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中华卫生应急电子杂志 ›› 2017, Vol. 03 ›› Issue (02) : 92 -97. doi: 10.3877/cma.j.issn.2095-9133.2017.02.006

所属专题: 文献

论著

氢气吸入对长时程心脏骤停复苏后家猪心功能的保护作用
文才1, 余涛1, 翟小竹1, 杨正飞1, 蒋龙元1,(), 唐万春1   
  1. 1. 510120 广州,中山大学孙逸仙纪念医院急诊医学科
  • 收稿日期:2017-03-15 出版日期:2017-04-18
  • 通信作者: 蒋龙元
  • 基金资助:
    国家自然科学基金(81000823); 广东省领军人才计划(81000-42020004); 中山大学高校基本科研业务费青年教师培育项目(214ykpy22)

Inhalation of hydrogen improves myocardial function and survival outcomes in a porcine model of prolonged cardiac arrest

Cai Wen1, Tao Yu1, Xiaozhu Zhai1, Zhengfei Yang1, Longyuan Jiang1,(), Wanchun Tang1   

  1. 1. Department of Emergency, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
  • Received:2017-03-15 Published:2017-04-18
  • Corresponding author: Longyuan Jiang
  • About author:
    Corresponding author: Jiang Longyuan, Email:
引用本文:

文才, 余涛, 翟小竹, 杨正飞, 蒋龙元, 唐万春. 氢气吸入对长时程心脏骤停复苏后家猪心功能的保护作用[J/OL]. 中华卫生应急电子杂志, 2017, 03(02): 92-97.

Cai Wen, Tao Yu, Xiaozhu Zhai, Zhengfei Yang, Longyuan Jiang, Wanchun Tang. Inhalation of hydrogen improves myocardial function and survival outcomes in a porcine model of prolonged cardiac arrest[J/OL]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2017, 03(02): 92-97.

目的

探究氢气吸入对长时程心脏骤停(CA)家猪心肺复苏(CPR)后的心功能保护作用。

方法

选择健康雄性家猪20头,3月龄,体重(38±3)kg电诱发室颤并维持10 min后开始CPR。动物恢复自主循环(ROSC)后随机分为对照组和氢气组:对照组ROSC后全程使用普通空气进行机械通气;氢气组ROSC后使用2%氢气(H2∶O2∶N2=2%∶21%∶77%)进行通气,至复苏后2 h改普通空气通气。持续监测血流动力学参数包括心率、平均动脉压、左室内压最大上升或下降速率(±dp/dtmax)、心指数等,分别于复苏后0.5,2,4和6 h检测动脉血气、乳酸水平及血清心肌损伤标志物肌钙蛋白T(cTnT)、B型氨基端利钠肽原(NT-pro-BNP)的浓度,观察动物CPR后96 h的生存结局。

结果

复苏后两组动物心功能均有下降,氢气治疗组动物心功能较对照组好,氢气组心功能参数复苏后5 h和6 h时[+dp/dtmax分别为(3320.1±433.4)mmHg/s和(3294.5±390.4)mmHg/s;-dp/dtmax分别为(3756.1±498.8)mmHg/s和(3667.4±406.8)mmHg/s;心指数分别为(6.8±1.0)L/min·m2和(6.7±1.2) L/min·m2]高于同时间点的对照组[+dp/dtmax分别为(2863.5±340.8)mmHg/s和(2925.2±251.3)mmHg/s;-dp/dtmax分别为(3245.4±259.6)mmHg/s和(3261.9±311)mmHg/s、心指数分别为(5.3±1.5)L/min·m2和(5.1±1.4)L/min·m2],差异均有统计学意义(P均<0.05);复苏后4 h和6 h时氢气组血清cTnT分别为(2.7±0.9 )ng/mL和(2.7±0.8)ng/mL、NT-pro-BNP分别为(0.34±0.13)ng/mL和(0.37±0.17)ng/mL)浓度低于对照组cTnT分别为(4.9±1.2)ng/mL和(5.8±1.2)ng/mL、NT-pro-BNP:分别为(0.54±0.12)ng/mL和(0.78±0.21)ng/mL浓度,差异均有统计学意义(P均<0.05)。氢气组动物CPR后生存时间明显较对照组长[氢气组vs.对照组(h):96(25,96)vs 16(12,22)],差异有统计学意义(P<0.05)。

