Yuan Wei, Wu Jun-Yuan, Zhao Yong-Zhen, Li Jie, Li Jie-Bin, Li Zhen-Hua, Li Chun-Sheng
Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China; Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, China.
Department of Emergency, Beijing Fu-Xing Hospital, Capital Medical University, Beijing 100038, China.
Am J Emerg Med. 2017 Nov;35(11):1645-1652. doi: 10.1016/j.ajem.2017.05.013. Epub 2017 May 11.
We utilized a porcine cardiac arrest model to compare early sequential hypothermia (ESH) with delayed hypothermia (DH) and no hypothermia (NH) to investigate the different effects on cerebral function after resuscitation.
After return of spontaneous circulation (ROSC), resuscitated 24 pigs divided into three groups. The ESH group implemented early sequential hypothermia immediately, and the DH group implemented delayed hypothermia at 1 h after ROSC. The core temperature, hemodynamic parameters and oxygen metabolism were recorded. Cerebral metabolism variables and neurotransmitter in the extracellular fluid were collected through the microdialysis tubes. The bloods were analyzed for venous jugular bulb oxygen saturation, lactate and neuron specific nolase. The cerebral function was evaluated using the cerebral performance category and neurologic deficit score at 72h after ROSC and cerebral histology in the right posterior frontal lobe were collected.
ESH reached the target temperature earlier and showed more favorable outcomes of neurological function than DH. Specifically, early sequential hypothermia reduced cerebral oxygen and energy consumption and decreased extracellular accumulation of neurotransmitters after resuscitation and protected the integrity of the BBB during reperfusion.
Early sequential hypothermia could increase the protection of neurological function after resuscitation and produce better neurological outcomes. The institutional protocol number: 2010-D-013.
我们利用猪心脏骤停模型比较早期序贯低温（ESH）、延迟低温（DH）和非低温（NH）对复苏后脑功能的不同影响。
自主循环恢复（ROSC）后，将复苏的24头猪分为三组。ESH组立即实施早期序贯低温，DH组在ROSC后1小时实施延迟低温。记录核心温度、血流动力学参数和氧代谢情况。通过微透析管收集细胞外液中的脑代谢变量和神经递质。分析血液中的颈静脉球血氧饱和度、乳酸和神经元特异性烯醇化酶。在ROSC后72小时使用脑功能分级和神经功能缺损评分评估脑功能，并收集右后额叶的脑组织学样本。
ESH组比DH组更早达到目标温度，且神经功能结局更优。具体而言，早期序贯低温可降低复苏后脑氧和能量消耗，减少复苏后神经递质的细胞外蓄积，并在再灌注期间保护血脑屏障的完整性。
早期序贯低温可增强复苏后脑功能的保护作用并产生更好的神经学结局。机构方案编号：2010-D-013。
