家兔心跳骤停复苏模型的研究进展

心跳骤停是临床医学中最为危急的事件之一,其发生发展过程涉及了一系列的病理生理学改变。近几年来,有关于心跳骤停复苏的研究有很多,也取得了一定的进展,但关于其各种不同类型心跳骤停的病理生理学改变的理解仍不是十分的全面,其有效地治疗药物和治疗手段也仍需要进一步的研究。因此,成功地制备与人类心跳骤停相似的动物模型就显得非常必要来,这不仅是深入研究心跳骤停复苏病理生理学改变的重要基础和研究途径,也是研制其治疗药物及方法的有效手段。本文重点讨论家兔各种类型心跳骤停复苏模型不同的研究方法。     

溺水致心跳呼吸骤停1例报告

<正>溺水是青少年常见的意外伤害,部分溺水者可出现心跳呼吸停止,需要立即给予急救处理。我科曾对1例溺水致心跳呼吸骤停患者行心肺复苏术取得成功,现报告如下。1病例介绍患者,男,26岁,因"溺水后约5min,呼吸停止10min",于2012年7月30日晚8时59分由我院急诊科出诊院前急救(行心肺复苏术)成功后转运院内进一步治疗。患者于2012年7月30日到我县一风景区旅游,并于当晚8时15分     

H2S对心跳骤停复苏大鼠脑血流动力学及神经功能的影响

目的:探讨吸入外源性H_2S对心跳骤停复苏大鼠脑血流动力学及神经功能的影响。方法:选择成年雄性SD大鼠18只,随机分为假手术组(sham,n=6)、窒息导致心跳骤停复苏组(CA,n=6)、心跳骤停复苏+H_2S组(H_2S,n=6),观察H_2S对心跳骤停复苏大鼠脑血流的影响。选择成年雄性SD大鼠45只,随机分为sham组(n=5)、CA(n=20)和H_2S组(n=20),观察H_2S对心跳骤停复苏大鼠神经功能和存活率的影响。结果:CA组与H_2S组在ROSC后MAP和CPP均快速上升,远高于基础值(P0.05);而后两组MAP和CPP均缓慢下降,实验结束时,明显低于基础值(P0.05)。两组间比较差异无统计学意义(P0.05)。CA组与H_2S组CBF曲线在ROSC后上升至峰值,随后逐渐下降,两组在峰值无明显差异,但H_2S组CBF减少量显著少于CA组(P0.05)。而在CVR曲线,在实验最后,CA组CVR值仍明显高于基础值(P0.05),而H_2S组基本降至基础值,明显低于CA组(P0.05)。H_2S组的14天存活率(80%)明显高于CA组(50%,P0.05)。在胶带移除实验(tape removal test,TRT)所需时间上,CA组与H_2S组在第1天、第3天及第14天都存在显著差异(P0.05)。H_2S组第14天海马CA1区神经元存活数(33±8)明显多于CA组(20±6,P0.05),但仍较假手术组少(53±10,P0.05)。结论:外源性H_2S吸入对大鼠心跳骤停复苏后MAP及CPP无明显影响。外源性H_2S通过降低CVR,改善CBF,从而改善大鼠心跳骤停复苏后的脑循环。外源性H_2S能明显提高心跳骤停复苏后大鼠的存活率,降低TRT所需时间,同时显著增加海马CA1区神经元的存活,改善大鼠心跳骤停复苏后神经功能转归。     

1例胸部刀伤并3次心跳骤停的护理

胸部刀伤并心跳骤停是外科危及生命的创伤,其伤情急重且复杂多变,并发症多,护理难度大,死亡率高。我科曾收治１例右胸部刀伤并３次心跳骤停的患者,术后采取有效的护理措施,未出现任何护理并发症,患者转危为安,住院４０ｄ,痊愈出院。现将我们的护理过程分析如下。...     

可视喉镜气管插管对心跳骤停抢救患者血流动力学及心肺复苏质量的影响

摘要 目的：探讨可视喉镜气管插管对心跳骤停抢救患者血流动力学及心肺复苏质量的影响。方法：选取联勤保障部队第九四〇医院于2020年4月~2022年5月期间收治的98例心跳骤停抢救患者为研究对象,根据插管方式将患者分为B组（可视喉镜气管插管,n=50）、A组（传统直接喉镜气管插管,n=48）。对比两组插管次数、声门暴露时间、插管时间、气道与牙齿损伤、心肺复苏质量及血流动力学指标变化情况,观察两组不良反应发生情况。结果：B组的插管次数少于A组,声门暴露时间、插管时间短于A组,气道与牙齿损伤比例少于A组（P<0.05）。B组的插管成功率、心肺复苏（CPR）成功率、存活率均高于A组（P<0.05）。B组插管后15 min的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）及心率（HR）均低于A组同期（P<0.05）。B组的不良反应发生率低于A组（P<0.05）。结论：相比于传统直接喉镜气管插管用于心跳骤停抢救患者,可视喉镜气管插管可维持血流动力学稳定,提高插管成功率和心肺复苏质量,安全性较好。     

