【作者】 周文秀；

【导师】 董晨明；

【作者基本信息】 兰州大学 ， 急诊医学， 2009， 硕士

【摘要】 目的目前的研究认为复苏后心肌功能障碍是心肺复苏（CPR）成功后早期导致死亡的主要原因之一。作为心肺复苏的首选药,肾上腺素（AD）在CPR过程中增加冠脉和脑的灌注压促进自主循环恢复（ROSC）的作用已得到广泛的临床验证,但有研究表明AD增加了复苏后心肌功能障碍的严重程度,并认为主要是AD对β和α₁受体激动所致。本研究拟在观察β和α₁肾上腺素能受体阻滞剂联用对家兔心肺复苏后血流动力学和B型脑钠肽（brain natriuretic peptide,BNP）浓度变化,以评价其对复苏后心肌损伤的影响。方法本实验采用电击致家兔室颤复苏模型,45只健康家兔按随机数字表法分为三组,每组15只,手术对照组（A组）、肾上腺素组（B组）、酒石酸美托洛尔+乌拉地尔组（C组）。在室颤发生前和复苏成功后30min、60min、120min、180min进行血流动力学和血浆BNP浓度指标的测量。结果复苏后家兔出现不同程度的心功能障碍。与A组比较,B组复苏后心率增快,C组复苏后心率明显低于B组（P＜0.05）;B、C组家兔心室压力变化速率（peak first derivative of left ventricular pressure,Peak dp/dt）、左室舒张末压（left ventricle end diastolic pressure,LVEDP）均存在显著差异（P＜0.01）,C组peak dp/dt值显著高于B组（P＜0.01）;与A组比较,B组和C组LVEDP值在自主循环出现后均有显著增加,而C组与B组比较,LVEDP明显降低（P＜0.05）;B、C组BNP值在复苏后较A组明显升高（P＜0.01）,并且在整个观察期间均高于基础值,C组BNP值明显低于B组（P＜0.01）。结论联用β和α₁肾上腺素能受体阻滞剂能在一定程度上改善家兔的复苏后心功能不全,降低血浆中BNP浓度。更多还原

【Abstract】 Objective Current investigations support the notion that postresuscitation myocardial dysfunction is one of the main causes which lead to deaths after initially successful cardiopulmonary resuscitation（CPR）.As the preferred vasopressor agent,adrenaline has been confirmed to improve coronary and cerebral perfusion and enhance the restoration of spontaneous circulation（ROSC） during CPR widely in many clinical settings.However,some evidences showed that adrenaline increased the seveyity of postresuscitation myocardial dysfunction in consequence of itsβandα₁-adrenergic actions during CPR.The present study is to observe the effects ofβ-andα₁-adrenergic blocker on the changes of hemodynamic values and concentration of BNP after rabbits’ cardiopulmonary resuscitation.Methods fourty-five rabbits were randomly allocated to one of 3 groups:sham control groug、adrenaline treatment group、metoprolol+urapidil pretreatment group（n=15,per group）.Hemodynamic values and concentration of BNP were measured at different points of before ventricular tachycardia（VF） and 30,60,120,180minutes after CPR.Results The left cardiac function was significantly reduced in all rabbits.Heart rate（HR） was significantly higher after CPR in B group than in A and C group （P＜0.05）.In B and C group,peak first derivative of left ventricular pressure（peak dp/dt） and left ventricle end diastolic pressure（LVEDP） were reduced compared with A group（P＜0.01）.The BNP of B and C groups was conspicuous higher compared A group,and the increases could be observed at each postresuscitation time intervals （P＜0.01）.The BNP of C group was lower than B group conspicuously（P＜0.01）.Conclusions During cardiopulmonary resuscitationβ-andal-adrenergic blocker can reduce the concentration of BNP and improve postresuscitation myocardial dysfunction.更多还原