心肺转流进行心肺脑复苏的实验研究

观察心肺转流对狗心脏停搏３０分钟后的心肺复苏效果。方法用静脉注射１０Ｔ氯化钾溶液使狗心搏、呼吸骤停３０分钟后,分两组进行心肺复苏,每组６只。对照组用常规法,实验和ＣＰＢ法,进行心电图、动脉压、静脉压、动脉血气监测和观察瞳孔,３０分钟后观察复苏效果。     

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。     

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。     

心肺复苏的院前急救进展

<正>心脏骤停是指心脏突然停止跳动,造成有效排血停止,引起各脏器包括心脏本身缺血缺氧,从而导致患者突然死亡[1]。心肺复苏(CPR)是指各种原因所引起的心搏、呼吸骤停时实施的基本急救措施,其目的是保护心脏和脑等重要器官,并尽快恢复自主呼吸和循环功能,保持完善的脑功能[2]。有研究显示,心脏骤停10min后实施CPR的成功率几乎为零[3],每早1min复苏成功率提高10%。但目前我国的院前     

心搏骤停26min后实施心肺脑复苏成功1例

1临床资料患者,男,35岁。2004年6月11日9时20分,在劳动中突然双手捂胸,继之昏倒在地。家人发现其面色紫绀,呼吸停止,脉搏不能触及,遂将其平卧在地,叩击心前区2次。发病26m in后急救医护人员到达,诊断为心搏骤停,立即给予心脏按压、人工呼吸。10m in送至医院急诊科,立即给予气管     

心肺复苏教学存在的问题及对策

心肺复苏术是医学生必须掌握的基本操作技能,医学生是否正确掌握该项技术,将影响其将来的临床工作急救能力,也影响心肺复苏术在社会的推广应用。虽然心肺复苏作为医学高等教育的重要部分,医学生在不同学习阶段接受了一定技能培训,但教学效果不尽人意。     

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。     

电针对大鼠心肺复苏后脑损伤的保护作用及对海马炎性因子表达的影响

目的:探讨电针对大鼠心肺复苏后脑损伤及海马炎性因子表达的影响。方法:雄性SD大鼠随机分三组:假手术组(Sham)、对照组(Control)、电针组(EA)。大鼠窒息8 min后进行心肺复苏,EA组于复苏同时在水沟、内关穴插入毫针并予以电针刺激,对照组仅在相同穴位插入毫针。计算大鼠复苏成功率,记录自主循环恢复时间,于复苏后24 h及72 h对大鼠进行神经功能缺损评分(NDS),水迷宫检测各组大鼠学习记忆能力,尼氏染色观察海马区神经元形态及存活数量,Western blot检测海马区炎性因子表达。结果:与Sham组相比,对照组与EA组大鼠复苏后24 h、72 h NDS降低,学习记忆能力明显减低,两组海马CA1区细胞排列紊乱、神经元存活数量减少,IL-10表达降低、IL-1与IL-6表达升高(P0.05)。而与对照组相比,EA组大鼠复苏成功率有所提高,但无统计学意义,自主循环恢复时间明显缩短(P0.05);复苏后24 h、72 h NDS评分提高(P0.05);水迷宫第六天逃避潜伏期缩短、空间探索能力显著增强(P0.05);海马CA1区细胞排列紊乱减轻,神经元存活数目增多;海马区炎性因子IL-1、IL-6表达降低,抗炎因子IL-10表达增多(P0.05)。结论:电针能够减轻大鼠心肺复苏后脑损伤,其保护作用可能与抑制炎性因子、促进抗炎因子表达有关。     

心肺复苏后脑缺血再灌注损伤治疗理念及相关动物模型研究进展

心肺复苏后脑缺血再灌注损伤是一个复杂的病理生理变化过程,由多种损伤机制共同参与。自心肺复苏后系统性综合治疗和亚低温治疗在临床上广泛应用后,目前已有多种治疗理念在不同的动物实验和动物模型基础上被提出,包括缺血预处理、药物预处理、缺血后处理、和药物后处理,而后吸入麻醉药对心肺复苏后脑缺血再灌注损伤的保护作用受到了人们的重视,而七氟烷后处理已经成为目前研究的热点之一。为了指导临床上的心肺复苏,人们一直在利用不同动物模型,探究不同保护方法,寻找有效的脑保护药物。而各种治疗理念的提出均是建立在动物实验和动物模型的基础上,窒息性心肺复苏模型模拟围术期气道梗阻,能较贴切的复制临床上由窒息引起的心肺复苏后脑损伤,对将来指导临床复苏具有重大意义。     

