经食道超声观察心肺复苏时胸外心脏按压的血流动力学变化  

Transesophageal echocardiography to assess the hemodynamic changes during cardiopulmonary resuscitation

作　　者：高燕[1] 傅向阳[2] 吕俊豪[2] 刘品明[2] 李公信[2] 叶文胜[2] 丁明学[2] 魏向荣[2] 肖雪华 

机构地区：[1]济南空军医院干部病房,250031 [2]第一军医大学珠江医院心内科 [3]新疆乌苏15医院

出　　处：《中华急诊医学杂志》2002年第6期368-370,I001,共4页Chinese Journal of Emergency Medicine

基　　金：国家重点基础研究发展规划 (973计划 )的子课题<老年多器官功能不全的肺启动机制研究与验证> (G2 0 0 0 0 5 70 0 4)资助

摘　　要：目的　探讨心肺复苏时胸外心脏按压的血流动力学机制。方法　 6例心搏骤停患者均为2 0 0 0～ 2 0 0 1年心内科患者 ,男性 5例 ,女性 1例。在心肺复苏胸外按压时用变频多平面食道超声及彩色多普勒观察心脏改变。结果　所有 6例病人 ,在胸外按压阶段 ,二尖瓣关闭 ,主动脉瓣开放。主动脉瓣峰值血流速度为 (5 9 0± 13 0 )cm/s。在放松阶段 ,二尖瓣开放 ,主动脉瓣关闭 ,二尖瓣峰值血流速度平均为(6 0 0± 2 0 0 )cm/s。在按压末左室内径明显减小为 (32 1± 7 1)mm ,放松末增大为 (42 1± 12 9)mm (P<0 0 5 )。按压末左室容积为 (39 0± 8 9)ml,放松末 (6 8 8± 2 1 7)ml (P <0 0 5 )。按压频率为 10 0次 /min ,心排血量为 (2 8± 0 8)L/min。按压时有创血压为 6 0～ 80 / 10～ 30mmHg,指端血氧饱和度可达 98%～99 %。结论　在实行心肺复苏胸外心脏按压的过程中 ,食道超声可清楚地显示二尖瓣关闭、主动脉瓣开放 ,左室容积减小 ,产生前向血流 。Objective To further define the hemodynamic changes of external chest compression during cardiopulmonary resuscitation using transesophageal echocardiography.Methods Five male and one female patients in the department of cardiology had cardiac arrest in years 2000 2001.Multiple transesophageal echocardiography(MTEE) and Color Doppler echocardiography were used to observe cardiac changes caused by external chest compression during cardiopulmonary resuscitation.Results During the compression phase (systole)of resuscitation,the mitral valve was closed and the aorta valve was opened.Mean aorta valve peak flow was (59 0±13 0)cm/s.During the release phase(diastole),the mitral value was opened and aorta value was closed.Mean mitral valve peak flow was(60 0±20 0)cm/s.Left ventricular internal diameter measured by MTEE was (32 1±7 1)mm during the compression phase and (42 1±12 9)mm during the release phase ( P <0 05).The end compression volume was(39 0±8 9)ml and end release volume(68 8±21 7)ml( P <0 05).Cardiac output(CO)was(2 8±0 8)L/min,blood pressure 60～80/10～30mmHg,and saturation of oxygen(SpO 2) reached 98%～99%.Conclusion Transesophageal echocardiograph recordings performed during actual cardiopulmonary resuscitation showed that mitral valve was closed,aorta valve opened,and ventricular cavity reduced. This supports the cardiac pump theory of cardioplmonary resuscitation. [

关 键 词：经食管超声 心肺复苏 胸外心脏按压 血流动力学 心搏骤停 心泵学说 

分 类 号：R459.7[医药卫生—急诊医学]