胸外心脏按压与心脏起搏的同步性对心肺复苏疗效的影响  

The Effect of Synchronization of Chest Compression and Cardiac Pacing during Cardiopulmonary Resuscitation

作　　者：黄巧娟[1] 郑君慧[1] 余丽菲[1] 陈蒙华[1] HUANG Qiao-juan, ZHENG Jun-Hui, YU Li-Fei, CHEN Meng-hua(Department of Cardiology, the Second Affiliated Hospital of Guangxi Medical University, Nanning, 53000)

机构地区：[1]广西医科大学第二附属医院心内科,530007

出　　处：《岭南急诊医学杂志》2018年第2期95-98,共4页Lingnan Journal of Emergency Medicine

基　　金：广西壮族自治区卫生厅自筹经费课题项目(Z2010339)

摘　　要：目的:探讨胸外心脏按压与心脏起搏的同步性对心肺复苏疗效的影响。方法:选用健康SD大鼠48只,随机分为四组:对照组(只接受常规CPR处理);起搏1组(同步起搏+ROSC后继续间歇起搏);起搏2组(同步起搏)和起搏3组(非同步起搏),建立大鼠窒息性骤停动物模型,在常规心肺复苏(CPR)的基础上,观察冠脉冠注压、自主循环恢复(ROSC)率和恢复时间、脱离呼吸机时间以及血压、心率的变化。结果:起搏1组和起搏2组大鼠ROSC率明显高于对照组和起搏3组(P<0.05);起搏1组出现自主呼吸的时间和脱离呼吸机的时间均明显早于起搏2组(P<0.05);CPR早期,起搏1组和起搏2组大鼠的冠状动脉内灌注压(CPP)普遍高于对照组和起搏3组(P<0.05),复苏20 min后,起搏1组的平均动脉压(MAP)呈现一种平稳状态,而起搏2组的MAP呈进行性下降趋势,25 min以后与起搏1组比较差异具有统计学意义(P<0.05)。结论:胸外心脏按压与心脏起搏的同步性对CPR疗效起着决定性的作用,ROSC后继续给予大鼠间歇性心脏起搏30 min有助于改善呼吸功能、提高心输出量、改善器官和组织的灌注进而延长生存时间。Objective ： To assess the benefit of synchronization of chest compression and cardiac pacing during cardio- pulmonary resuscitation （CPR）. Methods： Asphyxial cardiac arrest was induced in 48 male and female Sprague Dawley （SD） rats. The rats were then divided into four groups with twelve animals in each group. First group served as control, while the rest were exposed to different cardiac pacing modeduring CPR （groupl ： CPR combined with synchronous transoesophageal cardiac pacing until after 30 minutes following restoration of spontaneous circulation （ROSC） ; group2： CPR combined with synchronous transoesophageal cardiac pacing; group3： CPR combined with unsynehronized transoesophageal cardiac pacing）. Results： The rate of ROSC was significantly higher in groupl and group2 than that of the control and group3 （P〈0.05）. The time of spontaneous breathing andthe time of withdrawof ventilator after resuscitation in groupl were higher than those of group2 （P〈0.05）. Coronary perfusion pressure at early stage of CPR in groupl and group2 were higher than those in the control and group3 （P〈0.05）. In addition, after 25 minutes following ROSC, the mean arterial pressurehad more profound reduction in group2 compared to groupl （P〈0.05）. Conclusion： Chest compression combined with synchronous＇ transoesophageal cardiac pacing was associated with improved CPR quality and a more than 30 minutes after ROSCcardiac pacing may be a benefit approach for this asphyxial cardiac arrest rats.

关 键 词：心肺复苏 心脏起搏 胸外心脏按压 同步性 

分 类 号：R459.7[医药卫生—急诊医学]