Department of Surgical Sciences, Anaesthesiology and Critical Care Medicine, Uppsala University, SE-751 85 Uppsala, Sweden.
Resuscitation. 2013 Feb;84(2):256-62. doi: 10.1016/j.resuscitation.2012.06.024. Epub 2012 Jul 6.
To compare cerebral and hemodynamic consequences of different volumes of cold acetated Ringer's solution or cold hypertonic saline dextran administered in order to achieve mild hypothermia after cardiac arrest (CA) in a pig model of experimental cardiopulmonary resuscitation (CPR).
Using an experimental pig model of 12 min CA (followed by 8 min CPR or no resuscitation) we compared four groups of piglets: a control group, a normothermic group and two groups with different solutions administered for induction of hypothermia. The control group of 5 piglets underwent 12 min CA without subsequent CPR, after which the brain of the animals was removed immediately. After restoration of spontaneous circulation (ROSC) the resuscitated piglets were randomized into a normothermic group (NT group=10), and two hypothermic groups that received cold infusions of either 30 mL/kg acetated Ringer's solution (Much fluid group, M, n=10) or 3mL/kg hypertonic saline dextran solution (Less fluid group, L, n=10), respectively, administered during 30 min. Additional external cooling with ice packs was used in hypothermic groups. Sixty or 180min after ROSC the experiment was terminated. Immediately after arrest the brain was removed for histological analyses.
The median time to reach the target core temperature of 34 °C after ROSC was 51.5±7.8 min in L group and 48.8±8.6 min in M group. Less cerebral tissue content of water (p<0.001), sodium (p<0.0001), potassium (p<0.0001) and less central venous pressure (CVP) at 5 and 15 min after ROSC were demonstrated in L group. Increased brain damage was demonstrated over time in NT group (p<0.001). Less neurologic damage and BBB disruptions (albumin leakage) was observed at 180min in M group in comparison with both NT and L groups (p<0.001).
No statistical differences were observed between the hypothermic groups in the time to achieve mild hypothermia. Although inclusion of cold hypertonic crystalloid-colloidal solutions in the early resuscitation after ROSC may be more effective than cold crystalloids in reducing brain edema, this study demonstrates that mild hypothermia induced with small volumes of cold hypertonic crystalloid-colloids is less as effective as crystalloid's induced hypothermia in mitigating brain injury after cardiac arrest.
比较在心脏骤停（CA）后为实现轻度低温而给予不同体积的冷醋酸林格氏液或冷高渗盐水右旋糖酐对大脑和血液动力学的影响，在实验心肺复苏（CPR）的猪模型中。
使用 12 分钟 CA 的实验性猪模型（随后进行 8 分钟 CPR 或不复苏），我们比较了四组小猪：对照组、常温组和两组用于诱导低温的不同溶液组。对照组 5 只小猪进行 12 分钟 CA，随后不进行后续 CPR，然后立即取出动物的大脑。恢复自主循环（ROSC）后，复苏的小猪被随机分为常温组（NT 组=10），和两组接受冷输注的低温组，分别给予 30mL/kg 醋酸林格氏液（大量液体组，M，n=10）或 3mL/kg 高渗盐水右旋糖酐溶液（少量液体组，L，n=10），输注 30 分钟。低温组使用冰袋进行额外的外部冷却。ROSC 后 60 或 180 分钟结束实验。ROSC 后立即取出大脑进行组织学分析。
ROSC 后达到目标核心温度 34°C 的中位时间为 L 组 51.5±7.8 分钟，M 组 48.8±8.6 分钟。在 ROSC 后 5 分钟和 15 分钟，L 组的脑含水量（p<0.001）、钠（p<0.0001）、钾（p<0.0001）和中心静脉压（CVP）较低。NT 组随时间推移显示出更多的脑损伤（p<0.001）。与 NT 组和 L 组相比，M 组在 180 分钟时神经损伤和 BBB 破坏（白蛋白渗漏）较少（p<0.001）。
两组低温组达到轻度低温的时间无统计学差异。虽然在 ROSC 后早期复苏中加入冷高渗晶体-胶体溶液可能比冷晶体更有效地减少脑水肿，但本研究表明，与晶体诱导的低温相比，使用小体积冷高渗晶体-胶体诱导的轻度低温在减轻心脏骤停后的脑损伤方面效果较差。
