摘要目的 探讨不同窒息时间对心搏骤停家兔心肺复苏(CPR)后多器官功能障碍形成的影响,为后续研究建立一种CPR后多器官功能障碍综合征(CPR-MODS)的动物模型提供可行性依据.方法 采用窒息法致家兔心搏骤停,将30只家兔按随机数字表法分成窒息7 min组和窒息8 min组,每组15只.在CPR自主循环恢复(ROSC)后,观察两组家兔ROSC率、不同时间点死亡率和全身炎症反应综合征(SIRS)发生率;同时检测两组家兔复苏前及ROSC后12、24、48 h血清肿瘤坏死因子-a(TNF-a)、心肌肌酸激酶同工酶(CK-MB)、丙氨酸转氨酶(ALT)、肌酐(Cr)、血糖(Glu)水平及动脉血氧分压(PaO2);并计算CPR-MODS的发生率.结果 窒息7 min组CPR时间(s)明显短于窒息8 min组(147.60±22.09比193.08±23.07,P<0.01).窒息7 min组和窒息8 min组ROSC率分别为100.00%和86.67%,差异无统计学意义;两组家兔ROSC后存活24 h以上MODS发生率均为100.00%.窒息7 min组ROSC后6 h死亡率明显低于窒息8 min组(6.67%比46.67%,P<0.05);至48 h时窒息8 min组动物全部死亡.两组家兔ROSC后SIRS发生率均为100.00%.与窒息前比较,两组家兔ROSC后12 h即有TNF-a(ng/L)、CK-MB(U/L)明显升高(TNF-a:窒息7 min组100.71±20.43比49.13±8.64,窒息8 min组118.09±21.90比48.48±6.70;CK-MB:窒息7 min组786.88±211.84比468.20±149.45,窒息8 min组894.88±248.80比462.11±115.15,均P<0.05);ROSC后24 h ALT(U/L)、Glu(mmol/L)明显升高(ALT:窒息7 min组174.25±36.28比50.27±9.37,窒息8 min组205.50±10.61比51.13±10.37;Glu:窒息7 min组11.21±1.14比5.59±1.10,窒息8 min组11.55±0.35比6.41±1.23,均P<0.05);Cr(μmol/L)在窒息8 min组于ROSC 12 h即明显升高(98.83±16.70比65.93±13.81),窒息7 min组于ROSC 24 h明显升高(144.25±41.64比67.71±16.47,均P<0.05);两组PaO2均于ROSC 12 h明显升高,于24 h明显下降.结论 选择窒息7 min更适合建立家兔心搏骤停模型,为后续进一步建立CPR-MODS模型提供了可能性和可行性.

abstractsObjective To explore the effects of different asphyxia time on the reproduction of multiply organ dysfunction syndrome in rabbit after cardiopulmonary resuscitation (CPR-MODS) for cardiac arrest,in order to provide a method to reproduce an animal model of CPR-MODS for further research of cardiopulmonary resuscitation (CPR).Methods The rabbit cardiac arrest was caused by asphyxia as a result of clamping the trachea.Thirty rabbits were divided into 7-minute asphyxia group and 8-minute asphyxia group by means of random number table with 15 rabbits in each group.The rate of resumption of spontaneous circulation(ROSC),the mortality at different time points and the occurrence incidence of systemic inflammatory response syndrome (SIRS) of two groups were observed after CPR and the ROSC.The levels of serum tumor necrosis factor-a (TNF-a),myocardial MB-isoenzyme of creatine kinase (CK-MB),alanine aminotransferase (ALT),creatinine (Cr),glucose (Glu) and arterial partial pressure of oxygen (PaO2) before resuscitation and 12,24 and 48 hours after ROSC were measured simultaneously in the two groups.The incidence of CPR-MODS was calculated.Results The CPR time (seconds) in 7-minute asphyxia group was significantly shorter than that in 8-minute asphyxia group(147.60±22.09 vs.193.08±23.07,P<0.01).The ROSC rate of 7-minute asphyxia group and 8-minute asphyxia group was 100.00% and 86.67%,respectively,and there was no significant difference.The incidence of MODS in the rabbits surviving more than 24 hours after ROSC was 1 00% in both groups.The mortality at 6 hours after ROSC in 7-minute asphyxia group was remarkably lower than that of 8-minute asphyxia group(6.67% vs.46.67%,P<0.05).All the rabbits in 8-minute asphyxia group died at 48 hours.The incidence of SIRS after ROSC was 100% in both groups.Compared with that before asphyxiation,the 1evel of serum TNF-a(ng/L)as well as CK-MB(U/L) increased significantly at 12 hours after ROSC in both groups(TNF-a in 7-minute asphyxia group:100.71±20.43 vs.49.13±8.64,in 8-minute asphyxia group:118.09±21.90 vs.48.48±6.70;CK-MB in 7-minute asphyxia group:786.88±211.84 vs.468.20±149.45,in 8-minute asphyxia group:894.88±248.80 vs.462.11±115.15,all P<0.05).There was a significant elevation of ALT (U/L) and Glu (mmol/L) at 24 hours after ROSC (ALT in 7-minute asphyxia group:174.25±36.28 vs.50.27±9.37,in 8-minute asphyxia group:205.50±10.61 vs.51.13±10.37;Glu in 7-minute asphyxia group:11.21±1.14 vs.5.59±1.10,in 8-minute asphyxia group:11.55±0.35 vs.6.41±1.23,all P<0.05).Cr(μmol/L) was significantly higher at 12 hours after ROSC in 8-minute asphyxia group(98.83±16.70 vs.65.93±13.81),while it was elevated at 24 hours in 7-minute asphyxia group (144.25±41.64 vs.67.71±16.47,both P<0.05).PaO2 in both groups was significantly higher at 12 hours after ROSC and significantly decreased at 24 hours.Conclusion The model of cardiac arrest caused by 7 minutes asphyxia provided more possibility and feasibility for the subsequent study of reproducing CPR-MODS model.