Xu Yan, Liachenko Serguei, Tang Pei
Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine, Pa 15261, USA.
Stroke. 2002 Mar;33(3):837-43. doi: 10.1161/hs0302.104198.
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.
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.
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.
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.
虽然众所周知，心脏骤停（CA）持续时间较长通常与较差的长期预后相关，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在短时间CA后进行不充分且延长的复苏是否会比长时间CA后进行有效复苏导致更差的长期预后，前提是从CA发作到自主循环恢复的总时间相当。
38只大鼠被随机分为两组，分别进行名义上9分钟（第1组）和15分钟（第2组）的常温窒息性CA。每组根据复苏努力的持续时间进一步分为两个亚组（分别标记为S和L表示短和长）。因此，第1组S的窒息和名义复苏时间分别为8分钟和1分钟，第1组L为5分钟和4分钟，第2组S为14分钟和1分钟，第2组L为11分钟和4分钟。在CA之前、期间和之后，使用动脉自旋标记MRI技术在背侧海马水平连续测量脑灌注。复苏5天后评估存活时间、组织学损伤和神经功能缺损。
第1组S和第1组L的CA持续时间几乎相同（9.02±0.17分钟，n = 6对8.58±0.80分钟，n = 6）。第2组S和第2组L也是如此（15.51±0.59分钟，n = 11对15.65±1.25分钟，n = 15）。尽管窒息时间更长，但更短且更有效的复苏与长期预后显著改善以及再灌注早期更高的脑灌注相关。
有效的复苏增加了早期再灌注并改善了CA后的存活率。临床意义是不充分且延长的复苏可能对CA患者的恢复产生有害影响。
