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Effects of rapidly induced mild hypothermia with extracorporeal lung and heart assist on the neurological outcome after prolonged cardiac arrest in dogs.

体外肺和心脏辅助快速诱导的轻度低温对狗长时间心脏骤停后的神经系统结果的影响。

基本信息

批准号：
15390476
负责人：
TERASAKI Hidenori
金额：
$ 9.02万
依托单位：
Kumamoto University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B)
财政年份：
2003
资助国家：
日本
起止时间：
2003 至 2004
项目状态：
已结题

项目摘要

Background and Purpose : Propofol has been demonstrated to protect against neuronal damage-induced brain ischemia in small animal models. We previously reported that mild hypothermia(33℃) in combination with extracorporeal lung and heart assist(ECLHA) improved the neurological outcome in dogs with cardiac arrest(CA) induced by 15 min of normothermia. We investigated the neuroprotective effect of propofol infusion under mild hypothermia with ECLHA in this model.Methods : Fifteen female mongrel dogs were divided into three groups : Midazolam 0.1 mg/kg/h infusion group(M,n=5), Propofol 2 mg/kg/h infusion group(P2,n=5), Propofol 4 mg/kg/h infusion group(P4,n=5). All dogs were induced to normothermic ventricular fibrillation(VF) for 15 min, followed by brief ECLHA and 168 h of intensive care. The drug infusion was initiated at a constant rate from the establishment of the restoration of spontaneous circulation(ROSC) to 24 h. Mild hypothermia(33℃) was maintained for 20 h. Neurological deficit scores(NDS:0%=normal,100%=brain death) were evaluated for neurological function from 33 h to 168 h.Results : One dog in the M group died, and the remaining dogs survived for 168 h. The P4 group showed better neurological recovery compared with the M group(96 h,4±6% vs 19±10%,120h,4±5% vs 19±10%,144h,3±4% vs 19±10%,p<0.05).One dog in the P2 and three dogs in the P4 group achieved full neurological recovery(NDS:0%).Conclusion : The combination of propofol infusion at a rate of 4 mg/kg/h and rapidly induced mild hypothermia(33℃) with ECLHA might prove a successful means for cerebral resuscitation from CA.

背景和目的：在小动物模型中，丙泊酚已被证明对神经元损伤诱导的脑缺血具有保护作用。我们以前报道过，亚低温（33℃）联合体外心肺辅助（ECLHA）可改善由15分钟常温诱导的心脏骤停（CA）犬的神经功能结局。方法：15只杂种犬随机分为3组：咪达唑仑0.1mg/kg/h组（M组，n=5）、丙泊酚2 mg/kg/h组（P2组，n= 5）、丙泊酚4 mg/kg/h组（P4组，n=5）。所有犬均诱导常温室颤（VF）15 min，随后进行短暂ECLHA和168 h重症监护。从建立自主循环恢复（ROSC）至24 h，以恒定速率开始药物输注。维持亚低温（33℃）20 h。结果：M组1只犬死亡，其余犬存活168 h。与M组相比，P4组显示出更好的神经功能恢复（96 h，4± 6%vs 19± 10%，120 h，4 ± 5%vs 19± 10%，144 h，3 ± 4%vs 19± 10%，p <0.05）。P2组和P4组分别有1只和3只犬达到完全神经功能恢复（NDS：0%）。以4 mg/kg/h的速度输注异丙酚并快速诱导亚低温（33℃）和ECLHA联合应用，可成功地对CA进行脑复苏。