心肺复苏后血浆肾素活性与醛固酮分离现象的再研究

摘要

Objective To investigate the effect of separation of plasma renin activity and aldo⁃sterone on return of spontaneous circulation(ROSC)in patients with cardiopulmonary resuscitation (CPR). Method Thirty patients whose physical examinations were normal were randomly divided into group N; a total of 60 patients with sudden cardiac arrest who were treated with CPR were divided into two groups according to the effect of CPR, 28 patients with restoration of spontaneous circulation were group S, and 32 patients without restoration of spontaneous circulation were group U, at the Guizhou Province People's Hospital from January 2015 to December 2015. Peripheral venous blood of patients with CA 30 minites after CPR was collected, in order to test the plasma renin activity, aldosterone, serum potassium and sodium concentration and to compare each index between different groups. Results ①Compared to group N, plasma renin activity and aldosterone were obviously increased in group S and group U; and plasma renin activity and aldosterone in group U were higher than group S; the difference was statistically significant(P<0.05). ②The proportion of the separation of plasma renin activity and aldosterone in group S was lower than that in group U; the rate of ROSC in the group without separation of aldosterone was higher than the group with separation of aldosterone(2=4.63, P<0.05); and the level of serum potassium concentration in group with separation of aldosterone was higher than that in group with⁃out separation of aldosterone(P<0.01); the level of plasma sodium concentration in group without sepa⁃ration of aldosterone was lower than group with separation of aldosterone(P<0.01). Conclusion The phenomenon of the separation of renin activity and aldosterone exists in the patients who are treated with cardiopulmonary resuscitation, and the separation of plasma renin activity and aldosterone might induce hyponatremia and hyperkalemia, which is the disadvantage of cardiopulmonary resuscitation.%目的：探讨肾素活性与醛固酮分离现象对心肺复苏（CPR）患者的自主循环恢复（ROSC）的影响。方法选取2015-01～2015-12在贵州省人民医院，门诊体检正常患者30例分为N 组（n＝30），急诊心脏骤停并进行 CPR 的患者60例；据复苏效果分组，ROSC 为 S 组（n＝28）、未ROSC为U组（n＝32），于CPR开始30 min后抽取外周静脉血，检测血浆肾素活性、醛固酮、血清钾、钠离子水平，比较各组指标间的差异。结果①S组、U组患者的肾素活性、醛固酮比N组明显升高，U组比S组患者的肾素活性、醛固酮均值高，差异有统计学意义（P＜0.05）；②S组患者醛固酮分离现象比例低于U组患者，醛固酮未分离组ROSC率高于分离组（c2＝4.63，P＜0.05），而醛固酮分离组血钾水平高于醛固酮未分离组（P＜0.01），醛固酮分离组血钠水平低于醛固酮未分离组（P＜0.01）。结论 CPR 后存在肾素活性与醛固酮分离现象，醛固酮分离现象引起低钠、高钾血症，不利于CPR。