非创伤性心脏骤停复苏后早期脑保护的研究进展_田毅.pdf

海南医学2023年2月第34卷第4期Hainan Med J,Feb.2023.Vol.34,No.4278(52):52412-52424.36 Liwosz A,Lei T,Kukuruzinska MA.N-glycosylation affects the mo-lecular organization and stability of E-cadherin junctions J.J BiolChem,2006,281(32):23138-23149.37 Menni C,Gudelj I,Macdonald-Dunlop E,et al.Glycosylation profileof immunoglobulin G is cross-sectionally associated with cardiovas-cular disease risk score and subclinical atherosclerosis in two inde-pendent cohorts J.Circ Res,2018,122(11):1555-1564.38 Rodrigues JG,Balmana M,Macedo JA,et al.Glycosylation in can-cer:Selected roles in tumour progression,immune modulation andmetastasis J.Cell Immunol,2018,333:46-57.39 Lin MC,Huang MJ,Liu CH,et al.GALNT2 enhances migration andinvasion of oral squamous cell carcinoma by regulating EGFR glyco-sylation and activity J.Oral Oncol,2014,50(5):478-484.40 Chen L,Li Y,Zeng S,et al.The interaction of O-GlcNAc-modifiedNLRX1 and IKK-alpha modulates IL-1beta expression in M1 macro-phages J.In Vitro Cell Dev BiolAnim,2022,58(5):408-418.41 Xu Y,Sheng X,Zhao T,et al.O-GlcNAcylation of MEK2 promotesthe proliferation and migration of breast cancer cells J.Glycobiolo-gy,2021,31(5):571-581.42 Colomb F,Krzewinski-Recchi MA,El MF,et al.TNF regulates si-alyl-Lewisx and 6-sulfo-sialyl-Lewisx expression in human lungthrough up-regulation of ST3GAL4 transcript isoform BX J.Bio-chimie,2012,94(9):2045-2053.43 Petrus P,Lecoutre S,Dollet L,et al.Glutamine links obesity to in-flammation in human white adipose tissue J.Cell Metab,2020,31(2):375-390.44 Fabian O,Kamaradova K.Morphology of inflammatory bowel dis-eases(IBD)J.Cesk Patol,2022,58(1):27-37.45 Verhelst X,Dias AM,Colombel JF,et al.Protein glycosylation as adiagnostic and prognostic marker of chronic inflammatory gastroin-testinal and liver diseases J.Gastroenterology,2020,158(1):95-110.46 Makino A,Dai A,Han Y,et al.O-GlcNAcase overexpression revers-es coronary endothelial cell dysfunction in type 1 diabetic mice J.Am J Physiol Cell Physiol,2015,309(9):C593-C599.47 Yao D,Xu L,Xu O,et al.O-linked beta-N-acetylglucosamine modifi-cation of A20 enhances the inhibition of NF-kappaB(Nuclear Fac-tor-kappaB)activation and elicits vascular protection after acute en-doluminal arterial injury J.Arterioscler Thromb Vasc Biol,2018,38(6):1309-1320.48 Rebelo AL,Chevalier MT,Russo L,et al.Role and therapeutic impli-cations of protein glycosylation in neuroinflammation J.TrendsMol Med,2022,28(4):270-289.(收稿日期：2022-06-20)非创伤性心脏骤停复苏后早期脑保护的研究进展田毅1综述柳培雨2审校1.