腺苷对心脏停搏后自主循环恢复影响的实验研究

添加时间：2006-9-27-9:33 录入：eccm

Effects of adenosine in recovery of automatic circulation

CHEN Wei， SHEN Hong

Emergency Department of Chinese PLA General Hospital

【Abstract】 Objective Epinephrine given during closed-chest resuscitation increases blood flow across the coronary and cerebral circuits, which has been used for nearly 50 years. However, epinephrine worsens reperfusion, arrhythmias and intensifies postresuscitation myocardial and cerebrial dysfunction, which increase the early mortality. We investigated whether the combination of epinephrine plus adenosine could ameliorate such adverse effects and improve the successful rate of resuscitation.Methods Part one of the paper, 30 health rabbits were randomly allocated to three groups after cardiac arrest induced by ****hyxia. After 4min non-intervention interval, cardiopulmonary resuscitation (CPR) was started. After 4min CPR, the animals were randomly assigned to receive either 0.9% saline (group A,n=6) or epinephrine (bolus of 90 ug/kg, group B,n=12) or epinephrine plus adenosine (bolus of 90 ug/kg epinephrine followed by continuous infusion of 150 ug/（kg•min） adenosine, group C,n=12).The rate of recovery of automatic circulation(ROAC) and successful CPR,the level of creatinkinase,creatinkinase-MB,and lactic acid in blood plasma were observed. The pathological changes of hippocampus neurons and myocardium were observed under optical microscopy and electronmicroscope. Part two of the paper, 43 health Wistar rats were randomly allocated to three groups. The model of cardiac arrest and the experiment grouping were just like Part one. Mesentery blood vessel, blood flow rate, the numbers and area of cardiac blood capillary, and small intestine tissue perfusion were observed. Results （1）With the rate of ROAC and successful CPR in ****hyxia rabbits, group C(100%, 83.3%) were greater than that of group B (83.3%,58.3%) than that of group A(0,0); The level of creatinkinase, creatinkinase-MB, and lactic acid in blood plasma of group C[(855±191) U/L，（1 506±692） U/L，（8.4±2.7） mmol/L)] were lower than that of group B[(1 136±332) U/L，（2 365±957） U/L，（10.9±1.9） mmol/L)]，P<0.05; The damage in hippocampus neurons and myocardium of group B were greater than that of group C under optical microscopy and electronmicroscope. （2）With the rate of ROAC and successful CPR in ****hyxia rats, group C(92.9%,64.3%) were greater than that of group B(78.6%,50%) than that of group A(60%,20%), P<0.05; With the numbers and area of cardiac blood capillary in the successful CPR rats , group C(448±43，0.41±0.08%) were better than group B(302±25，0.30±0.05%) and group A(215±54，0.38±0.12%)，P <0.01; With the diameter and reperfusion of mesentery blood vessel and the velocity of microcirculation, group C were better than that of group B; Small intestine tissue perfusion of group C was better than that of group B, P<0.05.Conclusions Adenosine could ameliorate adverse effects of epinephrine in CPR, improve microcirculation and tissue perfusion, protect the myocardium and cerebral, increase the rate of successful CPR. The method of epinephrine with adenosine maybe act as a new method in the clinic practice in CPR in the future.
【Key words】 cardiopulmonary resuscitation; epinephrine; adenosine; microcirculation; cardiac arrest

【论文特点介绍】本研究在以下几个方面具有创新：（1）将腺苷引入心肺复苏治疗中，观察腺苷与肾上腺素合用对心跳停搏后自主循环恢复率和复苏成功率的影响，结果表明合用腺苷可明显提高自主循环恢复率和复苏成功率；（2）观察腺苷在心肺复苏中对兔心、脑组织病理结构和超微结构的影响，结果表明腺苷可以明显减轻心脑组织的损害；（3）观察腺苷窒息大鼠心脏和肠系膜微循环的影响，并观察到肾上腺素对微循环无明显改善作用，联合应用腺苷可以改善微循环；（4）将激光多普勒血流量图象仪引入心肺复苏中，动态观察窒息大鼠肠壁组织血液灌流量变化，并观察到腺苷可以增加肠壁组织血流灌注量。

研究生：陈威，男，主治医师，医学博士。解放军总医院急诊科。主要研究方向：危重病和心肺复苏．
导师：沈洪，男，主任医师，教授，博士生导师。解放军总医院急诊科。

世界急危重病医学杂志2006；3（5）：1457-1458