心肺复苏质量对心博骤停猪血流动力学及氧代谢的影响  

Effects of different cardiopulmonary resuscitation qualities on hemodynamics and aerobic metabolism in pigs with cardiac arrest

作　　者：刘朝霞[1] 李春盛[1] 

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,北京100020

出　　处：《中华急诊医学杂志》2008年第11期1152-1157,共6页Chinese Journal of Emergency Medicine

基　　金：2005年首都医学发展科研基金资助项目（2005-1006）

摘　　要：目的应用Q-CPR技术控制心肺复苏（CPR）质量，以观察在心脏骤停动物模型实施不同质量的CPR对复苏期间血流动力学和氧代谢的影响。方法18头体质量为（30±1）kg的北京长白猪麻醉后，右侧股静脉送入Swan—Ganz导管并连接爱德华Vigilance Ⅱ连续心排血量监测仪，左侧颈内静脉置管并放置电极到右心室，并分别行主动脉、右心房置管，连续记录血流动力学各指标，然后使用医用程控刺激仪电击致动物心博骤停，在室颤4min后，将实验猪随机分为2组，标准CPR组和不标准CPR组，利用飞利浦HeartStart MRx监护仪／除颤器的Q—CPR进行质量控制，监测胸外按压的深度、频率和回弹等。其中标准CPR组在复苏时进行标准胸外按压，频率为100次／min，按压通气比为30：2，按压深度为38～51mm，胸廓充分回弹；不标准CPR组按压频率和按压通气比不变，但是按压深度为标准按压的60％～70％，每次胸廓回弹均不完全。在按压和通气9min后开始电除颤。在各个时间点监测心排血量（CO）、平均主动脉压（MAP）等，计算冠脉灌注压（CPP），监测动静脉血气并计算氧输送量（DO2）和氧耗量（VO2）等，记录复苏成功的实验猪头数。数据处理采用SPSS11．5统计软件进行Χ^2检验和两个样本的t检验。结果标准CPR组的自主循环恢复（ROSC）的成功率达90．9％，明显高于不标准者的28．6％（P=0．013），标准CPR组主要血流动力学指标CPP、CO、MAP高（P〈0．05），全身血液氧合程度好，DO2和VO2高于对照组（P〈0．05）。结论在室颤心脏骤停猪模型中，应用规范化标准心肺复苏较不标准者能够明显提高CPP和CO，改善复苏期间的血流动力学，并可以提高DO2和VO2，对氧代谢的改善产生积极作用，因此ROSC成功率明显提高。Objective To investigate the effects of different cardiopulmonary resuscitation （CPR） qualities under Q-CPR control on hemodynamics and aerobic metabolism in pigs with cardiac arrest. Method After eighteen pigs （mass [ （30 ± 1） kg] were anesthetized, a Swan-Ganz catheter was positioned through the right femoral vein and linked with a continuous cardiac output monitor. An electrode cable was positioned into right ventricle through left internal jugular vein. Then different catheters were positioned in the arteriae aorta, carotid artery and right atrium successively. Ventricular fibrillation （VF） was induced by a programmed electrical stimulation equipment. All animals underwent 4 minutes of untreated VF and then were randomly assigned to either standard CPR or nonstandard CPR. A Philips HeartStart MRx Monitor/Defibrillator was used to ensure qualities of chest compression （ e. g., depth, rate and chest recovery） by Q-CPR technology. Pigs in standard CPR group were treated with stan- dard compression with a compression rate of 100 beat/min, a compression-ventilation ratio of 30：2, and a depth of with 38 - 51 mm with 100% decompression. Pigs in nonstandard CPR group were treated with nonstandard compression with a depth of 60% - 70% of standard depth with unsatisfactory decompression. Defibrillations were administered after 9 minutes of compressions and ventilations. Cardiac output （CO）, mean aortic pressure （MAP） and coronary perfusion pressure （CPP） were recorded at different periods. Oxygen delivery （DO2） and oxygen consumption （VO2） were calculated according to blood gas analysis. At last, number of the survivals was recorded. Data were calculated by SPSS 11.5 statistics software. Statistical analysis was performed using Chi-Square Test and two independent samples t testing. Results The return of spontaneous circulation （ROSC） achievement ratio with nonstandard CPR was 28.6% and with standard CPR was significantly greater （90.9%, P = 0.013）. Hemodynamics （e. g.,

关 键 词：心脏骤停 心肺复苏 胸外按压 血流动力学 

分 类 号：R459.7[医药卫生—急诊医学]