【作者】 徐鹏；

【导师】 刘忠民；

【作者基本信息】 吉林大学 ， 重症医学， 2016， 硕士

【摘要】 目的:观察参麦注射液对心搏骤停家兔自主循环恢复(restoration of spontaneous criculation,ROSC)和心肺复苏(cardiopulmonary resuscitation,CPR)后心肌组织ATP酶(Na+-K+ATP酶和Ca2+-Mg2+ATP酶)活性的影响,探讨参麦注射液对心肺复苏后心肌细胞损伤的干预机制。方法:将49只健康成年家兔随机分为7组,每组各7只:假手术组、生理盐水组(24h组、48h组、72h组)、参麦组(24h组、48h组、72h组)。采用窒息法致家兔心搏骤停,建立心肺复苏动物模型;假手术组仅麻醉、手术,但不窒息;参麦组在复苏开始即刻给予2ml/kg参麦注射液,ROSC后10min再次给予相同剂量一次,盐水组给予等量生理盐水。记录心搏骤停时间和ROSC时间;检测窒息前及ROSC后2h、4h、6h血乳酸水平;检测窒息前及ROSC后6h、12h、24h、48h、72h血清肌酸激酶同工酶(CK-MB)水平;按分组于ROSC后24h、48h、72h取心肌组织,使用超微量ATP酶测试盒测定心肌组织Na+-K+ATP酶和Ca2+-Mg2+ATP酶活力;制作心肌组织电镜切片。比较各组家兔血乳酸、血清CK-MB水平及心肌组织Na+-K+ATP酶和Ca2+-Mg2+ATP酶活力的动态变化;观察电镜下心肌细胞超微结构改变。结果:1.与假手术组相比,参麦组和生理盐水组家兔窒息前心率及平均动脉压差异无统计学意义;参麦组和生理盐水组家兔心搏骤停时间差异无统计学意义;参麦组家兔ROSC时间较生理盐水组缩短(P<0.05)。2.与假手术组相比,参麦组和生理盐水组家兔窒息前血乳酸水平差异无统计学意义,ROSC后两组血乳酸水平升高,ROSC后2h、4h参麦组和生理盐水组血乳酸水平差异无统计学意义,ROSC后6h参麦组血乳酸水平低于生理盐水组(P<0.05)。3.与假手术组相比,参麦组和生理盐水组家兔窒息前血清CK-MB水平差异无统计学意义,ROSC后两组血清CK-MB水平升高,ROSC后6h两组血清CK-MB水平差异无统计学意义,ROSC后12h、24h、48h、72h参麦组血清CK-MB水平均低于生理盐水组(P<0.05)。4.与假手术组相比,ROSC后参麦组和生理盐水组家兔心肌组织Na+-K+ATP酶及Ca2+-Mg2+ATP酶活力均降低,ROSC后24h、48h、72h两组心肌组织Na+-K+ATP酶及Ca2+-Mg2+ATP酶活力均逐渐上升,参麦组Na+-K+ATP酶及Ca2+-Mg2+ATP酶活力均始终高于生理盐水组(P<0.05)。5.与生理盐水组相比,参麦组心肌细胞超微结构损伤程度减轻。结论:1.参麦注射液可缩短窒息所致心搏骤停的家兔心肺复苏自主循环恢复时间。2.参麦注射液可降低心肺复苏后家兔血乳酸水平及血清CK-MB水平,提高心肺复苏后心肌组织Na+-K+ATP酶及Ca2+-Mg2+ATP酶活力,保护心肌细胞超微结构相对完整,减轻心肺复苏后心肌细胞损伤,起到保护心肌作用。更多还原

【Abstract】 Objective:To observe the effect of Shenmai Injection on restoration of spontaneous criculation(ROSC) and ATPase(Na+-K+atpase and Ca2+-Mg2+atpase) activity of cardiomyocyte in rabbits of cardiac arrest after cardiopulmonary resuscitation(CPR).To explore the intervention mechanism of Shenmai Injection on cardiomyocyte injury after CPR. Methods:Total of 49 rabbits were randomly divided into 7 groups of each 7:the sham group, the normal saline group(24h group,48 h group,72 h group), and Shenmai group(24h group,48 h group,72 h group).Rabbit cardiac arrest model was made with asphyxia by clamping the traches of rabbit.Rabbits in Shenmai group were injected with 2ml/kg Shenmai Injection immediately at the beginning of CPR, and the same dose of Shenmai Injection 10 minutes after CPR. Rabbits in the saline group were injected with the same volume of physiological saline instead at the same intervals as previous group.Recorded the time of cardiac arrest and ROSC of the two groups.The level of blood lactate and creatine kinase isoenzyme(CK-MB)were measured in all rabbits before asphyxia and different time after ROSC. Cardiomyocyte ATPase(Na+-K+atpase and Ca2+-Mg2+atpase) activities were mesured by using the colorimetric method.Compared dynamic levels of blood lactate and serum CK-MB and cardiomyocyte ATPhase activities between the two groups after CPR. Observed ultrastructure damage changes of cardiomyocyte under the elecron microscope. Results:1.There was no statestically significant difference in the time of cardiac arrest of rabbits between the two gruops, but the ROSC emerged sooner in Shenmai group(p<0.05).2.There was no statistically significant difference in the levels of blood lactate between the normal group and Shenmai group before asphyxia and 2, 4 hours after CPR,but there was a lower level in Shenmai group 6 hours after CPR(p<0.05).3.There was no statistically significant difference in the levels of serum CK-MB between the normal group and Shenmai group before asphyxia and 6 hours after CPR.There was a lower level in Shenmai group 12, 24, 48, 72 hours after CPR(p<0.05).4.Cardiomyocyte ATPase activities significantly reduced after CPR, and radually rose 24,48,72 hours after CPR. Cardiomyocyte ATPase activities of Shenmai group were always higher(p<0.05).5.Under the electron microscopy,cardiomyocyte ultrastructure of Shenmai group was mild damaged compared. Conclusion:1.Shenmai Injection can shorten ROSC time of cardiac arrest in rabbits.2.Shenmai Injecton can reduce the level of blood lactate and serum CK-MB after CPR, and it can improve cardiomyocyte ATPatpase activities and protect the structural integrity of cardiomyocyte, alleviate cardiomyocyte injury after CPR.更多还原