1007型THUMPER心肺复苏机在急诊心肺复苏中的临床观察

目的观察1007型THUMPER心肺复苏机（萨勃机）在急诊心肺复苏中的临床效果。方法将114例心肺骤停患者分为萨勃机组59例和徒手心肺复苏组55例,两组患者均使用电除颤和药物治疗,比较两种方法在心肺复苏中的有效率。结果萨勃机组在心肺复苏中的有效率明显高于徒手心肺复苏组,差异有统计学意义（P〈0.05）,但对患者的存活率无明显优势（P〉0.05）。结论 1007型THUMPER心肺复苏机在心肺复苏抢救中有效率得到提高,值得临床推广。     

心肺脑复苏后如何进行早期氧疗

心肺脑复苏（Cardiopulmonary—cerebralResuscitation,CPCR）是抢救心跳骤停（CardiacArrest）患者的重要手段,而早期氧疗（AcuteOxygenTherapy）是提高心肺脑复苏成功率的重要辅助措施。以往人们一直认为CPCR后应尽早给予患者高浓度氧疗;然而,近年认为早期氧疗不当非但达不到挽救心跳骤停患者生命、降低致残率之目的,反而会降低复苏成功率。基础研究和临床研究提示,与暴露于正常空气或低浓度氧气组相比,大脑缺氧后早期暴露于高浓度氧气中的动物或患者,脑组织损伤更加严重。其可能机制主要有高浓度氧含量引起的氧化应激和乳酸堆积造成的脑组织损伤。此外,复苏后高浓度氧疗还可造成心肌损伤,其主要机制有大量活性氧簇（ReactiveOxygenSpecies,ROS）造成心脏的继发性损伤、Ca2＋通道激活,引起血管收缩加重心肌缺血、K＋ATP通道关闭,造成心肌受损、血管紧张素Ⅱ释放增多和缩血管物质20-HETE生成增多,加重心肌缺血等。因此,在对复苏后病人进行氧疗过程中,目前主张限制复苏后早期氧疗。     

心肺复苏后脑复苏的研究进展

在过去的10年里,美国心脏学会进行了大量的基础和临床研究,于2010年10月颁布了《2010美国心脏协会心肺复苏及心血管急救指南》［1］。新指南强调了早期心脏按压的重要性,简化了心肺复苏的流程,对心脏按压的质量提出了新的要求。随着医疗技术的发展,近年来心脏骤停后自主循环恢复的成功率虽然已经有了一定的提高,但是患者长时间存活率并未提高,仍有25％~50％的心跳骤停患者虽然恢复了自主循环,但仅有2％～10％的患者不出现神经功能缺陷［2］。临床上心肺复苏后脑功能完全恢复非常少见。     

土壤渍涝对芝麻根系生长及抗氧化物酶活性的影响

在渍水条件下芝麻根系生长速度下降,干物质积累减少,根系的抗氧化物酶--超氧物歧化酶(SOD)、过氧化氢酶(CAT)和过氧化物酶(POD)活性先增后下降,POD活性下降较缓慢,超氧自由由基(O·-2)产生速率和丙二醛(MDA)含量随淹水时间的延长而升高.     

硝酸盐胁迫对不同抗性菠菜抗氧化物酶活性和甾醇含量的影响

以"大叶菠菜"和"超级菠菜"为试验材料,分析不同浓度硝酸盐(NO3-)对两种菠菜品种种子萌发、幼苗膜脂过氧化、抗氧化物酶活性、渗透调节物质和甾醇含量的影响.结果表明,160 mmol/L NO3-显著抑制菠菜种子萌发,且"超级菠菜"的相对发芽率高于"大叶菠菜",说明"超级菠菜"的抗性高于"大叶菠菜".160 mmol/L NO3-胁迫处理菠菜幼苗发现MDA(malondialdehyde)和H2O2(hydrogen peroxide)含量在处理24、48 h时显著高于对照,且"大叶菠菜"中含量高于"超级菠菜";SOD(superoxide dismutase)、POD(perioxidase)和CAT(catalase)三种抗氧化物酶活性及可溶性糖、可溶性蛋白含量增加,且"超级菠菜"含量高于"大叶菠菜";两品种中豆甾醇和谷甾醇含量在NO3-胁迫处理48 h后升高,"超级菠菜"中豆甾醇/谷甾醇的比值与"大叶菠菜"相比变化较小.以上结果表明,"超级菠菜"的抗性高于"大叶菠菜"可能与其胁迫后具有较高的抗氧化物酶活性、渗透调节物质和甾醇含量有关.     

