插入式腹主动脉按压对心搏骤停兔心肺脑复苏的实验研究  

Effects of interrupted abdominal aorta compression on cardiopulmonary cerebral resuscitation after cardiac arrest in rabbit

作　　者：窦微微[1,3] 王立祥[1] 刘惠亮[2] 张蓬川[3] 郭成成[1] 刘亚华[1] 马立芝[1] 孙鲲[1] 马文君[1] 汪茜[1] 郭晓东[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]北京市大兴区红星医院,100076

出　　处：《中华危重病急救医学》2014年第10期718-721,共4页Chinese Critical Care Medicine

基　　金：全军医学科研“十二五”课题计划（BWS11J077）;武警总部级一类课题（ZW20111010）

摘　　要：目的：探讨插入式腹主动脉按压心肺复苏（IAAC-CPR）对心搏骤停兔心肺脑复苏的效果。方法健康新西兰大白兔10只，雌雄不拘，按随机数字表法分为传统胸外按压心肺复苏（CC-CPR）组和IAAC-CPR组，每组5只。经颈静脉快速推注冰氯化钾并夹闭气管导管制备心搏骤停模型；心搏骤停3 min后开始实施心肺复苏（CPR），CC-CPR组为呼吸机辅助通气＋胸外按压；IAAC-CPR组为呼吸机辅助通气＋胸外按压＋腹主动脉按压。观察CPR过程中血流动力学和脑皮质血流的变化；记录自主循环恢复（ROSC）时间，观察动物24 h生存情况、24 h神经功能评分及腹部器官情况等。结果 IAAC-CPR组复苏后30、60、90、120 s时脑血流量（CBF，PU值）及平均动脉压（MAP，mmHg，1 mmHg＝0.133 kPa）均明显高于CC-CPR组（CBF 30 s：16.1±6.0比7.8±2.2，60 s：91.6±11.8比57.3±23.2，90 s：259.9±74.9比163.6±50.3，120 s：301.5±60.5比208.4±23.8；MAP 30 s：46.4±9.4比31.4±8.7，60 s：55.8±13.8比34.0±11.5，90 s：61.2±11.5比38.2±10.1，120 s：63.6±11.8比40.2±10.2；均P＜0.05）。与CC-CPR组比较，IAAC-CPR组ROSC所需时间明显缩短（s：182.0±59.0比312.6±86.6，t＝2.787，P＝0.024），24 h神经功能评分明显下降（分：2.4±1.7比4.6±0.6，t＝2.974，P＝0.023）；而复苏成功率（80.0%比60.0%，χ^2＝0.000，P＝1.000）、24 h存活率升高（80.0%比40.0%，χ^2＝0.417，P＝0.519），但差异无统计学意义。ROSC后24 h尸解动物均未发现肝脏损伤。结论在心搏骤停兔复苏早期，IAAC-CPR较CC-CPR取得了更好的脑血流灌注，明显减轻了心搏骤停兔的神经系统功能损伤，且无腹部器官损伤。Objective To explore the effect of the interrupted abdominal aorta compression after cardiopulmonary resuscitation （IAAC-CPR）on cardiopulmonary cerebral resuscitation in a rabbit model of cardiac arrest （CA）. Methods According to the random number table,10 New Zealand rabbits of both genders were equally divided into the chest compression-cardiopulmonary resuscitation （CC-CPR） group or IAAC-CPR group ,with 5 rabbits in each group. CA model was reproduced by injection of iced-potassium chloride into the jugular vein and obstruction of trachea to produce asphyxia. CA was maintained for 3 minutes before cardiopulmonary resuscitation （CPR）. CC-CPR was performed with assisted ventilation＋chest compression,while IAAC-CPR was performed by the way of assisted ventilation ＋ chest compressions ＋ compressions on abdominal aorta. The hemodynamics and cerebral cortex blood flow were observed during resuscitation. Time of return of spontaneous circulation （ROSC）,24-hour survival rates,and scores of neurological function,and situation of abdominal organs were recorded. Results At 30, 60,90 and 120 seconds after CPR,the cerebral blood flow （CBF,PU value）and mean arterial pressure（MAP, mmHg,1 mmHg=0.133 kPa）of IAAC-CPR group were significantly higher than those of CC-CPR group（CBF 30 seconds：16.1±6.0 vs. 7.8±2.2,60 seconds：91.6±11.8 vs. 57.3±23.2,90 seconds：259.9±74.9 vs. 163.6± 50.3,120 seconds：301.5 ±60.5 vs. 208.4 ±23.8;MAP 30 seconds：46.4 ±9.4 vs. 31.4 ±8.7,60 seconds：55.8 ± 13.8 vs. 34.0±11.5,90 seconds：61.2±11.5 vs. 38.2±10.1,120 seconds：63.6±11.8 vs. 40.2±10.2,all P〈0.05）. Compared with CC-CPR group,in IAAC - CPR group,the time necessary for ROSC was obviously shortened （seconds：182.0 ±59.0 vs. 312.6 ±86.6,t=2.787,P=0.024）,24-hour nerve function score was significantly lowered（2.4±1.7 vs. 4.6±0.6,t=2.974,P=0.023）. The successful recovery rate（80.0%vs. 60.0%,χ^2=0.000, P =1.000）and 24-hour survival rate （80.0% vs. 40.0%,χ^2=0.417,P

关 键 词：插入式腹主动脉按压 心肺复苏 心搏骤停 心肺脑复苏 平均动脉压 脑血流 

分 类 号：R459.7[医药卫生—急诊医学]