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目的探讨心脏骤停(CA)后心肺复苏(CPR)的基本生命支持(BLS)阶段组织微循环变化特点及抗凝溶栓药物对其影响。方法24只家兔随机分为实验组和对照组,每组12只。在交流电诱发CA后,对照组只进行BLS,实验组在此基础上给予尿激酶和肝素进行干预。分别于诱发CA前(0min)和CA后每隔3min测定兔耳的微循环血流量,在复苏30min时取心肌和肾脏组织进行形态学检查。结果对照组兔耳微循环血流量在CA发生后急剧下降(P<0.05),在BLS阶段随时间的延长不断下降(P<0.05)。实验组兔耳微循环血流量在CA发生后也急剧下降(P<0.05),在BLS复苏9min后下降速度趋缓。两组相比微循环血流量变化明显不同(P<0.05),两条变化曲线约在9min时相交,其后实验组的变化曲线趋于平坦,而对照组仍继续下降。对照组心肌和肾脏组织的微循环内可观察到红细胞聚集,而实验组无此现象。结论CA后在CPR的BLS阶段微循环血流量下降,有血细胞聚集现象,给予溶栓、抗凝药物的干预可以改善BLS阶段组织的微循环血流灌注,防止微循环内微血栓形成。
Objective To investigate the changes of tissue microcirculation in essential life support (BLS) stage of cardiopulmonary resuscitation (CPR) after cardiac arrest (CA) and the effect of anticoagulant thrombolytic drugs on it. Methods Twenty-four rabbits were randomly divided into experimental group and control group, with 12 in each group. After AC induction of CA, the control group only BLS, the experimental group on the basis of urokinase and heparin intervention. The microcirculation blood flow of rabbit ear was measured before induction of CA (0min) and every 3 minutes after CA. Cardiac and renal tissues were taken for morphological examination 30min after resuscitation. Results The blood flow of microcirculation in the control group decreased sharply after CA (P <0.05), but decreased with the prolongation of BLS (P <0.05). The blood flow of the microcirculation in the experimental group decreased sharply after the onset of CA (P <0.05), and then decreased slowly after 9 minutes of BLS resuscitation. The changes of microcirculation blood flow were significantly different between the two groups (P <0.05). The two curves intersect at about 9min, and then the curve of the experimental group tends to be flat, while the control group continues to decline. In the control group, the accumulation of erythrocytes was observed in the microcirculation of myocardium and kidney tissue, but not in the experimental group. Conclusions After BL, the blood flow of microcirculation in the BLR stage of CPR is decreased, there is the phenomenon of blood cell aggregation. After thrombolytic and anticoagulant intervention, the microcirculation blood flow perfusion in BLS stage can be improved and the micro-thrombus formation in microcirculation can be prevented.