【作者】 李响；

【导师】 李培杰；

【作者基本信息】 兰州大学 ， 急诊医学， 2006， 硕士

【摘要】 目的:复苏后心功能不全是成功现场心肺复苏后导致高死亡率的主要原因。B型脑钠肽是机体血液动力学发生改变时由心室释放的一种肽类激素,这种因子可以对左心功能进行评价。本室颤动物模型的实验研究目的是探讨超短效β受体阻滞剂对复苏后早期心功能和血浆B型脑钠肽浓度变化的影响。 方法:对18只试验用兔,随机分为3组,手术对照组进行室颤前全部操作,心脏骤停兔子模型分别应用肾上腺素或用肾上腺素前进行艾司洛尔预处理治疗,在室颤发生前和复苏成功后30—240分钟内的不同时间点进行血流动力学和血浆B型脑钠肽浓度指标的测量。 结果:复苏后兔心功能均呈现显著的、进行性减退。左室peak+dp/dt值在复苏后30分钟下降至基础值的57.1%,在120分钟时降至基础值的33.7%。艾司洛尔组兔左室peak+dp/dt值和单用肾上腺素组之间存在显著差异(P<0.01),左室peak-dp/dt值在上述两组间的检测时间点同样也出现显著差异(P<0.01)。两治疗组的左室舒张末压值在各采集时间点均较手术对照组有显著升高,并且两治疗组的LVEDP数据存在显著性差异(P<0.01)。两治疗组和手术组进行比较,在全部观察期间的血浆B型脑钠肽指标均明显增高,且两组间存在显著差异(P<0.01)。 结论:在对室颤导致的心脏骤停进行复苏时,应用短效β受体阻滞剂可以改善复苏后心功能不全,并可降低复苏早期B型脑钠肽的浓度。更多还原

【Abstract】 Objective: Postresuscitation myocardial dysfunction contributes to the high fatality rate following successful resuscitation. B-type natriuretic peptide (BNP) is the cytokine released from the ventricles of the heart in response to hemodynamic stress, and is known to assess the left ventricular dysfunction. The purpose of this animal research was to investigate the effects of short-acting β -adrenergic blocker on the changes of cardiac function and concentration of BNP in the plasma during the early stage after cardiopulmonary resuscitation(CPR) from sudden cardiac arrest(CA) attributable to ventricular fibrillation(VF ).Methods: Treated with epinephrine or epinephrine with esmolol pretreatment, Hemodynamic values and concentration of BNP were measured in eighteen anesthetized rabbits, twelve rabbits were performed CA from VF, and at different time points during the early stage of postresuscitation period (30-240 min).Results: The left cardiac function was significantly reduced and progressively declined in all rabbits during the early stage of postresuscitation period;the peak positive first derivative of left ventricular pressure (Peak + dp/dt) was significantly decreased to 57.1% of baseline at 30 min, 33.7 % of baseline at 120 min in only epinephrine group. And peak + dp/dt in the epinephrine with esmolol-pretreatment group was significantly different fromthe epinephrine-treatment group. The peak negative first derivative of left ventricular pressure (Peak-dp/dt) also differed significantly between the two study groups. The left ventricular end-diastolic pressure (LVEDP) showed a marked rise in the two treatment -groups at all time points, and there was significantly different between epinephrine-treated group and epinephrine with esmolol-pretreated group. In both treatment-groups, the BNP concentrations in plasma were detected higher than control group throughout the observation period. The increases in measured BNP concentrations could be observed at each postresuscitation time intervals, and the differences of the BNP concentrations weie significant between the two treatment-groups during the observation period.Conclusion : A short-acting P -adrenergic blocker administered immediately during resuscitation improved postresuscitation myocardial dysfunction, and reduced the concentration of BNP during the early postresuscitation period after CPR from CA.更多还原