2月龄和4月龄大鼠制备心肺复苏模型后神经功能评价及亚组评分的比较

目的：本研究旨在选择适合的大鼠,对比2月龄大鼠与4月龄大鼠CPR后神经功能评分及亚组评分,摸索利用不同月龄的大鼠CPR的可行性。方法通过严格监测SD大鼠制备模型过程中的心电、血压生理指标、测定各组大鼠不同时间点的神经功能缺失评分以及神经功能亚组评分、对比制备4月龄和2月龄大鼠心肺复苏模型的稳定性。结果电刺激致室颤,4月龄组大鼠的成模率为87.5％,远高于2月龄组大鼠,而死亡率无差异;在电刺激诱发CA过程中造成的血压变化,4月龄组大鼠明显低于2月龄组大鼠,存在极显著性差异（ P ＜0.01）;4月龄组大鼠与2月龄组大鼠CPR后各时间点的神经功能评分无统计学差异,而4月龄组大鼠与2月龄组大鼠的神经功能亚组评分在不同时间点,存在显著差异（P ＜0.05）,4月龄大鼠与2月龄大鼠对比,心肺复苏后脑损伤的程度加重。结论4月龄大鼠更适合制备心肺复苏模型,该月龄组的大鼠制备模型成模率高,脑损伤程度重,更适合于用于心肺复苏的基础研究及治疗评价。     

北虫草抗氧自由基和羟自由基作用的研究

基于很多疾病与脂质过氧化有关 ,探讨了利用人工培育的北虫草的抗脂质过氧化作用。结果显示 :人工培育的北虫草子座对 Fenton反应生成的羟自由基具有较强的清除作用 ,且作用明显强于相同剂量的羟自由基特异清除剂甘露醇 (P<0 .0 1 ) ;北虫草对邻苯三酚自氧化体系产生的氧自由基亦具有清除作用 ,与对照组比较 P<0 .0 1 ,但作用弱于相同剂量的抗坏血酸。结果提示 :北虫草具有抗脂质过氧化作用。     

氧自由基清除剂的应用

对筛选和研究氧自由基清除剂的方法和模型、已知的自由清除剂、具抗氧化作用的中草药与食物及开发中的微生物来源的自由基清除剂的研究现状和最新进展作了概述。     

计算机模拟技术结合多媒体教学法在心肺复苏培训中的应用

目的:探讨和评价计算机模拟技术结合多媒体教学法在心肺复苏培训中的应用价值。方法:对62名急诊医生进行心肺复苏理论和技能测试,应用算机模拟技术结合多媒体教学模式,进行综合模拟演练并再次考核,比较两次成绩的差异;并发放调查问卷,分析对教学方法的评价及满意度。结果:培训后再次考核理论成绩、技能成绩和团队合作能力较初步测试成绩有显著提高,P0.05;98.3%喜欢该教学法,95.1%认为该教学法可以提高团队合作能力。结论:计算机模拟技术结合多媒体教学法在心肺复苏培训中具有重要的应用价值,可以显著提高团队合作能力。     

Decrease of myocardial infarct size with desferrioxamine: possible role of oxygen free radicals in its ameliorative effect

The ability of an iron chelator, desferrioxamine, to inhibit the infarct size in in vivo rat heart was assessed. Anaesthetised rats were subjected to coronary artery ligation (CAL) for 72 hr and infarct size was measured macroscopically using TTC staining. Systolic blood pressure and ECG were monitored. Desferrioxamine (10 mg/kg and 20 mg/kg i.v.) administered half an hour after CAL markedly reduced the infarct size. However, drug treatment did not alter the systolic blood pressure of animals. In addition, desferrioxamine in vitro and in vivo demonstrated an inhibition of rat PMN-evoked and luminol-enhanced chemiluminiscence. The capacity of desferrioxamine to impair the generation or to scavenge directly oxygen free radicals may be responsible for its beneficial effect on myocardial infarct size in rats.     

模拟空气潜水对大鼠脾组织氧自由基生成的影响

目的:观察模拟空气潜水对大鼠脾组织氧自由基(OFR)生成的影响。方法:腹腔注射自旋捕捉剂,高气压处理后检测大鼠脾组织生成的OFR。结果:模拟空气潜水后大鼠脾组织OFR生成增多,并检测到了.OH信号。结论:空气模拟潜水时呼吸气中高分压氧可促进脾组织OFR生成,主要类型可能为羟自由基。     

The activity of recombinant human neuroglobin as an antioxidant and free radical scavenger

