本文選題：心臟驟停 + 心肺復(fù)蘇�。� 參考：《廣州醫(yī)學(xué)院》2009年碩士論文

【摘要】： 背景大鼠是常用的實驗研究動物,但由于體型小,口腔狹窄,暴露聲門難度大,大鼠氣管插管一直是個難題。文獻報道的大鼠氣管插管方法主要有:氣管切開插管法,盲插法,直視下插管法。既往的方法都它的局限性,容易出現(xiàn)插管失敗和并發(fā)癥。因此,有必要尋求一種新的插管方法,實現(xiàn)安全、準確的大鼠氣管插管。我們利用氣管導(dǎo)管內(nèi)置入直徑為0.9mm的光纖作為光源和導(dǎo)絲,建立一種新型大鼠氣管插管方法。 復(fù)蘇后心功能不全主要表現(xiàn)為低血壓、休克、致命性的室性心律失�；蛟俅伟l(fā)生心跳停搏,是心臟驟�；颊邚�(fù)蘇后早期死亡的首要原因。約60%-70%成功復(fù)蘇后的患者因出現(xiàn)低血壓、休克或致命性室性心律失常而于24h內(nèi)死亡,最終只有4.5%能存活出院。復(fù)蘇后心功能不全主要歸因于心臟驟停期間處于的全心缺血狀態(tài)以及再灌注后所致的心肌損傷。 促紅細胞生成素(erythropoietin , Epo)是分子量為34KDa的糖蛋白類激素,主要作用于紅系祖細胞,調(diào)節(jié)血循環(huán)中的紅細胞容積。最近發(fā)現(xiàn),Epo能在缺血再灌注中發(fā)揮廣泛的組織保護作用,包括心臟、大腦、視網(wǎng)膜、腎臟、肝臟和皮膚等。在心肌缺血再灌注實驗研究中, Epo能減少心肌梗死面積和減輕缺血再灌注損傷,改善心功能。 基于缺血再灌注損傷是復(fù)蘇后機體的主要病理生理過程。在心肺復(fù)蘇期間給予Epo,有望發(fā)揮心肌保護作用,改善復(fù)蘇后心功能。 第一部分大鼠新型氣管插管方法的建立 1.研究目的 利用氣管導(dǎo)管內(nèi)置入直徑為0.9mm的光纖作為光源,建立一種新型的大鼠經(jīng)口氣管插管方法。 2.研究方法 將Sprague-Dawley大鼠分為2組(n=40):ⅰ)傳統(tǒng)光源直視下的經(jīng)口氣管插管組(簡稱傳統(tǒng)直視組n=20),ⅱ)氣管導(dǎo)管內(nèi)置入光纖引導(dǎo)下的經(jīng)口氣管插管組(簡稱光纖引導(dǎo)組n=20)。比較兩組間的經(jīng)口氣管插管時間、插管次數(shù)、一次插管成功率。將上述經(jīng)口氣管插管的大鼠,與小型動物呼吸機連接,調(diào)整呼吸頻率(60次/分)和潮氣量(0.65ml/100g),持續(xù)通氣60min后拔除氣管插管,并比較拔除氣管插管后1周的存活率。 3.結(jié)果 3. 1光纖引導(dǎo)組的經(jīng)口氣管插管時間和插管次數(shù)[(36.00±16.43)s和(1.05±0.22)],均較傳統(tǒng)直視組明顯減少([86.20±56.48)s和(1.75±1.02)],(P0.01)。 3. 2光纖引導(dǎo)組的經(jīng)口氣管插管一次成功率(95%)高于傳統(tǒng)直視組(60%)(P0.05)。 3. 3光纖引導(dǎo)組拔除氣管插管后的1周存活率(100%)高于傳統(tǒng)直視組(80%);但其差異無統(tǒng)計學(xué)意義(P0.05)。 4.結(jié)論 氣管導(dǎo)管內(nèi)光纖引導(dǎo)下的經(jīng)口氣管插管法是一種創(chuàng)新的大鼠氣管插管方法,能實現(xiàn)快速、有效、準確的氣管插管,值得推廣應(yīng)用。 第二部分促紅細胞生成素對心肺復(fù)蘇后心肌的影響 1.研究目的 觀察窒息性大鼠心臟驟停-心肺復(fù)蘇后的心功能和心肌損傷的情況;探討促紅細胞生成素對大鼠心肺復(fù)蘇后的心肌保護作用。 2.研究方法 夾閉氣管8min ,建立窒息性大鼠心臟驟停-心肺復(fù)蘇動物模型。Sprague-Dawley大鼠(n=24),隨機分為3組:ⅰ)正常對照組(n=8):進行氣管插管、血管置管,不予夾閉氣管和心肺復(fù)蘇。ⅱ)常規(guī)心肺復(fù)蘇(CPR)組(n=8):夾閉氣管8min后,進行胸外按壓、機械通氣和腎上腺素0.02mg/kg,于恢復(fù)自主循環(huán)(ROSC)后3min經(jīng)股靜脈推注0.9%NaCl 0.5ml。ⅲ)Epo治療組(n=8):夾閉氣管8min后,進行胸外按壓、機械通氣和腎上腺素0.02mg/kg,于ROSC后3min,將Epo5000U/kg與0.9%NaCl稀釋成0.5ml后,注入股靜脈。