The Activity of Principal Antioxidant Enzymes and the Content of Metabolites in Dormancy Breaking and Germination of Davidia involucrate Seeds

The principal antioxidant enzymes and metabolites were reported to play a very important role in eliminating reactive oxygen species and maintaining vigour in dormancy breaking and germination of Davidia involucrate seeds. However, the researches on the change laws of content and activity are seldom. In present study, we chose Davidia involucrate seeds which collected from the Mabian Nature Reserve as experimental materials, and then investigated the activity of principal antioxidant enzymes and the content of metabolites in dormancy breaking and germination of the seeds. The results showed that the activity of peroxidase (POD), catalase (CAT), superoxide dismutase (SOD) and glutathione reductase (GR) exhibited an increasing trend but the activity of total antioxidant capacity (T AOC) decreased greatly in early stage of stratification. Comparing with the decrease of protein (Pr), the content of ascorbic acid (Vc) and free amino acid (FAA) significantly increased. In middle stage of stratification, the activity of SOD and T AOC increased firstly and then decreased at last. The activity of POD always maintained a higher level although the activity of CAT and GR decreased greatly. In terminal stage of stratification, the activities of POD, GR, T AOC and the content of FAA and Vc exhibited an increasing trend, while the activity of CAT and SOD maintained a low level. In germination stage, the activity of all antioxidant enzymes and the content of Vc and FAA were increased obviously (P < 005), but the content of the protein was decreased. These results suggested that Davidia involucrata seeds may have a good ability to efficiently remove the effects on cell structure caused by reactive oxygen species (ROS) by keeping the interaction of antioxidant enzymes and metabolites successively during the period of dormancy breaking and germination. This adjustment helps to ensure the germination of seeds by acceleration the post ripening in morphological and physiological of progresses.     

Regulation of Antioxidant Enzymes by Salicylic Acid in Cucumber Leaves

Activities of the antioxidant enzymes involved in superoxide anion (O2-) and hydrogen peroxide (H2O2) metabolism were determined and the contents of O2 and 14202 were also measured. All concentrations of sahcylic acid (SA) tested (0.5, 1.0, 2.5 and 5.0 mmoL/L) significantly enhanced superoxide dismutase (SOD) and peroxidase (POD) activities not only in the first treated true leaf (leaf 1 ) but also in the second untreated true leaf (leaf 2) of Cucumis sativus L. When the leaves were treated with 1 mmol/L SA within 6 to 72 h, the activity of POD increased by 22 % to 67% in the treated leaf 1 and by 14% to 86% in the untreated leaf 2. However, no changes were observed during 3 h after treatment and at 96 h following treatment. Measurement of O2- and H202 showed that there was a significant decrease in 02' content and an increase in H202 content after SA treatment, but catalase (CAT) activity was only slighfiy inhibited and this suggested that the reason of the increase in H2O2 by SA treatment is not due to the inhibition of CAT but rather the increase in SOD activity. It was also found that SA at all concentrations tested could not induce new SOD isozyme but it induced 1 to 2 bands of new POD isozyme within one day after treatment. The results indicate that SA might involve in the regulation of antioxidant enzymes.     

盐度、温度对卵形鲳鲹选育群体肝抗氧化酶活力的影响

通过盐度渐变和温度骤变的方法,分别研究了不同盐度(10、20、30、40)处理和不同温度(18.0℃、21.0℃、24.6℃、29.0℃、32.0℃)处理对卵形鲳鲹(Trachinotus ovatus)选育群体肝超氧化物歧化酶(SOD)、过氧化氢酶(CAT)和谷胱甘肽过氧化物酶(GPX)活力的影响.在实验结束时,盐度10组酶活力与对照组无显著差异(P＞0.05),盐度20组SOD活力极显著低于对照组(P＜0.01);盐度40组120 h时,SOD和GPX活力极显著低于对照组(P＜0.01),CAT活力与对照组差异不显著(P＞0.05).18.0℃和21.0℃ SOD活力在1、3、6、12、24 h这5个取样时间点均高于对照组,CAT活力在实验结束时(24 h)极显著高于对照组(P ＜0.01);29.0℃SOD和CAT活力在实验结束时(24 h)显著高于对照组(P＜0.05);32.0℃ SOD和CAT活力在5个取样时间点均显著低于对照组(P＜0.05).结果表明,适当的盐度或温度变化可以改变卵形鲳鲹肝抗氧化酶活力,达到机体耐受极限时酶活力下降.     