Free radicals are by-products of metabolism and exist in a homeostasis between generation and scavenging in vivo. Excessive free radicals cause various diseases, including nervous system diseases. Neuroglobin (Ngb), a nervous system-specific oxygen-binding protein, has been suggested to be a potential free radical scavenger in the nervous system in vivo; however, its underlying mechanism remains unclear. In this study, we investigated the antioxidant potential and free radical scavenging properties of recombinant human Ngb (rhNgb) in vitro. Interestingly, we found that the rhNgb protein itself has a direct and distinct antioxidant capacity and can efficiently scavenge a variety of free radicals, including the [2,2'-azino-di-(3-ethyl-benzthiazoline-6-sulfonic acid)] (ABTS) cation, superoxide anion, hydrogen peroxide, and hydroxyl radical. The capacity of rhNgb to scavenge the superoxide anion and hydrogen peroxide was even comparable to that of vitamin C. In addition, rhNgb had Fe(2+) chelating activity but hemoglobin did not. In conclusion, our results indicated that the rhNgb protein itself has antioxidant and free radical scavenging activities, providing fundamental evidence for the neuroprotective function of Ngb. These data provide key information for the origin of the neuroprotective and physiological role of Ngb and will promote the treatment of reactive oxygen species (ROS)-related diseases using this novel oxygen-binding globin.     

Lidocaine: a hydroxyl radical scavenger and singlet oxygen quencher

Lidocaine, a local anaesthetic, has been shown to reduce ventricular arrhythmias associated with myocardial infarction and ischemic myocardial injury and its protective effects has been attributed to its membrane stabilizing properties. Since oxygen radicals are known to be produced during ischemia induced tissue damage, we have investigated the possible antioxidant properties of lidocaine and found that lidocaine does not scavenge 0₂ ^–· radicals at 1 to 20 mM concentrations. However, lidocaine was found to be a potent scavenger of hydroxyl radicals and singlet oxygen. Hydroxyl radicals were produced in a Fenton type reaction and detected as DMPO-OH adducts by electron paramagnetic resonance spectroscopic techniques. Lidocaine inhibited DMPO-OH adduct formation in a dose dependent manner. The amount of lidocaine needed to cause 50% inhibition of that rate was found to be approximately 80 M and at 300 M concentration it virtually eliminated the DMPO-OH adduct formation. The production of OH-dependent TBA reactive products of deoxyribose was also inhibited by lidocaine in a dose dependent manner. Lidocaine was also found to inhibit the ¹O₂-dependent 2,2,6,6-tetramethylpiperidine N-oxyl (TEMPO) formation in a dose dependent manner. ¹O₂ was produced in a photosensitizing system using Rose Bengal or Methylene Blue as photosensitizers and was detected as TEMP-¹O₂ adduct by EPR spectroscopy. The amount of lidocaine required to cause 50% inhibition of TEMP-¹O₂ adduct formation was found to be 500 M. These results suggest that the protective effect of lidocaine on myocardial injury may, in part, be due to its reactive oxygen scavenging properties. These results may also explain the membrane stabilizing actions of lidocaine by scavenging OH · and ¹O₂ that are implicated in membrane lipid peroxidation.     

天竺葵花清除自由基作用的研究

用化学发光法研究了天竺葵花粗担液对超氧阴离子自由基（Ｏ２）＾＝和羟自由基（ＯＨ）的清除作用,用分光不镀法研究了它对１,１－二苯基－２－苦肼基自由基（ＤＰＰＨ０的清除作用。结果表明,天竺葵花具有很强的清除自由基活性。其粗提物清除Ｏ２＾－分别为３．５μｇ／ｍｌ（红花）,３．０μｇ／ｍｌ（粉花）,１．６μｇ／ｍｌ（浅粉花）,与茶多酚（ＩＣ５０＝１．１μｇ／ｍｌ）相近,清除ＯＨ的ＩＣ５０分别为５．７μｇ／     

In vivo reduction of chromium (VI) and its related free radical generation

Chromium (VI) compounds are widely recognized as human carcinogens. Extensive studies in vitro and in model systems indicate that the reactive intermediate, Cr (V), generated by cellular reduction of Cr (VI), is likely the candidate for the ultimate carcinogenic form of chromium compounds. Here we review our current understanding of the in vivo reduction of Cr (VI) and its related free radical generation. Our results demonstrate that Cr (V) is indeed generated from the reduction of Cr (VI) in vivo, and that Cr (V) thus formed can mediate the generation of free radicals. Cr (V) and its related free radicals are very likely to be involved in the mechanism of Cr (VI)induced toxicity and carcinogenesis. These studies also illustrate that in vivo EPR spectroscopy and magnetic resonance imaging can be very useful and powerful tools for studying paramagnetic metal ions in chemical and biochemical reactions occurring in intact animals.     

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。