中南大学湘雅医学院附属海口医院/海口市人民医院麻醉(疼痛)科，海南海口570208；2.武警海南总队医院麻醉科，海南海口570203【摘要】非创伤性心脏骤停复苏后出现的脑损伤是复苏后高死亡率的主要原因之一，如何保护患者的神经功能，提高复苏后质量和生存率仍是心脏骤停患者治疗的重点。临床上应针对非创伤性心脏骤停的发生原因和心肺复苏后脑损伤的临床特点进行治疗和评估急性神经系统损伤。早期脑保护除提高CPR质量外，应尽早实施包括多种模式和方法在内的保护策略。本文对各种脑保护策略和评估方法的可行性、适应证及目标导向等方面进行分析，同时对在脑保护实施过程用于评估其神经功能的评估手段和方法进行综述，为进一步治疗提供临床决策。【关键词】心脏骤停；复苏；脑损伤；早期；脑保护；决策【中图分类号】R605.974【文献标识码】A【文章编号】10036350（2023）04059204Research progress on early brain protection after resuscitation from non-traumatic cardiac arrest.TIAN Yi1,LIUPei-yu2.1.Department of Anesthesiology,Haikou Hospital Affiliated to Xiangya Medical College of Central South University/Haikou Peoples Hospital,Haikou 570208,Hainan,CHINA;2.Department of Anesthesiology,Hainan Corps Hospital ofChinese Peoples Armed Police Forces,Haikou 570203,CHINA【Abstract】Brain injury after resuscitation from non-traumatic cardiac arrest is still one of the main causes ofhigh post-resuscitation mortality.How to protect the neurological function of patients and improve the quality and surviv-al rate after resuscitation is still the focus of treatment for patients with cardiac arrest.In clinic,it is important to treatand evaluate the acute nervous system injury according to the causes of non traumatic cardiac arrest and the clinical char-acteristics of brain injury after cardiopulmonary resuscitation.In addition to improving the quality of CPR,protectionstrategies including various modes and methods should be implemented as early as possible.This article reviews the fea-sibility,indications,and goal orientation of various brain protection strategies and evaluation methods,summarizes the 综述 doi:10.3969/j.issn.1003-6350.2023.04.029基金项目：2021年海南省自然学科基金高层次人才项目(编号：821RC724)；2020年海南省医药卫生项目(编号：20A200157)。第一作者：田毅(1975)，女，博士，主任医师，主要研究方向为围术期脏器保护、认知功能。通讯作者：柳培雨(1974)，男，博士，主任医师，主要研究方向为急救复苏、脏器保护，E-mail：。592Hainan Med J,Feb.2023.Vol.34,No.4海南医学2023年2月第34卷第4期心脏骤停(cardiac arrest，CA)复苏成功的患者中60%70%因心脏骤停后脑损伤而导致死亡，而在我国心脏骤停幸存者中仅有10.2%左右的患者复苏后其神经功能保持良好。院间复苏成功后的存活率差异较大，这提示改善CA造成的急性神经系统损伤是提高患者存活出院率的关键。现将非创伤性及脑源性CA患者心肺复苏后早期脑保护相关研究进展做一综述。1心肺复苏后脑损伤机制脑组织因高代谢、低储备、易损伤、难修复等特点，导致其易损性较高。现阶段较公认的心肺复苏后脑损伤的主要机制包括脑缺血和脑缺血-再灌注损伤，即脑血流灌注停止造成的原发性损伤(微循环再灌注衰竭、线粒体功能异常、细胞水肿与凋亡、弥漫性血管内凝血活化、脑水肿等)，以及心肺复苏后脑血流灌注恢复后发生的缺血-再灌注损伤(微血管功能障碍、自由基损害、细胞内钙超载、兴奋性氨基酸细胞毒性作用等)1-2。2心肺复苏早期的脑保护策略心肺复苏时越早开展高质量的脑复苏对患者的整体预后及神经功能保护都是至关重要的，因此心脏骤停后应争分夺秒地进行高质量脑复苏并做好后续治疗和临床评估。2.1持续提高CPR质量CA后除立即去除引起CA的病因外，应尽早对患者实施多元化、个体化的CPR手段和有效的复苏措施，通过监测与反馈按压深度、频率，胸廓回弹、按压分数、临床评估、脑部血氧饱和度、舒张期的有创动脉血压、呼气末二氧化碳波形图、心电图波形、心电滤波等评估指标提高救治措施有效性的反馈和改进。同时，对引起CA的病因，如缺氧、高/低血钾、高/低体温、低血容