aortic diastolic pressure (AOD),mean arterial pressure(MAP),central venous pressure(CVP),intracranial pressure(ICP) was measured. coronary perfusion pressure(CoPP), cerebral perfusion pressure(CePP),restoration of spontaneous circulation (ROSC) was calculated. The cerebral microcirculation perfusion was markded by injection of 0.3/kg 10% fluorescent isothiocyanate- albumin(FITC) after ROSC 30 minutes and the animals were decapitated 30 minutes later. At different levels three slices of the rabbit brain were observaed using 100 times fluorescence microscopy.Capillary filling with FITC areas were identified and calculated,quantified using image processing software IMAGEJ.Results:The data were analyzed with SPSS 11.5 statistical software, Group A was higher than Group B in ASP、AOD、MAP、CoPP、CePP (they had no difference between two groups before ventricular fibrillation). CoPP and CePP had difference (P<0.05) , a continuous epinephrine infusion compared with repeated bolus doses. 8 of 10 animals could survive to the end of the experimental in A group, while 6 of 10 animals could survive to the end of the experimental in B group. According to Fisher exact propability, rate of ROSC had no difference between two groups(p=0.628,p>0.05). the difference of the cerebral perfusion area (P<0.01)was also significant between A group(62.35±3.51%) and B group (31.92±3.86%).The two sham operated animals showed homogeneous cerebral microcirculation perfusion.Conclusions:Continuous infusion of epinephrine generated a better hemodynamics and cerebral circulation perfusion during CPR as compared to intermittent bolus doses. Thus, continuous infusion with computer micro pump was superior to intermittent bolus doses administering epinephrine during CPR.更多还原