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胸外心脏按压机制探讨 被引量:95

Hemodynamic and mechanism of closed chest cardiac massage(CCCM) during CPR in human body
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摘要 目的:探讨临床心跳骤停病人行胸外按压时的血流动力学机制。方法:13例使用Swan-Ganz导管和有创血压监测的危重病人在呼吸心跳停止后给予高浓度吸氧,并持续胸外按压(频率80~170次/min)心肺复苏,分段测血流动力学指标。结果:1.心排量(0.98~4.18L/min,平均2.34±1.19L/min)在按压的前1~3min内呈先升后降变化;2.所测各处右房压、肺动脉压、外周动脉压不等,心脏灌注压为5.60±6.80/0.80±1.87(平均压2.00±3.33)kPa。由于收缩压差大,舒张压差小,故按压期可能为心脏的灌注期;3.心排量在按压频率100~150次/min范围可获得较高心排量,高频率的作用在于使胸壁、胸腔、大血管(动脉、静脉)、心腔之间产生了最佳的频率共振,达到了较理想的心排量,可能最佳胸外按压频率在120~140次/min之间,能有2倍于常规频率(80~100次/min)的能量传递;4.肺循环阻力(PVR)大于外周循环阻力(SVR),右心室功(RVW)及右室每搏功(RVSW)下降幅度小于左心室功(LVW)、左室每搏功(LVSW),说明胸外按压更多影响在肺循环和右心腔部分。结论:胸外心脏按压在高频率时存在频率共振机制,最佳的共振频率可能在120~140次/min。 Aim: To evaluate the hemodynamic and mechanism of CCCM during CPR in human body.Methods: 13 critically ill patients with Swan-Ganz catheters and ventilator support, were treated with CCCM at frequency of 80~170/min for 30 minutes and intermittently measured cardiac output (CO), RAP, PAP and intraarterial pressure for 5 times, afer cardiac arrest. Results: ①CO (0.98~4. 18L/min, 2 .34 ±1. 19L/min) increased at the beginning and then decreased gradually during the first 1~3 minutes. ②The RAP,PAP, AP, AP-RAP (coronary perfusion pression) were not equal. Comparing with the differency of systolic and diastolic pression, the coronaly Perfusion may mainly occur in the compressing phase. ③Larger Co could be obtained with high compression frequency (100~150/min). Higher compression frequency can lead to a better cardiac output due to the best frequency resonance effect of chest wall, thorcic cavity, cardiac chambers and large vesseles. The energy with high frequency (120~140/min) is about two times as that of the routine (80~100/min). ④PVR is larger than SVR, the level of decreased RVW and RVSW is less than that of LVW and LVSW, suggesting the effect of compression contribute larsely to pulmonary circulation and right cardiac chamber. Conclusion: There may be a frequency resonance meachanism during high frequency compression.The best frequency may be at 120~140/min.
出处 《急诊医学》 CSCD 1998年第6期371-375,共5页
关键词 胸外心脏按压 心肺复苏 心跳骤停 Closed chest cardiac massage CPR
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