肝素钠和小剂量高渗盐水对复苏后兔小肠微循环灌注障碍的影响

目的研究CPR期间给予肝素钠和小剂量高渗盐水治疗对复苏后兔小肠微循环灌注障碍的影响。方法 60只家兔开胸致室性颤动（室颤）,室颤5 min后行胸内CPR,CPR过程中随机分为生理盐水（NS组）2 mL.kg-1.10 min-1或生理盐水2 mL.kg-1.10 min-1和普通肝素钠60 U.kg-1组（H组）或7.5%NaCl 2 mL.kg-1.10 min-1＋普通肝素钠60 U.kg-1组（HSH组）,每组20只。观察各组小肠灌注区域;室颤前及自主循环恢复（ROSC）后测血浆可溶性P选择素（sP）及内毒素（ET）浓度的变化情况。结果实验过程中各组之间的平均动脉压（MAP）差异无统计学意义（P〉0.05）,兔经历5 min心脏骤停（CA）和CPR后,ROSC后30 min仍有严重的微循环灌注障碍,H组和NS组相比二者之间差异有统计学意义（P〈0.01）;HSH组和其他2组相比差异均有统计学意义（P〈0.01）。ROSC后20、30 min HSH组血浆sP水平均明显低于其他2组（均P〈0.01）。各组之间ET基础值差异无统计学意义（P〉0.05）,CA后随着自主循环的恢复,兔血浆ET浓度明显升高,并随着自主循环恢复时间延长有逐渐升高的趋势。ROSC后30、60、120 min,ROSC 3、4 h时HSH组、H组ET浓度与NS组比较差异均有统计学意义（均P〈0.01）;而HSH组和H组之间差异无统计学意义（P〉0.05）。结论 CPR期间给予肝素钠和小剂量高渗盐水治疗可以改善复苏后兔小肠微循环灌注障碍,降低复苏后兔血浆内毒素浓度,并不增加出血的发生率。

The Effect of Heparin and Small Volume Hypertonic Saline on the Post-resuscitation Intestine Microcirculation Perfusion Disorder of Rabbits

Objective Evaluating the beneficial effect of heparin and small volume hypertonic saline during the cardiopulmonary resuscitation（CPR） on the post-resuscitation intestine microcirculation perfusion disorder of rabbits.Methods Sixty domestic rabbits were anesthetized with embutal,30 mg·kg-1 and Cardiac arrest was induced by electrical ventricular fibrillation,animals randomly received 2 mL·kg-1 of either 0.9% NaCl（NS） or 0.9% NaCl combined with heparin 60 U·kg-1（H） or 7.5% NaCl combined with heparin 60 U·kg-1（HSH） in CPR.Observe each group of small intestinal perfusion area.Ventricular fibrillation ROSC measured before and after plasma sP and ET concentration change.Results After the ROSC,the MAP were no difference in all groups,The area of intestine perfusion was higher in group HSH than the other two groups,the difference was extreme significance（P〈0.01）,respectively.Between the group NS and group H,the difference of intestine perfusion area was also significant.At the time point of ROSC 20 min and ROSC 30 min the plasma concentration of sP was lower in group HSH than the other two groups.ET between the groups no significant difference between the basic value,CA Later,following the restoration of spontaneous circulation,rabbit plasma ET concentration was significantly increased,and with the restoration of spontaneous circulation has gradually increased the time to extend the trend.ROSC 30 min,ROSC 60 min,ROSC 120 min,ROSC 3 hours,ROSC 4 hours when the HSH group,H group of ET were significantly lower than NS group（P〈0.01）;while the HSH group and the H was no significant difference between group（P〉0.05）.Conclusion The administration of heparin and small volume hypertonic saline during the CPR could attenuate the perfusion disorder and reduce the recovery of plasma endotoxin concentration in rabbit,but not increased the risk of bleeding.