左西孟旦改善复苏后急性肠道微循环功能障碍部分独立于其对全身循环的影响：一项在大鼠心脏骤停模型中的初步研究。

Levosimendan Ameliorates Post-resuscitation Acute Intestinal Microcirculation Dysfunction Partly Independent of its Effects on Systemic Circulation: A Pilot Study on Cardiac Arrest in a Rat Model.

机构信息

Department of Emergency Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.

出版信息

Shock. 2021 Oct 1;56(4):639-646. doi: 10.1097/SHK.0000000000001771.

DOI:10.1097/SHK.0000000000001771

PMID:33710108

Abstract

BACKGROUND

Cardiac arrest (CA) is recognized as a life-threatening disease; however, the initial resuscitation success rate has increased due to advances in clinical treatment. Levosimendan has shown potential benefits in CA patients. However, its exact function on intestinal and systemic circulation in CA or post-cardiac arrest syndrome (PCAS) remained unclear. This study preliminarily investigated the link between dynamic changes in intestine and systemic hemodynamics post-resuscitation after levosimendan administration.

METHODS

Twenty-five rats were randomized into three groups: sham control group (n = 5), levosimendan group (n = 10), and vehicle group (n = 10). Intestinal microcirculation was observed using a sidestream dark-field imaging device at baseline and each hour of the return of spontaneous circulation (≤6 h). Systemic hemodynamics, serum indicators of cardiac injury, and tissue perfusion/metabolism were measured by echo-cardiography, a biological signal acquisition system, and an enzyme-linked immunosorbent assay, respectively.

RESULTS

Myocardial injury and global and intestinal perfusion/metabolism were significantly improved by levosimendan treatment. There was no statistically significant difference in the mean arterial pressure values between the vehicle and levosimendan groups (P > 0.05). The intestinal and systemic circulation measurements showed poor correlation (Pearson r-value of variable combinations in the levosimendan group was much less than 0.75; P < 0.01, levosimendan vs. vehicle group).

CONCLUSIONS

Levosimendan significantly reduced the cardiac injury and corrected the metabolic status in an experimental rat model of ventricular fibrillation induced CA and cardiopulmonary resuscitation. Levosimendan may ameliorate PCAS-induced intestinal microcirculation dysfunction, partly independent of its effects on macrocirculation.

摘要

背景

心脏骤停（CA）被认为是一种危及生命的疾病；然而，由于临床治疗的进步，初始复苏成功率有所提高。左西孟旦已显示出对 CA 患者的潜在益处。然而，其在 CA 或心脏骤停后综合征（PCAS）中的肠道和全身循环的确切功能仍不清楚。本研究初步探讨了左西孟旦给药后复苏后肠和全身血液动力学动态变化之间的联系。

方法

将 25 只大鼠随机分为三组：假手术对照组（n = 5）、左西孟旦组（n = 10）和载体组（n = 10）。在基线和自主循环恢复后的每小时（≤6 小时）使用边流暗场成像设备观察肠道微循环。通过超声心动图、生物信号采集系统和酶联免疫吸附试验分别测量全身血液动力学、心脏损伤的血清指标和组织灌注/代谢。