摘要
目的观察电针对窒息性心搏骤停(CA)大鼠模型复苏的结果,探讨其对心搏骤停综合征(PCAS)大鼠的神经及循环系统损伤的影响。方法将107只雄性SD大鼠按随机数字表法分为假手术组、模型组和电针组。各组大鼠均予以动脉置管、气管插管等处理。假手术组不予以诱导窒息;通过窒息法建立CA-心肺复苏(CPR)模型,模型组大鼠在自主循环恢复(ROSC)后予以基础呼吸支持及液体复苏;电针组ROSC后在模型组基础上予以电针百会穴,选择疏密波,频率4~20 Hz,电流强度调至可引起头皮抽搐的最小强度,疗程30 min。记录并比较各组大鼠基线资料、ROSC后的血流动力学指标、神经功能缺损评分(NDS)、脑组织病理学改变、血清生物标志物水平。采用Kaplan-Meier生存曲线分析大鼠72 h存活率。经苏木素-伊红(HE)染色观察大鼠脑组织海马CA1区坏死神经元病理学改变,用尼氏染色和原位末端缺刻标记法(TUNEL)检测细胞凋亡和损伤。结果与模型组比较,电针组大鼠ROSC后15 min的平均动脉压(MAP)明显升高〔mmHg(1 mmHg≈0.133 kPa):125.00(94.00,136.25)比92.00(72.00,122.50),P<0.05〕。电针组与假手术组大鼠NDS评分比较差异无统计学意义,但模型组大鼠在ROSC后6 h的NDS评分较假手术组显著降低(分:46.00±10.61比80.00±0.00,P<0.05)。Kaplan-Meier生存曲线分析表明,电针针刺并未能提高大鼠72 h存活率(假手术组为100%,模型组为25%,电针组为30%,P>0.05)。经TUNEL法分析显示,电针组大鼠ROSC后6 h海马CA1区神经元凋亡率较模型组显著减少〔(62.84±2.67)%比(71.29±3.70)%,P<0.05〕。与模型组比较,电针组大鼠ROSC后6 h的血清S100钙结合蛋白B(S100B)水平明显降低(ng/L:19.30±13.87比132.28±31.67,P<0.05),但两组肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平比较差异均无统计学意义。结论电针百会穴可提高PCAS大鼠的血流动力学稳定性,具有一定的神经保护作用,但电针百会穴并未减轻大鼠全身炎症反应以及提高存活率,其作用机制仍有待进一步研究验证。
Objective To observe the results of electroacupuncture(EA)on the resuscitation of a rat model of asphyxia cardiac arrest(CA).And to explore its effect on the neurologic deficits and hemodynamic instability of post-cardiac arrest syndrome(PCAS).Methods A total of 107 male SD rats were randomly divided into sham,CA,and EA groups.Each group received arterial catheterization and tracheal intubation.The sham group was not induced asphyxia.Asphyxial cardiac arrest was established by endotracheal tube clamping.Rats in the CA group received basic respiratory support and fluid resuscitation in return of spontaneous circulation(ROSC)and rats in the EA group received EA at Baihui based on the treatment of CA group after ROSC,with a dense-dispersed wave at frequencies of 4-20 Hz,while the current intensity was adjusted minimum to induce a twitch of the scalp,the course of treatment was 30 minutes.The baseline data,hemodynamics after ROSC,neurological deficit score(NDS),pathological changes of brain tissue,and levels of serum biomarker were recorded and compared among the three groups.The 72-hour survival of rats was analyzed by Kaplan-Meier survival curve.Hematoxylin-eosin(HE)staining was used to observe the pathological changes of necrotic neurons in the hippocampal CA1 region of rat brain.Meanwhile,Nissl staining and TdT-mediated dUTP nick-end labeling(TUNEL)were used to detect cell apoptosis and injury.Results Compared with the CA group,the mean arterial pressure(MAP)in the EA group increased significantly at 15 minutes after ROSC[mmHg(1 mmHg≈0.133 kPa):125.00(94.00,136.25)vs.92.00(72.00,122.50),P<0.05].There was no significant difference in the NDS score between the EA group and the sham group.Still,the NDS score of the rats in the CA group at 6 hours after ROSC were significantly lower than that in the sham group(46.00±10.61 vs.80.00±0.00,P<0.05).Kaplan-Meier survival curve analysis showed that EA did not improve the 72-hour survival rate of rats(100%in the sham group,25%in the CA group,and 30%in the EA group,P>0.05).The analysis by TUNEL showed that the apoptosis rate of neurons in CA1 region of the hippocampus in EA group at 6 hours after ROSC was significantly lower than that in CA group[(62.84±2.67)%vs.(71.29±3.70)%,P<0.05].Compared with the CA group,the level of serum S100 calcium binding protein B(S100B)in the EA group at 6 hours after ROSC was significantly lower(ng/L:19.30±13.87 vs.132.28±31.67,P<0.05),but there were no significant differences in the levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)between these two groups.Conclusions In the present study,EA at Baihui can stabilize the hemodynamic,moreover,it has a particular neuroprotective effect on PCAS rats.Still,EA at Baihui does not reduce the systemic inflammatory response and improve the survival rate of rats,and its mechanism remains to be verified in further research.
作者
曾瑞峰
钟悦嘉
吴炎华
王鹏
赖成志
刘相圻
段云彪
李尊江
余涛
丁邦晗
Zeng Ruifeng;Zhong Yuejia;Wu Yanhua;Wang Peng;Lai Chengzhi;Liu Xiangqi;Duan Yunbiao;Li Zunjiang;Yu Tao;Ding Banghan(The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong Provincial Hospital of Chinese Medicine,Guangdong Provincial Key Laboratory of Research on Emergency in Traditional Chinese Medicine,Guangzhou 510120,Guangdong,China;Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,Guangdong,China;Shenzhen Hospital of Guangzhou University of Chinese Medicine,Shenzhen 518034,Guangdong,China;Wuyi Traditional Chinese Medicine Hospital of Jiangmen,Jiangmen 529000,Guangdong,China;Doctoral Candidate of Guangzhou University of Chinese Medicine,Guangzhou 510006,Guangdong,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2022年第12期1285-1290,共6页
Chinese Critical Care Medicine
基金
广州市科技计划项目(201803010030)
广东省科技厅项目(2017ZC0164)
广东省中医急症研究重点实验室(2017B030314176)。
关键词
心搏骤停后综合征
心肺复苏
动物模型
窒息
电针
生存率
脑损伤
再灌注损伤
Post-cardiac arrest syndrome
Cardiopulmonary resuscitation
Animal model
Asphyxia
Electroacupuncture
Survival rate
Brain injury
Reperfusion injury