所有大鼠經(jīng)右頸總動脈逆行插管至左心室和股動脈插管,持續(xù)監(jiān)測心率(HR)、平均動脈壓(MAP)、左室收縮壓(LVSP)、左室舒張末壓(LVEDP)、左室內(nèi)壓上升和下降最大變化速率(±dp/dtmax )和標準II導(dǎo)聯(lián)心電圖,肛門插入內(nèi)置式溫度探頭記錄深部直腸溫度,用加熱燈保持體溫在36. 5±0. 5℃。 于觀察終點(ROSC后120min),采集血樣測定血清CTnI含量,取出心臟,光鏡和透射電鏡觀察心肌組織的損傷情況。 3.結(jié)果 3. 1三組間基線水平的HR、MAP、LVSP、LVEDP、±dp/dtmax無顯著性差異(P 0.05)。 3. 2常規(guī)CPR組和Epo治療組大鼠自主循環(huán)復(fù)蘇后(ROSC)30min、60min、90min、120min的HR、MAP、LVSP和±dp/dtmax均正常對照組明顯下降(P 0.01),ROSC120min的LVEDP較正常對照組明顯升高(P 0.01)。 3. 3常規(guī)CPR組ROSC后120min血清CTnI水平較正常對照組明顯升高(P 0.01);常規(guī)CPR組出現(xiàn)心肌細胞水腫變性、壞死、炎癥細胞浸潤,以及胞膜完整性喪失、線粒體腫脹、嵴斷裂、溶解等心肌組織的損傷性改變。 3.4 Epo治療組ROSC后30min、60min、90min、120min的LVSP(P0.05)、±dp/dtmax(P 0.01)較常規(guī)CPR組明顯升高,ROSC120min的LVEDP較常規(guī)CPR組降低(P 0.01),兩組間的HR和MAP無顯著性差異(P 0.05)。 3.5同組內(nèi)不同時間點比較顯示,正常對照組的各項血流動力學(xué)指標無顯著性差異(P 0.05),常規(guī)CPR組和Epo治療組ROSC30 min、60min、90min、120min的HR、MAP、LVSP和±dp/dtmax較各自的基線水平明顯下降(P0.01);ROSC120min的LVEDP較各自的基線水平顯著升高(P0.01),而常規(guī)CPR組和Epo治療組ROSC30 min、60min、90min、120min之間無顯著性差異(P0.05)。 3.6 Epo治療組與常規(guī)CPR組ROSC后120min血清CTnI水平比較無顯著性差異(P 0.05);心肌組織的病理學(xué)結(jié)構(gòu)和超微結(jié)構(gòu)的損傷性改變較常規(guī)CPR組減輕。 4.結(jié)論 4.1窒息性大鼠心臟驟停-心肺復(fù)蘇成功后存在心功能不全和心肌損傷。 4.2 Epo可以改善窒息性大鼠心臟驟停-心肺復(fù)蘇成功后的心功能和減輕心肌損傷。 全文結(jié)論 1.氣管導(dǎo)管內(nèi)光纖引導(dǎo)下的經(jīng)口氣管插管法是一種創(chuàng)新的大鼠氣管插管方法,能實現(xiàn)快速、有效、準確的氣管插管,值得推廣應(yīng)用。 2.窒息性大鼠心臟驟停-心肺復(fù)蘇成功后存在心功能不全和心肌損傷。 3. Epo能改善窒息性大鼠心臟驟停-心肺復(fù)蘇后的心功能和減輕心肌細胞損傷,對復(fù)蘇后心肌具有保護作用。
[Abstract]:Background rats are commonly used experimental animals, but the tracheal intubation of rats has been a difficult problem because of small size, narrow oral cavity and great difficulty in exposing the glottis. The main methods of tracheal intubation in rats are the tracheotomy intubation method, blind insertion method and direct under intubation method. Therefore, it is necessary to seek a new intubation method to achieve safe and accurate endotracheal intubation in rats. A new method of endotracheal intubation in rats is established by using the endotracheal tube into a fiber with a diameter of 0.9mm as a light source and a guide wire.
