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背景实施亚低温可能对全身各重要脏器的功能和代谢产生一定影响,这些影响有利还是有弊,需要进一步研究考证。目的在亚低温治疗脑梗死的同时测定心脏的能量储备,心电图,观察其超微结构,从而探讨亚低温对心脏功能的影响。设计随机对照实验。单位武汉大学人民医院神经内科。材料实验在武汉大学人民医院神经内科实验室完成。选择SD大鼠58只,随机分为假手术组10只,脑梗死后常温组(简称常温组)24只,脑梗死后亚低温治疗组(简称亚低温组)24只。方法常温组、亚低温组采用线栓法制作大脑中动脉梗死模型,假手术组仅切开皮肤及结扎血管,不穿线入大脑中动脉。亚低温组动物置于4℃环境中将动物肛温控制在(34±1.0)℃;假手术组、常温组动物置于室温(20℃)环境中。12h后测定心肌组织的三磷酸腺苷、二磷酸腺苷和磷酸腺苷值及能量储备值,并于电镜下观察心肌超微结构改变。主要观察指标①各组大鼠心肌能量代谢的改变。②各组大鼠心电生理改变。③各组大鼠心肌超微结构。结果58大鼠均进入结果分析。①缺血后12h时常温组和亚低温组大鼠心肌三磷酸腺苷、二磷酸腺苷、能量储备值均低于假手术组(P<0.01),但亚低温组的三磷酸腺苷和能量储备值却高于常温组(P<0.01)。②常温组和亚低温组异常心电图发生率差异无显著性意义(P>0.05);但亚低温组的心率明显低于常温组[(290.92±44.18),(472.20±12.79)次/m in,P<0.01],有3只大鼠的心率低于150次/m in。③超微结构显示常温组和亚低温组心肌均有缺血性损伤,但亚低温组的损伤较常温组轻。结论全身亚低温治疗脑梗死时可显著减缓心率,改善心肌的能量储备,减轻脑梗死引起的心肌缺血,不会增加心电图异常的发生率。
Background Mild hypothermia may exert some influence on the function and metabolism of various vital organs in the body. Whether these effects are beneficial or not requires further research. Objective To measure the heart’s energy reserve and electrocardiogram (ECG) and to observe its ultrastructure while treating cerebral infarction in order to explore the effect of mild hypothermia on cardiac function. Design randomized controlled trials. Department of Neurology, Wuhan University People’s Hospital. Material experiment in the Department of Neurology, Wuhan University People’s Hospital completed. Fifty-eight SD rats were randomly divided into sham operation group (n = 10), post-infarction normothermia group (n = 24) and post-cerebral infarction mild hypothermia group (n = 24). Methods The model of middle cerebral artery occlusion was established by the method of thread occlusion in the normal temperature group and the mild hypothermia group. The sham-operated group only incised the skin and ligated the blood vessels without penetrating the middle cerebral artery. Animals in the mild hypothermia group were kept in an environment at 4 ° C, and the rectal temperature was controlled at 34 ± 1.0 ° C. Animals in the sham group and normal temperature group were placed in a room temperature (20 ° C) environment. After 12 hours, the ATP, ADP and AMP were measured and myocardial ultrastructural changes were observed under electron microscope. MAIN OUTCOME MEASURES ① Changes of myocardial energy metabolism in rats in each group. ② rats electrophysiological changes in each group. ③ myocardial ultrastructure of rats in each group. Results 58 rats were involved in the result analysis. ① At 12h after ischemia, myocardial adenosine triphosphate (ATP) and adenosine diphosphate (AMP), energy reserve in normal temperature group and mild hypothermia group were lower than those in sham operation group (P <0.01), but ATPase and energy reserve in hypothermia group were higher than Normal temperature group (P <0.01). ② There was no significant difference in the incidence of abnormal ECG between the normal temperature group and the mild hypothermia group (P> 0.05), but the heart rate in the mild hypothermia group was significantly lower than that in the normal temperature group [(290.92 ± 44.18), (472.20 ± 12.79) times / P <0.01]. The heart rate of 3 rats was less than 150 beats / min. ③ The ultrastructure showed that the myocardium of normal temperature group and mild hypothermia group had ischemic injury, but the damage of mild hypothermia group was lighter than that of normal temperature group. Conclusion The whole body mild hypothermia can significantly slow down the heart rate during cerebral infarction, improve the energy reserve of myocardium and relieve the myocardial ischemia caused by cerebral infarction, and will not increase the incidence of ECG abnormalities.