Todd M M, Chadwick H S, Shapiro H M, Dunlop B J, Marshall L F, Dueck R
Anesthesiology. 1982 Aug;57(2):76-86. doi: 10.1097/00000542-198208000-00003.
To define the utility of high-dose barbiturate therapy following an episode of complete global cerebral ischemia, we investigate the effects of 60 mg/kg of thiopental given to cats five minutes after resuscitation from 12, 14, or 16 min of electrically induced ventricular fibrillation (VF). All aspects of the arrest, resuscitation, with post-arrest care were carefully controlled, with the EEG becoming isoelectric 20-25 s after the onset mean resuscitation time of 2.5 +/- 0.2 (SEM) min. For any given duration of VF, there were no differences (control vs thiopental) in any pre- or post-arrest parameters (blood pressure, blood gases, electrolytes, etc.) A total of 68 resuscitated cats were entered into various treatment and control groups, and all but one group received 20-24 h of post-resuscitation paralysis, mechanical ventilation, and ICU support before being extubated. Cats received an additional six days of aggressive nursing care, and daily examinations were performed with the assignment of a neurologic deficit score (NDS) between 0 (normal) and (brain dead). Autopsies were performed to determine the cause of death in animals which died before the end of the seven-day observation period. The early post-arrest period was marked by the occurrence of repetitive, rhythmic bursts of high-frequency electroencephalographic (EEG) activity (? seizures) in 38 per cent of control animals (16/42, all arrest times combined). Ten of these animals died as a result of severe neurologic injuries. By contrast, only 12 per cent of treated cats (3/26) developed similar EEG patterns (P less than 0.05) and there were no neurologic deaths in the thiopental groups. The differences in the incidence of neurologic deaths (control vs. thiopental) was significant (P less than 0.02). The change in overall mortality did not quite reach significance (36 per cent vs. 21 per cent), and treatment had no effect on the incidence of deaths due to cardiovascular causes (e.g., myocardial infarctions). In spite of the effects on mortality, treatment had no effect on the neurologic function of survivors (assessed by NDS). These findings suggest that thiopental improved survival rates by suppressing an unusual post-arrest EEG pattern (? anticonvulsant effect), but had no additional cerebral protective effects.
为了确定全脑完全缺血发作后大剂量巴比妥酸盐疗法的效用，我们研究了在因12、14或16分钟电诱导室颤（VF）复苏后五分钟给猫注射60mg/kg硫喷妥钠的效果。对心脏骤停、复苏及骤停后护理的各个方面都进行了仔细控制，脑电图在平均复苏时间2.5±0.2（标准误）分钟后20 - 25秒变为等电位。对于任何给定的室颤持续时间，在任何骤停前或骤停后参数（血压、血气、电解质等）方面，（对照组与硫喷妥钠组）均无差异。共有68只复苏后的猫被纳入不同的治疗和对照组，除一组外，所有组在拔管前均接受20 - 24小时的复苏后麻痹、机械通气及重症监护病房支持。猫接受了另外六天的积极护理，并每天进行检查，分配一个介于0（正常）和（脑死亡）之间的神经功能缺损评分（NDS）。对在七天观察期结束前死亡的动物进行尸检以确定死因。在对照组动物（16/42，所有骤停时间合并）中，38%在骤停后早期出现重复性、节律性高频脑电图（EEG）活动（？癫痫发作）。其中十只动物因严重神经损伤死亡。相比之下，仅12%的治疗组猫（3/26）出现类似的脑电图模式（P<0.05），且硫喷妥钠组无神经功能死亡。神经功能死亡发生率（对照组与硫喷妥钠组）的差异具有显著性（P<0.02）。总体死亡率的变化未完全达到显著性（36%对21%），且治疗对心血管原因导致的死亡发生率（如心肌梗死）无影响。尽管对死亡率有影响，但治疗对幸存者的神经功能（通过NDS评估）无影响。这些发现表明，硫喷妥钠通过抑制一种异常的骤停后脑电图模式（？抗惊厥作用）提高了生存率，但没有额外的脑保护作用。
