Dependence of early cerebral reperfusion and long-term outcome on resuscitation efficiency after cardiac arrest in rats.
Dependence of early cerebral reperfusion and long-term outcome on resuscitation efficiency after cardiac arrest in rats.
复制标题
大鼠心脏骤停后早期脑再灌注和长期结果对复苏效率的依赖性。
作者：
Xu,Yan;Liachenko,Serguei;Tang,Pei
背景和目的：众所周知，心脏骤停（CA）持续时间越长，长期预后越差，但复苏效果对缺血后恢复的影响尚不清楚。本研究的目的是调查短时间CA后不充分和延长的复苏是否会导致比长时间CA后有效复苏更差的长期结果，前提是CA发生到自然循环恢复的总时间是可比的。方法：38只大鼠随机分为2组，分别给予名义上9分钟（1组）和15分钟（2组）的常温窒息CA，每组根据复苏时间的长短再分为2个亚组（短、长分别用S和L标记）。因此，窒息和名义复苏时间分别为1S组8分钟和1分钟，1L组5分钟和4分钟，2S组14分钟和1分钟，2L组11分钟和4分钟。采用动脉自旋标记MRI技术，在CA之前、期间和之后连续测量海马背侧水平的脑灌注。复苏后5天评估存活时间、组织损伤和神经功能缺损。结果：1S组和1L组CA持续时间基本相同（9.02±0.17 min, n=6）；2S组和2L组差异无统计学意义（15.51±0.59 min, n=11 vs 15.65±1.25 min, n=15）。尽管窒息时间较长，但较短和更有效的复苏与显著改善的长期预后和早期再灌注时较高的脑灌注相关。结论：有效的复苏可增加CA患者的早期再灌注，提高CA患者的生存率。临床提示，复苏不充分和复苏时间过长可能对CA患者的康复产生不利影响。
Background and Purpose—While it is well known that longer duration of cardiac arrest (CA) is often associated with poorer long-term outcome, the influence of resuscitation efficacy on postischemia recovery is less clear. The objective of the present study is to investigate whether an inadequate and prolonged resuscitation after a shorter CA can lead to worse long-term outcomes than an effective resuscitation after a longer CA, provided that the total time from the onset of CA to the return of spontaneous circulation is comparable.Methods—Thirty-eight rats were randomized into 2 groups with nominal 9 minutes (group 1) and 15 minutes (group 2) of normothermic asphyxial CA. Each group was further divided into 2 subgroups on the basis of the duration of resuscitation efforts (labeled as S and L for short and long, respectively). Thus, the asphyxia and nominal resuscitation times were 8 and 1 minute, respectively, for group 1S, 5 and 4 minutes for group 1L, 14 and 1 minute for group 2S, and 11 and 4 minutes for group 2L. Cerebral perfusion was measured continuously at the dorsal hippocampus level before, during, and after the CA, with the use of the arterial spin labeling MRI technique. The survival time, histological damage, and neurological deficit were evaluated 5 days after resuscitation.Results—Groups 1S and 1L had nearly the same duration of CA (9.02±0.17 minutes, n=6 versus 8.58±0.80 minutes, n=6). The same is true for groups 2S and 2L (15.51±0.59 minutes, n=11 versus 15.65±1.25 minutes, n=15). Despite longer asphyxia, shorter and more effective resuscitation was associated with significantly improved long-term outcomes and higher cerebral perfusion at the early stage of reperfusion.Conclusions—Effective resuscitation increased early reperfusion and improved survival after CA. The clinical implication is that inadequate and prolonged resuscitation may have detrimental effects on the recovery of CA patients.