长时程电诱发心室纤颤致心搏骤停与心肺复苏家猪模型的建立  

Establishment of porcine model of prolonged cardiac arrest and cardiopulmonary resuscitation electrically induced by ventricular fibrillation

作　　者：文才[1] 李恒[2] 翟小竹 丁有得[3] 周华涛[1] 欧阳志明[1] 杨正飞[1] 蒋龙元[1] 唐万春[1] 余涛[1] 

机构地区：[1]中山大学孙逸仙纪念医院急诊医学科,广东广州510120 [2]中山大学附属东华医院重症医学科,广东东莞523110 [3]广州医科大学生物医学工程系,广东广州510120

出　　处：《中华危重病急救医学》2017年第6期536-541,共6页Chinese Critical Care Medicine

基　　金：广东省领军人才计划项目（81000-42020004）

摘　　要：目的探讨经右心室电诱发心室纤颤（VF）致心搏骤停（CA）模型的损伤时间节点，建立一种稳定的长时程VF致CA-心肺复苏（CPR）家猪模型。 方法按随机数字表法将40只健康雄性家猪分为VF 8、10、11、12 min组，每组10只。通过右心室交流电致颤法诱发VF，分别于VF 8、10、11、12 min时进行CPR 6 min。记录动物复苏及存活情况；复苏后持续监护6 h，记录血流动力学及动脉血气指标变化；复苏后96 h内，每24 h对复苏成功动物进行1次神经功能缺损评分（NDS）.结果VF 8 min组动物所需CPR时间最短（min：6.9±1.3），首次除颤成功率最高（7/10），复苏成功率高达100%；CPR期间冠状动脉灌注压（CPP）升高最为明显，复苏后神经功能损伤较轻；复苏后血流动力学稳定，动脉血pH值和乳酸水平在复苏后能较快恢复正常，动物存活时间较长，机体损伤并不十分明显。VF 12 min组动物所需CPR时间最长（min：10.3±2.9），首次除颤成功率最低（1/10），自主循环恢复（ROSC）动物仅有4只且无动物存活至96 h；CPR期间多数动物始终无法获得满意的CPP，复苏动物NDS评分最高。VF 10 min组和VF 11 min组缺血缺氧对机体造成的损伤相对居中，动物所需CPR时间分别为（7.0±2.1）min和（8.2±2.6）min，分别有9只和7只动物复苏成功，6只和4只存活至96 h；复苏后2 h内血流动力学波动较为显著，复苏后1 h心率（HR，次/min）分别升至172（155，201）、168（136，196），平均动脉压（MAP，mmHg，1 mmHg=0.133 kPa）分别降至97（92，100）、81（77，100），心排血量（CO，L/min）分别降至5.0（4.0，5.8）、3.7（3.0，5.4）；复苏动物神经功能损伤明显〔复苏后24~96 h NDS评分分别为180（110，255）~20（0，400）和275（223，350）~240（110，400）〕；复苏后0.5 h动脉血pH值分别降至7.26±0.09、7.23±0.09，血乳酸水平（mmol/L）分别升高至9.17±1.48、ObjectiveTo investigate the optimal injury time point of cardiac arrest （CA） induced electrically, and establish a reproducible prolonged CA and cardiopulmonary resuscitation （CPR） model in pigs.MethodsForty healthy domestic male pigs were randomly divided into four groups, which were ventricular fibrillation （VF） 8, 10, 11, and 12 minutes groups, each group for 10 animals. In these groups, VF was induced by alternating current delivered to right ventricular endocardium and untreated for 8, 10, 11, and 12 minutes, respectively, followed by 6 minutes of CPR procedure. The resuscitation and survival outcomes were recorded. Hemodynamic parameters and arterial blood gases of animals after successful resuscitation were measured and recorded for 6 hours. Those successful resuscitation animals were regularly evaluated for the neurological deficit score （NDS） and survival outcomes every 24 hours till 96 hours after resuscitation.ResultsThe shortest duration of CPR （minute： 6.9±1.3） and the highest successful ratio of the first defibrillation （7/10） were observed in group VF 8 minutes, and the ratio of successful resuscitation was 100%. The best coronary perfusion pressure （CPP） during the CPR, less neurological impairment, longer survival time, more stable hemodynamics, and shorter time for arterial pH and lactate level restoring to the original state after CPR were also observed in group VF 8 minutes, and no severe damage was found in those animals. The longest duration of CPR （minute： 10.3±2.9） and the lowest successful ratio of the first defibrillation （1/10） were observed in group VF 12 minutes, and only 4 animals achieved restoration of spontaneous circulation （ROSC）, and no animal survived to CPR 96 hours. The worst CPP during CPR and the highest NDS after resuscitation were also found in VF 12 minutes animals compared to those animals in the other groups. The injuries caused by ischemia and hypoxia in groups VF 10 minutes and VF 11 minutes were in between those of the

关 键 词：心搏骤停 心肺复苏 心室纤颤 动物模型 

分 类 号：R-332[医药卫生] R459.7