纳洛酮对心搏骤停患者心肺复苏后氧化应激反应及缺血缺氧性脑病的影响

目的:探讨纳洛酮对心搏骤停患者心肺复苏(CPR)后氧化应激反应及缺血缺氧性脑病的影响。方法:将我院收治的78例骤停时间≤10 min的心搏骤停患者随机分为治疗组和对照组,每组各39例。两组均按照美国心脏学会心肺复苏指南进行标准的心肺复苏,治疗组在此基础上静脉注射纳洛酮2 mg,复苏后用纳洛酮0.4 mg/(kg·d)微量注射泵24h持续泵入。比较两组的CPR成功率、血浆丙二醛(MDA)含量和谷胱甘肽过氧化物酶(GSH-PX)、超氧化物歧化酶(SOD)活性,监测其不同时点脑氧摄取量(CEO2)的变化。结果:与对照组比较,治疗组自主循环恢复成功率、复苏后24 h存活率均显著升高(P<0.05)。自主循环恢复后,治疗组SOD、GSH-PX活性较对照组明显增加(P<0.05);复苏后24 h,两组MDA含量均显著升高,SOD、GSH-PX活性明显减弱,而治疗组各氧化应激指标明显优于对照组(P<0.05)。两组患者在复苏早期CEO2迅速升高,但在复苏后24 h开始下降,48~72 h处于相对稳定的水平,治疗组各时间点CEO2均明显高于对照组(P<0.05)。结论:纳洛酮可减轻心搏骤停患者CPR后体内氧化应激损伤和缺血缺氧性脑病,改善患者的预后。     

肢体远程预处理通过上调机体抗氧化酶活性诱导兔脊髓缺血耐受

目的:证实抗氧化酶活性上调是肢体远程预处理(remote preconditioning,RPC)诱导兔脊髓缺血耐受效应的主要机制之一。方法:60只雄性新西兰大白兔随机分成对照组、远程预处理组、缺血组及RPC 缺血组(对照组n=6,余组n=18)。RPC组行双下肢短暂缺血2次(每次10min,间隔10min);缺血组仅行脊髓缺血模型;RPC 缺血组在远程预处理后1h行脊髓缺血;对照组为假手术组。对照组于脊髓缺血再灌注后48h行神经功能评分后取脊髓,作为对照。余三组分别于再灌注后6h、24h及48h评分后取材,各时间点各取6只。所有动物于缺血前、缺血20min、再灌注20min及再灌注6h采动脉血测血清抗氧化酶活性和丙二醛(MDA)含量;于取材后测定脊髓匀浆抗氧化酶活性和MDA含量。结果:再灌注后6h、24h及48h时对照组、远程预处理组及远程预处理 缺血组神经功能评分均明显高于缺血组(P<0.05)。血浆超氧化物歧化酶(SOD)活性和过氧化氢酶(CAT)活性在每个时间点RPC组均高于对照组,RPC 缺血组高于缺血组(P<0.05);其中缺血20min时,缺血组血浆SOD、CAT活性低于对照组,RPC 缺血组低于RPC组(P<0.05);而与缺血前相比,缺血20min时缺血组及RPC 缺血组SOD和CAT活性显著下降(P<0.05)再灌注24h和48h时,脊髓匀浆SOD、CAT活性对照组低于RPC组,缺血组低于RPC 缺血组(P<0.01);而MDA含量再灌注24h时对照组高于RPC组,缺血组高于RPC 缺血组(P<0.05)。脊髓匀浆SOD、CAT活性与神经功能评分具有显著相关性。结论:RPC诱导脊髓缺血耐受的机制可能为上调抗氧化酶活性,增强机体在缺血再灌注过程中清除氧自由基的能力,从而减少氧自由基介导的损伤,发挥脊髓保护作用。     

