主动脉弓输血在失血性心脏骤停兔复苏时对血流动力学的影响  

Effect of rapid blood transfusion through aortic arch on hemodynamics during resuscitation in rabbits with exsanguination cardiac arrest

作　　者：郑汝钢 张旻海 菅洪健 梁国栋[1] 钟涛[1] 武钢[1] Zheng Ru-gang;Zhang Min-hai;Jian Hong-jian;Liang Guo-dong;Zhong Tao;Wu Gang(Department of Emergency, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China)

机构地区：[1]南方医科大学南方医院急诊科,广东广州510515

出　　处：《中国急救医学》2018年第5期437-443,共7页Chinese Journal of Critical Care Medicine

基　　金：广东省科技计划项目（2014A020212192）

摘　　要：目的 比较失血性心脏骤停兔复苏过程中,主动脉弓快速输血与中心静脉快速输血对冠状动脉灌注压和复苏效果的不同影响.方法 经股动、静脉联合快速放血构建失血性心脏骤停兔模型.45只新西兰兔随机分为三组（每组n=15）：①主动脉弓输血联合胸外按压组（AAT组）;②中心静脉输血联合胸外按压组（CVT组）;③单纯主动脉弓输血组（SAAT组）.维持15min心脏骤停状态后给予复苏.复苏过程予以胸外按压联合经股动脉置管至主动脉弓快速自体血回输（AAT）,或股静脉置管至下腔静脉的中心静脉快速输血（CVT）.SAAT组单纯给予主动脉弓快速输血、不联合胸外按压.全程连续记录血流动力学指标（SBP、DBP、MAP和CVP）,取不同时间点计算冠状动脉灌注压（CPP）进行对比分析,并比较自主循环恢复（ROSC）后6h生存情况.结果 45只新西兰兔平均失血（79.18±11.79） mL后成功构建失血性心脏骤停兔模型.复苏阶段,在输血的第1、2、3分钟时间点,各组CPP分别为AAT组（61.24±33.00） mm Hg,（75.97±33.72） mm Hg,（73.17-32.74） mm Hg;CVT组（23.72±16.53）mm Hg,（27.25±21.10）mm Hg,（30.22±19.13）mm Hg;SAAT组（50.32±21.45）mm Hg,（60.93±25.07） mm Hg,（65.65±25.26） mm Hg,组间差异有统计学意义（均P＜0.001）.在ROSC后第10、20、30分钟时间点,各组CPP分别为AAT组（92.75±25.64） mm Hg,（90.53±26.07） mm Hg,（86.47±20.83） mm Hg;CVT组（62.36±13.14）mm Hg,（62.94±11.75） mm Hg,（61.06±15.22） mm Hg;SAAT组（81.94±16.16）mm Hg,（84.82±8.92） mm Hg,（84.69±10.57） mm Hg,差异有统计学意义（P=0.004,P=0.003,P=0.001）.各组动物ROSC率分别为AAT组（12/15） 80.0％、CVT组（10/15） 66.7％、SAAT组（12/15） 80.0％,差异无统计学意义（P =0.618）.ROSC后6h,中位生存时间分别为：AAT组（5.0±0.41）h、CVT组（3.0±0.78）h、SAAT组（4.0±0.34）h,差异有统计学意义（P=0.027）.结�Objective We established a rabbit model of exsanguination cardiac arrest （ECA） to simulate the extreme state of haemorrhagic shock,and sought to compare the effects of rapid blood transfusion through the aortic arch with central vein on coronary perfusion pressure （CPP） during resuscitation.Methods Forty-five New Zealand rabbits were divided randomly into three groups：aortic arch transfusion with chest compression （AAT） （n =15）,central vein transfusion with chest compression （CVT）（n =15）,and simple aortic arch transfusion without chest compression （SAAT） （n =15）.Exsanguination cardiac arrest was induced by rapid exsanguination from the left femoral artery and vein.Resuscitation was not initiated until 15 mins passed without any intervention.Rapid blood transfusion from the aortic arch through catheterizing the left femoral artery with （AAT）or without （SAAT）chest compression,and from the venae cava inferior through catheterizing the left femoral vein with chest compression （CVT）were performed.Hemodynamic parameters （SBP,DBP,MAP and CVP） were continuously recorded.CPP was calculated and analyzed at each data Point.Animals were observed for 6 h after restoration of spontaneous circulation （ROSC）.Results Mean blood loss was 79.18 ± 11.79 mL.At the 1st,2nd and 3rd minutes of blood transfusion,group AAT[（61.24 ±33.00）mm Hg,（75.97 ± 33.72） mm Hg,（73.17 ± 32.74） mm Hg,respectively] and SAAT [（50.32 ± 21.45） mm Hg,（60.93 ± 25.07） mm Hg,（65.65 ± 25.26） mm Hg,respectively] had significantly higher CPP thanCVT[（23.72 ± 16.53） mm Hg,（27.25 ±21.10） mm Hg,（30.22 ± 19.13） mm Hg,respectively] （P ＜ 0.001,P ＜ 0.001,P ＜ 0.001,respectively）.At the 10 th,20 th,and 30 th minutes after ROSC,CPP in group AAT [（92.75 ± 25.64） mm Hg,（90.53 ± 26.07）mm Hg,（86.47 ± 20.83） mm Hg,respectively] and SAAT[（81.94 ± 16.16） mm Hg,（84.82 ± 8.92） mm Hg,（84.69 ± 10.57） mm Hg,respectively] were significantly higher t

关 键 词：失血 心脏骤停(CA) 主动脉 输血 冠状动脉灌注压(CPP) 

分 类 号：R654.1[医药卫生—外科学]