猪经胸阻抗大小对除颤有效性和安全性的影响  

Effect of transthoracic impedance on defibrillation efficacy and safety in a porcine model

作　　者：武军元[1] 李眷盛 袁伟[1] 

机构地区：[1]心肺脑复苏北京市重点实验室,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》2017年第3期308-312,共5页Chinese Journal of Emergency Medicine

基　　金：北京市自然科学基金（7132092）

摘　　要：目的建立猪心室颤动（VF）模型，应用体外电阻器制作高低不同经胸阻抗，比较两种阻抗对除颤成功率、心脏和皮肤损伤的影响。方法16头实验猪随机（随机数字法）分为低阻抗组（约50Ω，n=8）和高阻抗组（约100Ω，n=8）。诱发VF后15s除颤，首次能量选择推荐的150J，如果失败给予2min胸外按压，以后除颤选择最大200J。除颤成功后稳定0．5h再诱发下次VF，以此类推每头猪共诱发5次VF。结果低阻抗组诱发VF39次，除颤43次，成功39次，高阻抗组诱发VF40次，除颤70次，成功40次。低阻抗组首次除颤经心电流是（34．9±3．2）A，成功率94．9％，均高于高阻抗组的（19．1±2．1）A和50％（P均〈0．05）。两组皮肤损伤程度差异无统计学意义，高阻抗组心肌损伤程度更轻微。结论经胸阻抗升高时选择推荐的能量（150J），首次除颤成功率明显下降。影响心肌损伤的主要因素是经心电流大小，而不是除颤次数。Objective Two different transthoracic impedances were made with an adjustable impedance instrument to compare the success rate of defibrillation, heart and skin damage in a porcine model Methods A total of sixteen pigs were randomly （random number） divided into two groups： low impedance group （about 50 Ω, n = 8） and high impedance group （about 100 l-l, n = 8 ）. Defibrillation （recommended 150Ω） was first attempted at 15 s after induction of ventricular fibrillation （VF）. If spontaneous circulation was not recovered, 2-minute chest compression and subsequent defibrillation attempts （maximum 200 J） were attempted. Model animal kept stabilization for 30 rain after return of spontaneous circulation before induction of the next episode of VF, which was induced five episodes in each pig. Results In the low impedance group, VF was induced 39 times, 39 of 43 attempted defibrillations were successful. In the high impedance group, VF was induced 40 times, 40 of 70 attempted defibrillations were successful. The current and success rate of the first defibrillation were （34.9±3.2） A and 94.9% respectively in the low impedance group, while those of the high impedance group were （19. 1±2. 1 ） A and 50% respectively （ both P 〈 0.05 ）. There were no significant differences in skin damage between two groups, but myocardial injury was lighter in the high impedance group. Conclusions Success rate of the first defibrillation with recommend 150 J obviously decreases with the increase of transthoracic impedance. The main factor of myocardial injury is current instead of the numbers of defibrillation.

关 键 词：电除颤 经胸阻抗 经心电流 心肌损伤 猪 

分 类 号：R541.7[医药卫生—心血管疾病]