猪心肺复苏中颈动脉血流与脉搏血氧波形衍生参数的相关性研究  

The correlation between carotid blood flow and the parameters derived by pulse oximetry plcthysmographic waveform during cardiopulmonary resuscitation in a porcine model

作　　者：尹路 王建岗[3] 罗伟 付阳阳 朱华栋[1] 徐军[1] 于学忠[1] Yin Lu;Wang Jiangang;Luo Wei;Fu Yangyang;Zhu Huadong;Xu Jun;Yu Xuezhong(Department of Emergency,Peking Union Medical College Hospital,Chinese Academy of Medical Science,Beijing 100730,China;Intensive Care Unit,the Second Hospital of Anhui Medical University,Hefei 230601,China;Medical Education and Training Department,Hangzhou Emergency Medical Center,Hangzhou 310021,China;Institute of Life Monitoring,Mindrav Corporation,Shenzhen 518057,China)

机构地区：[1]中国医学科学院北京协和医院急诊科,北京100730 [2]安徽医科大学第二附属医院重症医学科,合肥230601 [3]杭州市急救中心医教培训科,杭州310021 [4]深圳迈瑞生物医疗电子股份有限公司,深圳518057

出　　处：《中华急诊医学杂志》2022年第1期24-30,共7页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金项目(82172179);睿E(睿意)急诊医学研究专项基金资助项目(R2021005)。

摘　　要：目的探讨猪心肺复苏中颈动脉血流与脉搏血氧波形衍生参数的相关性, 为心肺复苏中颈动脉血流监测提供新指标。方法选择7只雄性家猪通过电刺激法建立室颤心脏骤停模型。心脏骤停8 min后予以人工胸外按压4 min, 在按压2 min后予以肾上腺素20 μg/kg静脉注射。持续监测并记录按压频率、按压深度、右颈动脉血流量、脉搏血氧波形、主动脉压、右心房压力及呼气末二氧化碳分压。从按压30 s至4 min, 每隔30 s为时间点, 计算时间点前6 s的平均右颈动脉血流量、脉搏血氧波形曲线下面积、平均灌注指数、平均冠状动脉灌注压及平均呼气末二氧化碳分压, 并将右颈动脉血流量与脉搏血氧波形曲线下面积及灌注指数分别作相关性分析。结果 7只雄性家猪均成功被诱发室颤。4 min胸外按压过程中, 每分钟的平均按压频率及按压深度的差异无统计学意义。胸外按压30 s测算的右颈动脉血流量为(92.7±32.7)mL/min, 在按压1 min时下降至(48.5±23.5)mL/min(P<0.05)。注射肾上腺素前后血流量变化差异无统计学意义(P>0.05)。胸外按压期间脉搏血氧波形曲线下面积及灌注指数与右颈动脉血流量呈同步变化趋势。冠状动脉灌注压及呼气末二氧化碳分压与右颈动脉血流量呈不同变化趋势。右颈动脉血流量与脉搏血氧波形曲线下面积具有正相关性(r=0.66, P<0.01), 与灌注指数也呈正相关性(r=0.57, P<0.01)。结论猪心肺复苏中颈动脉血流量与脉搏血氧波形曲线下面积和灌注指数具有正相关性, 即时监测这两种脉搏血氧波形衍生参数一定程度上可反映颈动脉血流量的变化情况。Objective To explore the correlation between carotid blood flow and the parameters derived by pulse oximetry Plethysmographic waveform in cardiopulmonary resuscitation,so as to provide a new index for carotid blood flow monitoring in cardiopulmonary resuscitation.Methods Seven male domestic pigs were utilized for cardiac arrest model through ventricular fibrillation induced by electrical stimulation.Eight minutes after cardiac arrest,artificial chest compression was given for 4 min,and epinephrine 20^lg/kg was injected intravenously at 2 min after chest compression.The compression frequency,compression depth,right carotid blood flow,pulse oximetry plethysmographic waveform,aortic pressure,right atrium pressure and end tidal carbon dioxide partial pressure were continuously monitored and recorded.From 30 s to 4 min after chest compression,the values of the mean right carotid blood flow,the area under curve(AUC)of pulse oximetry plethysmographic waveform,the mean perfusion index,the mean coronary perfusion pressure and the average end-tidal carbon dioxide partial pressure during 6 s before time point were calculated every 30 s.The correlations between right carotid blood flow and the AUC of pulse oximetry plethysmographic wavefonn and perfusion index were analyzed respectively.Results Ventricular fibrillation was induced successfully in seven animals.There were no significant differences in the mean chest compression frequency and depth per min during 4 min of chest compression.Right carotid blood flow at 30 s after chest compression was(92.7±32.7)mL/min,and decreased to(48.5±23.5)mL/min at 1 min after chest compression(P<0.05).There was no significant difference in blood flow before and after epinephrine injection(P>0.05).The AUC of the blood oxygen plethysmographic waveform and perfusion index showed synchronous change trends with right carotid blood flow.Both coronary perfusion pressure and end-tidal carbon dioxide partial pressure showed different change trends with right carotid blood flow.There was a positi

关 键 词：心肺复苏 心脏骤停 颈动脉血流 脉搏血氧波形 灌注指数 冠状动脉灌注压 呼气末二氧化碳分压 

分 类 号：R459.7[医药卫生—急诊医学]