Fischer M, Hossmann K A
Max-Planck-Institute for Neurological Research, Department of Experimental Neurology, Köln, Germany.
Intensive Care Med. 1995 Feb;21(2):132-41. doi: 10.1007/BF01726536.
Successful resuscitation of the brain requires unimpaired blood recirculation. The study addresses the question of the severity and reversibility of no-reflow after cardiac arrest.
Adult normothermic cats were submitted to 5, 15 and 30 min cardiac arrest by ventricular fibrillation. The extent of no-reflow was assessed in each cardiac arrest group after 5 min closed chest cardiac massage in combination with 0.2 mg/kg epinephrine or after successful resuscitation followed by 30 min recirculation.
Reperfusion of the brain was visualized by labelling the circulating blood with FITC-Albumin. Areas of no-reflow, defined as absence of microvascular filling, were identified by fluorescence microscopy at 8 standard coronal levels of forebrain, and expressed as percent of total sectional area. During cardiac massage, no-reflow affected 21 +/- 5%, 42 +/- 38% and 70 +/- 27% of forebrain after 5, 15 and 30 min cardiac arrest, respectively. After 30 min spontaneous recirculation following successful resuscitation of the heart, no-reflow significantly declined to 7 +/- 11% after 5 min cardiac arrest (p < 0.05) but persisted in 30 +/- 11% and 65 +/- 21% of forebrain after 15 and 30 min cardiac arrest, respectively (n.s.).
Our observations demonstrate that resuscitation of the heart by closed chest massage causes severe (and after prolonged cardiac arrest irreversible) no-reflow of the brain. This suggests that no-reflow is an important cause of post-resuscitation brain pathology.
大脑的成功复苏需要血液再循环不受损害。本研究探讨心脏骤停后无复流现象的严重程度及可逆性问题。
成年常温猫通过室颤分别经历5、15和30分钟的心脏骤停。在每组心脏骤停后，通过5分钟的闭胸心脏按压联合0.2mg/kg肾上腺素，或在成功复苏并再循环30分钟后，评估无复流的程度。
用异硫氰酸荧光素标记的白蛋白标记循环血液，以观察脑再灌注情况。通过荧光显微镜在前脑的8个标准冠状层面识别无微血管充盈定义的无复流区域，并表示为总截面积的百分比。在心脏按压期间，5、15和30分钟心脏骤停后，无复流分别影响前脑的21±5%、42±38%和70±27%。心脏成功复苏后30分钟自发再循环，5分钟心脏骤停后无复流显著降至7±11%（p<0.05），但15和30分钟心脏骤停后分别仍有3场±11%和65±21%的前脑存在无复流现象（无统计学差异）。
我们的观察结果表明，闭胸按压心脏复苏会导致严重的（长时间心脏骤停后不可逆的）脑无复流现象。这表明无复流是复苏后脑病理改变的一个重要原因。