结论

CPR后氢气吸入可改善长时程心脏骤停家猪CPR后的心功能和生存结局。

Objective

To investigate the beneficial effect of hydrogen(H2)on myocardial dysfunction after cardiopulmonary resuscitation (CPR) in a pig model with a prolonged cardiac arrest.

Methods

Healthy domestic pigs were subjected to 10 minutes of ventricular fibrillation cardiac arrest induced electrically and followed by CPR. After achieving the return of spontaneous circulation (ROSC), the post-cardiac arrest pigs were randomized into two groups: mechanically ventilated with room air (control group); mechanically ventilated with 2% H2(H2∶O2∶N2=2%∶21%∶77%)for 2 hours after ROSC and turned to ventilate with room air (H2 group). Hemodynamic parameters including HR, MAP, left ventricular pressure derivative (±dp/dtmax) and cardiac index (CI) were recorded for 6 hours continually after successful resuscitation. Arterial blood gas, lactate and serum marker of myocardial injury (cTnT and NT-pro-BNP) were measured at baseline, and at 0.5, 2, 4 and 6 hours after CPR. The survival outcomes of animals were evaluated and recorded until 96 hours after CPR.

Results

Worse post-resuscitation myocardial function was found in both groups compared to the status prior to CA, but the myocardial function of the H2 group was superior to that of the control group. The indicators of myocardial function in the H2 group especially at 5 hours and 6 hours after CPR [+ dp/dtmax: (3320.1±433.4)mmHg/s and (3294.5±390.4)mmHg/s; -dp/dtmax: (3756.1±498.8)mmHg/s and (3667.4±406.8)mmHg/s; CI: (6.8±1.0) L/min·m2 and(6.7±1.2)L/min·m2] were much better than those of the control group at the same time points [+ dp/dtmax: (2863.5±340.8)mmHg/s and(2925.2±251.3) mmHg/s; -dp/dtmax: (3245.4±259.6)mmHg/s and (3261.9±311)mmHg/s; CI: (5.3±1.5)L/min·m2 and(5.1±1.4)L/min·m2](all P<0.05). At 4 hours and 6 hours after CPR, the serum levels of cTnT and NT-pro-BNP in H2 group [cTnT: (2.7±0.9)ng/mL and (2.7±0.8)ng/mL; NT-pro-BNP: (0.34±0.13)ng/mL and(0.37±0.17)ng/mL] were obviously lower compared to the control group [cTnT: (4.9±1.2)ng/mL and (5.8±1.2)ng/mL; NT-pro-BNP: (0.54±0.12)ng/mL and(0.78±0.21)ng/mL](all P<0.05). In addition, greater survival duration was also observed in H2 group compared to the control group [96(25, 96)hours vs. 16(12, 22)hours, P<0.05].

Conclusion

Inhalation of H2 improves post-resuscitation myocardial dysfunction and survival outcomes in a porcine model with prolonged cardiac arrest.

表1 两组长时程CA家猪在建模前的基础生理参数及初始复苏结果的比较(±s)
表2 两组长时程CA家猪CPR后动脉血气分析和乳酸水平的比较(±s)
图1 两组长时程CA家猪复苏前后心率比较
图2 两组长时程CA家猪复苏前后平均动脉压比较
图3 两组长时程CA家猪复苏前后+dp/dtmax比较
图4 两组长时程CA家猪复苏前后-dp/dtmax比较
图5 两组长时程CA家猪复苏前后心指数比较
图6 两组长时程CA家猪复苏前后血清cTnT比较
图7 两组长时程CA家猪复苏前后血清NT-pro-BNP浓度比较
图8 两组长时程CA家猪CPR后96 h Kaplan-Meier生存分析
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