盐胁迫对红麻幼苗生长及抗氧化酶活性的影响

为研究不同盐胁迫时间和不同盐浓度胁迫对红麻（Hibiscus cannabinusL.）幼苗的生长及抗氧化酶活性的影响,探寻红麻耐盐的生理机制,为盐碱地种植红麻提供科学依据,本研究对红麻幼苗进行了两种不同条件的盐胁迫处理。一种将红麻幼苗在0（对照组）、140 mmol/L NaCl的半强度Hoagland营养液下分别处理3、6、9 d,另一种是在0（对照组）、70、140、200 mmol/L NaCl的1/2 Hoagland营养液下处理6 d,分别测定两种盐胁迫条件下植株的鲜重、根长、茎长、叶片H2O2、丙二醛（MDA）含量、超氧化物歧化酶（SOD）、过氧化物酶（POD）、过氧化氢酶（CAT）和谷胱甘肽还原酶（GR）活性。结果显示：（1）在第一种处理条件下,随着盐胁迫时间的延长,处理组红麻幼苗的鲜重相对于对照分别减轻了19.63%、19.35%和39.03%,株高则分别降低了25.59%、19.17%和18.48%,处理组的SOD活性先增后减,POD活性先减后增,MDA和H2O2的含量、CAT和GR活性基本随胁迫时间的增长而增高。（2）在第二种处理条件下,随着胁迫盐浓度的增加,处理组鲜重相对于对照分别减轻了16.79%、19.35%和44.73%,株高则分别降低了11.21%、19.17%和23.62%,处理组SOD活性都稍高于对照,但三者无显著差异,POD活性先减后增,MDA和H2O2的含量、CAT和GR活性基本上随着盐浓度增加而增加。实验表明,在两种不同条件的盐胁迫下,红麻幼苗受盐害的程度基本上随胁迫时间和盐浓度的增加而加重。处理组植株的SOD和POD活性较对照组增加不明显,甚至有所降低,而CAT和GR活性则相对较高,CAT和GR可能在红麻幼苗抵御盐害时起较重要作用。     

Modulation of Endogenous Antioxidant Enzymes by Nitric Oxide in Rat C6 Glial Cells

Abstract: To understand the possible mechanism of nitric oxide (NO)-mediated cytotoxicity, we investigated the effect of NO on the endogenous antioxidant enzymes (AOEs) catalase, glutathione peroxidase (GPX), and CuZn- and Mn-superoxide dismutases (SODs) in rat C₆ glial cells under conditions in which these cells expressed oligodendrocyte-like properties as evidenced by the expression of 2′,3′-cyclic-nucleotide 3′-phosphohydrolase. The 24-h treatment with S-nitroso-N-acetylpenicillamine (SNAP), a NO donor, decreased the activities and the protein levels of catalase, GPX, and Mn-SOD in a dose-dependent manner. Alternatively, the activity and the protein level of CuZn-SOD were increased. 2-Phenyl-4,4, 5,5-tetramethylimidazoline-1-oxyl-3-oxide (PTIO), a NO scavenger, blocked the effect of SNAP. Moreover, the treatment of C₆ cells with sodium nitroprusside, another NO donor, or with a combination of lipopolysaccharide (LPS) and interferon-γ (IFN-γ), which induce excessive production of NO, also significantly modulated the AOE activities in a manner similar to that seen with SNAP treatment. The compounds/enzymes that inhibit the production of NO (e.g., N-nitro-l -arginine methyl ester hydrochloride, arginase, and PTIO) blocked the effects of LPS and IFN-γ on the activities of AOEs. Treatment with SNAP and a combination of LPS and IFN-γ also modulated the mRNA levels of AOEs, parallel to the changes in their protein levels and activities, except for Mn-SOD where the combination of LPS and IFN-γ markedly stimulated the mRNA expression. In spite of the stimulation of mRNA level, LPS and IFN-γ significantly inhibited the activity of Mn-SOD within the first 24 h of incubation; however, Mn-SOD activity gradually increased with the increase in time of incubation. These results suggest that alterations in the status of AOEs by NO may be the basis of NO-induced cytotoxicity in disease states associated with excessive NO production.     

Effect of Transient Cerebral Ischaemia and Cardiac Arrest on Brain Extracellular Dopamine and Serotonin as Determined by In Vivo Dialysis in the Rat

The effects of 20-min transient, global, forebrain ischaemia and cardiac arrest on extracellular concentrations of dopamine (DA), serotonin (5-HT), and their respective metabolites, homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA), were measured in vivo by dialysis of rat striatum and hippocampus. During the ischaemic period, striatal DA content increased (250-fold basal concentrations) with parallel but much less marked increases of both striatal and hippocampal 5-HT content (eight- to 10-fold). Baseline values were restored during reperfusion. Subsequent increases of DA and 5-HT levels on cardiac arrest were comparable after both sham operation and ischaemia. Significant decreases of HVA and 5-HIAA levels were observed following ischaemia or cardiac arrest. The differential effects of ischaemia on DA and 5-HT suggest selective alterations in disposition or metabolism of the two transmitters and that dopaminergic neurones may be more vulnerable to ischaemic insults.