插入式腹主动脉按压心搏骤停兔复苏效果  

Effects of interposed abdominal aorta compression for cardiopulmonary cerebral resuscitation on cardiac arrest in rabbit models

作　　者：窦微微[1] 王立祥[1] 刘惠亮[2] 郭静[3] 郭成成[1] 刘亚华[1] 马立芝[1] 孙鲲[1] 马文君[1] 

机构地区：[1]武警总医院急救医学中心,北京100039 [2]武警总医院心内科,北京100039 [3]武警总医院科训科,北京100039

出　　处：《中华急诊医学杂志》2014年第10期1114-1119,共6页Chinese Journal of Emergency Medicine

基　　金：全军医学科技“十二五”课题计划（BWS11J077）;武警总部级一类课题（WZ2011010）;国家实用新型专利（ZL200920160376.3）

摘　　要：目的 通过比较插入式腹主动脉按压心肺复苏（IAAC-CPR）与传统胸外按压心肺复苏（CC-CPR）对心搏骤停（CA）兔复苏过程中血流动力学及神经系统改变情况,初步评价IAAC-CPR的心肺脑复苏效果及其影响脑灌注和复苏预后的机制.方法 健康新西兰大白兔28只,体质量在2.0～2.5 kg,雌雄不拘,按随机数字表法,分为CC-CPR组（实施传统胸外按压）和IAAC-CPR组（于胸外按压放松期,施行腹主动脉按压）,每组14只.冰氯化钾联合气管夹闭建立CA模型,由建模前5 min开始持续监测动物心电图（ECG）、主动脉收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）及脑皮质血流（CBF）情况直至实验结束;分别记录复苏前基础值（1次/min）,复苏30 s、60 s、90 s及120 s的MAP与SBP及脑皮质血流;并于建模前基础时点、自主循环恢复（ROSC）后2h、6h留取血液标本.比较两组动物的平均动脉压（MAP）、收缩压（SBP）、脑皮质血流（CBF）、血清S100B蛋白含量、ROSC率、复苏成功率、24 h存活率及24 h神经功能评分的差异.比较两组间差异时,均数比较采用独立样本t检验,率的比较用x2检验确切概率法.结果 复苏30 s、60 s、90 s、120 s内,IAAC-CPR组MAP、SBP及CBF均高于CC-CPR组,其中MAP值（mm Hg,1 mm Hg =0.133 kPa）为[30 s：（46.4±9.4） vs.（31.4±8.7,60）s：（55.8±13.8）vs.（34.0±11.5）; 90s：（61.2±11.5）vs.（38.2±10.1）; 120 s：（63.6±11.8） vs.（40.2±10.2）;95％ CI,30s：-21.73～-12.41,60 s：-28.03～-16.26,90s：-25.27～-14.87,120 s：-25.38～-13.19;t值2：30 s：-7.536,60 s：-7.734,90 s：-7.943,120s：-6.505; P＜0.05,P＜0.01];SBP值（mm Hg）为[30s：（62.6±9.2）vs.（43.4±15.1）; 60s：（75.4±14.0）vs.（50.4±13.8）; 90s：（78.4±12.6）vs.（59.4±16.2）,120s：（82.8±10.3）vs.（64.3±15.9）;95％ CI,30 s：-28.91～-9.51,60 s：-35.82～-14.18,90s：-30.28～-7.71,120s：-28.93～-8.07;t值2：Objective To determine the effects of interposed abdominal aorta compression as a novel approach on cardiopulmonary resuscitation （CPR） in rabbits with cardiac arrest （CA）.Methods Twentyeight healthy New Zealand rabbits with 2.0-2.5 kg body weight were randomly （random number） divided into two groups in equal number （n =14）.And they were resuscitated either by external chest compression CPR （CC-CPR） or by interposed abdominal aorta compression for cardiopulmonary resuscitation （IAAC-CPR）,in which the abdominal aorta was compressed intermittently at the same rate of external chest compression.The model of CA was made by injection of iced potassium chloride combined with occlusion of trachea.Electrocardiogram （ECG）,hemodynamic variables including mean arterial pressure （MAP）,aorta systolic blood pressure （SBP）,and cerebral blood flow （CBF） were monitored continuously from 5 minutes before cardiac arrest to the end of experiment.MAP,SBP and CBF were calculated and compared at 30 s,60 s,90 s and 120 s of resuscitation between both groups.Blood samples were taken before modeling,and 2 h and 6h after the restoration of spontaneous circulation （ROSC）.The rate of ROSC and successful resuscitation,24-hour survival rate,24-hour neurological deficit score and changes of S100B in serum were recorded and compared.The ultramicro-structures of myocardium,lung and brain tissues were observed with HE staining.The data were analyzed by using t-test or Fisher＇s exact probability test.Results Compared with CC-CPR,the MAP （mmHg）,SBP and CBF values in the IAAC-CPR group were significantly increased within 2 minutes of resuscitation,MAP：[30 s：（46.4 ± 9.4） vs.（31.4 ± 8.7,60） s：（55.8±13.8） vs.（34.0±11.5）; 90s：（61.2±11.5） vs.（38.2±10.1）; 120s：（63.6±11.8）vs.（40.2±10.2）; 95％CI,30 s：-21.73--12.41,60s：-28.03--16.26,90 s：-25.27--14.87,120s：-25.38--13.19; t：30 s：-7.536,60 s：-7.734,90 s：-7.943,120 s：-6.505; P＜0.05,P＜0.01];

关 键 词：心搏骤停 心肺脑复苏 插入式腹主动脉按压 传统胸外按压心肺复苏 平均动脉压 脑皮质血流 S100B蛋白 神经系统功能评分 

分 类 号：R459.7[医药卫生—急诊医学]