按压自主同步通气模式对猪心肺复苏效果影响的研究  

The study on the effect of automatic compression synchronous ventilation mode on cardiopulmonary resuscitation in pigs

作　　者：曹光立 高贵锋 徐杰丰[1] 王旭光 葛风 朱锦江 周梅亚 王双卫 张茂[1] Cao Guangli;Gao Guifeng;Xu Jiefeng;Wang Xuguang;Ge Feng;Zhu Jinjiang;Zhou Meiya;Wang Shuangwei;Zhang Mao(Department of Emergency Medicine,The Second Affiliated Hospital of Zhejiang University School of Medicine/Zhejiang Key Laboratory of Diagnosis,Treatment and Emergency Rescue of Severe Burn Wounds/Zhejiang Critical and Critical Care Clinical Medical Research Center,Hangzhou 310009,China;Department of Emergency Medicine,Shaoxing Second Hospital,Shaoxing 312000,China;Guangdong Engineering Research Center of First Aid and Life Support Medical Equipment,Shenzhen 518000,China;Department of Emergency Medicine,Ningbo First Hospital,Ningbo 315000,China;Department of Emergency Medicine,Yiwu Central Hospital,Yiwu 322000,China;Hangzhou First Aid Center,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第二医院急诊医学科/浙江省严重烧创伤诊治与应急救援重点实验室/浙江省急危重症临床医学研究中心,杭州310009 [2]绍兴第二医院急诊医学科,绍兴312000 [3]广东省急救和生命支持类医疗设备工程技术研究中心,深圳518000 [4]宁波市第一医院急诊医学科,宁波315000 [5]义乌市中心医院急诊医学科,义乌322000 [6]杭州市急救中心,杭州310003

出　　处：《中华急诊医学杂志》2024年第9期1257-1264,共8页Chinese Journal of Emergency Medicine

基　　金：国家重点研发计划(2022YFC2401900);国家自然科学基金(82072126、82372204);浙江省重点研发计划项目(2021C03073)。

摘　　要：目的建立猪心脏骤停复苏模型,探讨新型的按压自主同步通气(automatic compression synchronous ventilation,ACSV)对猪心肺复苏效果的影响。方法选取雄性白猪12头,体重(38±3)kg,应用随机数字表法分为ACSV组和间歇正压通气(intermittent positive pressure ventilation,IPPV)组,每组6头。以经右心室电极释放交流电诱发室颤6 min+按压8 min制备猪心脏骤停-复苏模型,机械胸外按压深度5 cm、频率100次/min。ACSV组设置潮气量3 mL/kg、频率100次/min;IPPV组为潮气量7 mL/kg、频率10次/min。于复苏前及复苏1、4、7 min时抽取动脉血进行血气分析。复苏期间监测冠脉灌注压(coronary perfusion pressure,CPP)、呼气末二氧化碳分压(end-respiratory carbon dioxide,ETCO_(2))和颈动脉血流流速(carotid blood flow,CBF)等指标。于复苏前及复苏后1、2和4 h,通过压力监测导管记录每搏输出量(stroke volume,SV)及全心射血分数(global ejection fraction,GEF),并在各时间点及复苏后24 h采集静脉血标本检测心肌肌钙蛋白(cardiac troponin I,cTnI)、神经元特异性烯醇化酶(neuron specific enolase,NSE)、丙氨酸氨基转移酶(alamine aminotransferase,ALT)、肌酐(creatinine,Cr)、肠型脂肪酸结合蛋白(intestinal fatty acid binding protein,IFABP)等。结果(1)复苏期间ACSV组的CPP、ETCO_(2)、CBF等指标均略高于IPPV组,但组间差异无统计学意义。(2)复苏期间两组的pH、PaCO_(2)、HCO_(3)^(-)、乳酸等指标比较,组间差异均无统计学意义。ACSV组的PaO_(2)显著高于IPPV组,在4 min和7 min时组间比较差异有统计学意义。(3)两组动物复苏成功率均为83.3%,复苏前后SV及GEF值相比较,组间差异无统计学意义。(4)复苏后ACSV组的cTnI、NSE、ALT、Cr、IFABP等指标低于IPPV组,其中cTnI在复苏后24 h、ALT在复苏后2 h和24 h时、IFABP在复苏后4 h和24 h时,组间比较差异均有统计学意义(均P<0.05)。结论本研究初步提示新型的ACSV能显著提高猪心肺复Objective To establish pig cardiac arrest resuscitation model,and explore the effect of automatic compression synchronous ventilation(ACSV)on cardiopulmonary resuscitation in pigs.Methods Twelve male white pigs with body weight of(38±3)kg were divided into ACSV group and intermittent positive pressure ventilation(IPPV)group with 6 pigs in each group by random number table method.A porcine cardiac arrest and resuscitation model was prepared with ventricular fibrillation induced by alternating current release via right ventricular electrode for 6 min and compression for 8 min.Mechanical chest external compression depth 5 cm,frequency 100 times/min.The tidal volume of ACSV group was 3 mL/kg and the frequency was 100 times/min.In the IPPV group,the tidal volume was 7 mL/kg and the frequency was 10 times/min.Arterial blood was drawn before resuscitation and at 1,4 and 7min during resuscitation for blood gas analysis.Coronary perfusion pressure(CPP),end-respiratory carbon dioxide(ETCO_(2))and carotid blood flow(CBF)were monitored during resuscitation.Stroke volume(SV)and global ejection fraction(GEF)were recorded by pressure monitoring catheter before and 1,2 and 4 h after resuscitation.Venous blood samples were collected at each time point and 24 h after resuscitation to detect cardiac troponin I(cTnI),neuron specific enolase(NSE),alamine aminotransferase(ALT),creatinine(Cr),and intestinal fatty acid binding protein(IFABP).Results(1)During resuscitation,CPP,ETCO_(2)and CBF in ACSV group were slightly higher than those in IPPV group,but the differences between groups were not statistically significant.(2)There was no significant difference in pH,PaCO_(2),HCO_(3)^(-)and lactic acid between the two groups during resuscitation.The PaO_(2)in ACSV group was higher than that in IPPV group,and the difference was statistically significant at 4 and 7 min.(3)The success rate of resuscitation in both groups was 83.3%,and there was no significant difference in SV and GEF before and after resuscitation.(4)After resuscitation,cTnI,

关 键 词：心脏骤停 心肺复苏 通气模式 血流动力学 多器官损伤 动物模型 

分 类 号：R459.7[医药卫生—急诊医学]