腹部提压法对窒息性心搏骤停猪复苏效果的实验研究  

An experimental study on the effects of rhythmic abdominal lifting and compression during cardiopulmonary resuscitation in a swine model of asphyxia

作　　者：李秀满[1] 王立祥[2] 刘亚华[2] 孙鲲[2] 马立芝[2] 郭晓东[2] 李会清[2] 

机构地区：[1]徐州医学院江苏省麻醉学重点实验室,221004 [2]武警总医院急救医学中心,北京100039

出　　处：《中国危重病急救医学》2012年第4期237-240,共4页Chinese Critical Care Medicine

摘　　要：目的比较胸外按压心肺复苏（CC—CPR）与腹部提压心肺复苏（ALC—CPR）对窒息性心搏骤停猪复苏时血流动力学指标和呼吸指标的影响，初步评价腹部提压法对窒息性心搏骤停猪的复苏效果。方法健康家猪30只，按随机数字表法分为两组，每组15只。建立窒息性心搏骤停模型，分别实施CC—CPR和ALC—CPR。窒息前10rain开始连续记录心电图（ECG）、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）、主动脉收缩压（SBP）、舒张压（DBP）、中心静脉压（CVP）和潮气量（VT）直至实验结束；计算主动脉平均动脉压（MAP）、冠状动脉灌注压（CPP）和分钟通气量（MV）；分别在窒息前10min、窒息后10rain及复苏后5、10、20rain抽取动脉血查血气。观察两组动物的自主循环恢复（ROSC）率、24h存活率和24h后神经功能缺损评分。结果两组窒息前10min和窒息后10min各项指标均无明显差异。复苏后2rain，CC—CPR组MAP（mmHg，lIIlInHg=O．133kPa）和CPP（iilmHg）高于ALC—CPR组（MAP：43．60±12．91比33．40±6．59，P〈O．05；CPP：21．67±11．28比11．80±4．16，P〈0．01）；ALC—CPR组V1、（m1）和MV（L／rain）高于CC—CPR组（VT：111．67±18．12比56．60±7．76；MV：11.17±1．81比5．54±0．79，均P〈0．01）。在复苏后5、10、20rain，ALC—CPR组pH值、动脉血氧分压（PaO2，mmHg）和动脉血氧饱和度（SaO：）均升高，HCO3（mmol／L）、剩余碱（BE，mmoL／L）均降低，且均高于CC—CPtl组（复苏20min时pH值：7．16±0．16比7．01±0．14；Pa02：82．73±13．20比58．33±17．77；HC03-：27．71±3．11比21．04±3．62；BE：-4．78±4．30比-10．23±2．12；Sa02：0．893±0．088比0．764±0．122），动脉血二氧化碳分压（PaCO2，rrllnHg）、K＋（mmo]／L）和乳酸（Lae，mmol／L）均明显低于CC—CPR组（复苏20rain时PaCO2 49．40±15．60比79．80±15．35；K2：7．Objective To compare the hemodynamic and respiratory influences of chest compression- cardiopulmonary resuscitation （CC-CPR） and rhythmic abdominal lifting and compression-cardiopulmonary resuscitation （ALC-CPR） in a swine model of asphyxia cardiac arrest （CA）, and evaluate the effectiveness of rhythmic abdominal lifting and compression. Methods Thirty swines were randomly divided into two groups, with 15 swines in each group. CA modal was reproduced by asphyxia as a result of clamping the trachea, and CC-CPR and ALC-CPR was conducted in two groups, respectively. Electrocardiogram （ECG）, pulse oxygen saturation （SpO2）, end-tidal partial pressure of carhondioxide （P^CO2）, aorta systolic blood pressure （SBP）, diastolic blood pressure （DBP）, central venous pressure （CVP）, and tidal volume （V,r） were monitored continuously from 10 minutes before asphyxia to the end of experiment. The aorta mean arterial pressure （MAP）, coronary perfusion pressure （CPP） and minute ventilation （MV） were calculated. Artery blood samples were collected to determine the blood gas analysis at 10 minutes before asphyxia, 10 minutes after asphyxia, and 5, 10, 20 minutes after resuscitation. The restoration of spontaneous circulation （ROSC） rate, 24-hour survival rate and 24-hour neurological function score were observed. Results There were no significant differences in all mentioned indexes between two groups at 10 minutes before and 10 minutes after asphyxia. At 2 minutes after the resuscitation, the MAP （ram Hg, 1 mm Hg=O.133 kPa） and CPP （mm Hg） in CC-CPR group were significantly higher than those in ALC-CPR group

关 键 词：心肺复苏 平均动脉压 冠状动脉灌注压 自主循环恢复率 腹部提压法 

分 类 号：R459.7[医药卫生—急诊医学]