Cardiac insufficiency after resuscitation is mainly characterized by hypotension, shock, fatal ventricular arrhythmias or heartbeat arrest, which is the primary cause of early death after the resuscitation of cardiac arrest patients. After the successful resuscitation of 60%-70%, patients died within 24h due to hypotension, shock or fatal ventricular arrhythmias, and only 4.5% can eventually be found. Survival after discharge. Cardiac dysfunction after resuscitation is mainly attributable to whole heart ischemia during cardiac arrest and myocardial injury induced by reperfusion.
Erythropoietin (Epo) is a glycoprotein hormone molecular weight 34KDa, which mainly acts on erythroid progenitor cells and regulates the volume of red cell in blood circulation. Recently, it has been found that Epo can play a wide tissue protection role in ischemia reperfusion, including heart, brain, retina, kidney, liver and skin. In the study of reperfusion, Epo can reduce infarct size, alleviate ischemia reperfusion injury and improve cardiac function.
Ischemia-reperfusion injury is the main pathophysiological process of the body after resuscitation, which is given to Epo during cardiopulmonary resuscitation, which is expected to play the role of myocardial protection and improve the cardiac function after resuscitation.
Part one establishment of new tracheal intubation in rats
1. purpose of research
A new type of rat trachea cannula was established by using a 0.9mm diameter optical fiber as the light source.
2. research methods
The Sprague-Dawley rats were divided into 2 groups (n=40): the oral tracheal intubation group (n=20) under the traditional light source (referred to as the traditional direct vision group), II) the endotracheal intubation group (referred to as the optical fiber guide group) under the optical fiber guided catheter (n=20). The time of intubation, the number of intubation and the success rate of the first intubation were compared. The rats of the tube intubation were connected with the miniature animal ventilator, the respiratory frequency (60 / sub) and the tidal volume (0.65ml/100g) were adjusted, and the tracheal intubation was extracted after continuous ventilation 60min, and the survival rate was compared for 1 weeks after the extraction of tracheal intubation.
3. results
3.1 the time of tracheal intubation and the number of intubation (36 + 16.43) s and (1.05 + 0.22) in the optical fiber guided group were significantly decreased ([86.20 + 56.48) s and (1.75 + 1.02)) compared with the traditional direct vision group (P0.01).
3.2 the success rate of fiberoptic catheterization group was 95% higher than that of the conventional group (60%) (P0.05).
3.3 the survival rate of 1 weeks after tracheal intubation in the fiber guided group was 100% higher than that in the conventional group (80%), but the difference was not statistically significant (P0.05).
4. conclusion
Endotracheal intubation under the fiber-optic guided endotracheal tube is an innovative method of endotracheal intubation in rats. It can achieve rapid, effective and accurate tracheal intubation. It is worth popularizing.
The second part is the effect of erythropoietin on myocardium after cardiopulmonary resuscitation.
