摘要
目的 研究纳洛酮 (Nal)在缺氧型心跳呼吸骤停小猪模型复苏中对心、肺、脑的作用。方法 将 2 7只小猪随机分成Nal 1、Nal 2组和对照组。夹闭气管插管制成缺氧型心跳呼吸骤停模型 ,自主循环恢复者给予不同剂量Nal ,对照组给生理盐水 ;自主呼吸恢复者监护 2h (监护期 ) ,继续观察至心跳骤停后 2 4h ,监测动脉血气、平均动脉压、心肌钙蛋白I(cTnI)、肿瘤坏死因子α(TNFα)、β 内啡肽(β EP)及心跳骤停后 4h、2 4h神经系统评分。 结果 三组自气管插管夹闭至大动脉搏动消失至心跳骤停至自主循环恢复时间均相近 ,Nal 1、Nal 2组自主循环恢复至自主呼吸恢复时间分别为(9.2± 2 .7)、(10 .7± 4.6 )min ,与对照组的 (2 2 .8± 7.6 )min相比 ,差异有非常显著意义 (P <0 .0 1) ;Nal 1、Nal 2组和对照组存活小猪心跳骤停后 4h神经系统评分分别为 0～ 16 0 (M 0 )、70～ 12 5 (M 10 0 )、115～ 310 (M 2 15 )分 (三组比较 ,P >0 .0 5 ) ,2 4h神经系统评分分别为 0～ 2 0 (M 0 )、0～ 35 (M 2 7.5 )、40～ 310 (M 117.5 )分 (P <0 .0 0 9) ;三组麻醉后至自主循环恢复各点cTnI值均逐渐升高 ,但差异无显著性 ;两Nal组存活者给予Nal后监护期cTnI值下降 ,对照组上升 ;监护期平均动脉压较高 (P <0 .0 5 )、β
The pharmacology of pediatric resuscitation continues to be an active area of investigation, naloxone (Nal) is one of four debated drugs in this area. Objective To determine whether the outcome improved or not for two different doses of Nal given during cardiopulmonary cerebral resuscitation (CPCR) in a asphyxial cardiopulmonary arrest model of piglets. Methods Twenty seven domestic male piglets (14 35 days of age) were anesthetized with diazepam and ketamine, endotracheal tubes were clamped to cause asphyxial cardiopulmonary arrest. The cardiopulmonary resuscitate intervention was followed by pediatric life support. Piglets with spontaneous circulation restoration were randomly given 0.01 mg/ kg of Nal (Nal 1 group, n =9) and 0.04 mg/kg of Nal (Nal 2 group, n =9). Nal was diluted with normal saline and reached a final volume of 2 ml. Piglets were given 2 ml of normal saline instead of Nal as the control group. The intravenous bolus of Nal or saline was carried out by every 5 min for 3 consecutive times. Successfully resuscitated piglets accepted 2 hour period of intensive care, and then were watched on until 24 hours post cardiac arrest. The electrocardiogram, arterial blood gas, mean arterial blood pressure, cardiac troponin I ( cTn I ), TNFα, β endorphin (β EP ) and neurologic scores were monitored. Results (1) The durations from endotracheal tube clamping to restoration of spontaneous circulation in piglets showed no marked difference. The time of restoration of spontaneous respiration in Nal 1 and Nal 2 was (9.2±2.7) and (10.7±4.6) min,respectively, and showed differences from the control group (22.8±7.6) min, P <0.01). (2) The 24 h neurologic scores in Nal 1 and Nal 2 groups were significantly lower than those in control group ( P <0.009). (3) The cTnI values in Nal 1 and Nal 2 groups declined at the end of 2 hour period care (an average decline of 0.19 μg/L in Nal 1 group, 0.35 μg/L in Nal 2 group) while ascended in controls (an average growth of 2.05 μg/L) , and no obvious difference among 3 groups at the 24 th hour post cardiac arrest; mean arterial blood pressure values were higher in two Nal groups [(101±12) mm Hg and (95±10) mm Hg, respectively] than that in controls during 2 hour period care [(82±12) mm Hg, P <0.05]. (4) TNF α level was kept normal from post anesthesia to 2 hour period care, and increased in all groups at the 24 th hour ( P >0.05). (5)β EP levels raised from post anesthesia to 2 hour period care and lowered at the 24 th hour ( P >0.05). β EP in Nal 1 and Nal 2 groups [(21.4±2.3) ng/L and (19.5±2.0) ng/L, respectively] was significantly higher than that in control group [(14.6±1.4) ng/L, P <0.01] during 2 hour period care. (6) Both resuscitation rate and 24h survival rate were similar in 3 groups. Conclusion Naloxone showed therapeutic/protective action in piglets of asphyxial cardiopulmonary arrest, and might be given at a higher dose and used during CPCR.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2000年第11期678-681,共4页
Chinese Journal of Pediatrics
关键词
纳洛酮
心肺复苏术
心脏骤停
呼吸暂停
Naloxone
Cardiopulmonary resuscitation
Heart arrest
Apnea