1. purpose of research
To observe the cardiac function and myocardial injury after cardiac arrest and cardiopulmonary resuscitation in asphyxiated rats, and to explore the protective effect of erythropoietin on myocardium after cardiopulmonary resuscitation in rats.
2. research methods
.Sprague-Dawley rats (n=24) of asphyxiated rat cardiac arrest and cardiopulmonary resuscitation (n=24) were randomly divided into 3 groups: normal control group (n=8): tracheal intubation, vascular catheterization, no clipping trachea and cardiopulmonary resuscitation. II) routine cardiopulmonary resuscitation (CPR) group (n=8): after clamping the trachea 8min, chest compressions, mechanical ventilation were carried out. And adrenaline 0.02mg/kg, after the recovery of the autonomic circulation (ROSC), 3min was injected into the 0.9%NaCl 0.5ml. III Epo treatment group (n=8) through the femoral vein. After clamping the trachea 8min, the chest compressions, mechanical ventilation and adrenaline 0.02mg/kg were carried out after ROSC 3min. The femoral vein was injected into the femoral vein. All rats were reversed through the right cervical artery. Intubation of the left ventricle and femoral artery, continuous monitoring of heart rate (HR), mean arterial pressure (MAP), left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP), the maximum change rate of left indoor pressure and decrease (+ dp/dtmax) and standard II lead electrocardiogram. The anus inserted into the built-in temperature probe to record the deep rectal temperature and keep the temperature with the heating lamp. At 36.5 + 0.5 degrees centigrade.
At the end of observation (120min after ROSC), blood samples were collected to measure serum CTnI level, and heart was removed. Light and transmission electron microscopy were used to observe the myocardial injury.
3. results
3.1 there was no significant difference in baseline HR, MAP, LVSP, LVEDP, and dp/dtmax between the three groups (P 0.05).
3.2 after the spontaneous circulation resuscitation (ROSC), 30min, 60min, 90min, 120min HR, MAP, LVSP and dp/dtmax in the normal control group were significantly decreased (P 0.01) in the routine CPR group and the Epo group (0.01).
3.3 the serum CTnI level of 120min after ROSC in the routine CPR group was significantly higher than that in the normal control group (P 0.01); in the routine CPR group, the myocardial cell edema degeneration, necrosis, inflammatory cell infiltration, and the loss of membrane integrity, mitochondrial swelling, crista fracture, dissolving and other myocardial tissue damage were changed.
In 3.4 Epo treatment group, LVSP (P0.05), 60min, 90min, 120min, LVSP (P0.05), and 120min 0.01 (P 0.01) in the treatment group were significantly higher than those in the conventional CPR group (0.01), and there was no significant difference between the two groups (0.05).
3.5 the comparison of different time points in the same group showed that there was no significant difference in the hemodynamic indexes of the normal control group (P 0.05). The HR, MAP, LVSP and + dp/dtmax of ROSC30 min, 60min, 90min, 120min in the routine CPR group and the Epo treatment group were significantly lower than those of the respective baseline levels. There was no significant difference in ROSC30 min, 60min, 90min and 120min between the conventional CPR group and the Epo treatment group (P0.05).
There was no significant difference in the level of CTnI between the 3.6 Epo treatment group and the routine CPR group (P 0.05) after ROSC (P 0.05), and the pathological structure and ultrastructure of the myocardial tissue were less damaged than those in the conventional CPR group.
4. conclusion
4.1 cardiac arrest in asphyxiated rats: cardiac dysfunction and myocardial injury after successful cardiopulmonary resuscitation.
4.2 Epo can improve cardiac function and reduce myocardial injury after asphyxiated cardiac arrest in rats.
Full text conclusion
1. endotracheal intubation under the guidance of fiber guided endotracheal tube is an innovative method of endotracheal intubation in rats. It can achieve rapid, effective and accurate tracheal intubation. It is worth popularizing.
2. cardiac arrest in asphyxiated rats: cardiac dysfunction and myocardial injury after successful cardiopulmonary resuscitation.
3. Epo can improve cardiac function and myocardial cell damage after asphyxiated cardiac arrest in rats, and has protective effect on myocardium after resuscitation.
【學(xué)位授予單位】：廣州醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2009
【分類號】：R-332

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