经皮穿刺急诊体外循环心肺复苏的实验与临床研究

The experimental and clinical study of emergency cardio pulmonary bypass by percutaneous puncture in cardio-pulmonary resuscitation

目的探讨经皮穿刺插管快速建立急诊体外循环(ECPB)心肺复苏(CPR)的方法与疗效。方法自行研制经皮穿刺体外循环插管及鼓泡式氧合器、动脉滤器、泵管、管道连接的一体化无菌密闭系统。先将15只犬随机分为有搏动经皮穿刺插管组(A组)5只,无搏动经皮穿刺插管组(B组)5只,无搏动切开插管组(C组)5只。通过动物实验探讨经皮穿刺插管方法建立急诊体外循环的可行性及对心肺复苏的影响。后将6例心脏停搏常规复苏8min无效患者进行床边经皮穿刺急诊体外循环方法的研究及对心肺复苏疗效的观察。结果无论在动物或人体上均快速建立了ECPB,使CPR的自主循环恢复率(ROSC)显著提高。结论经皮穿刺周围大血管插管能快速建立急诊体外循环,使CPR的ROSC显著提高。

Objective To investigate the effect of emergency cardio pulmonary bypass by percutaneous puncture and intubation rapidly in cardio pulmonary resuscitation.Methods A sterile airtight system was invented which was consisted of percutaneously inserted intubation for cardio pulmonary bypass,bubble oxygenator,arterial colander,pump tube and pipeline. Fifteen dogs were randomly separated into three groups named A?B and C,and each group had 5 dogs.The dogs in A group had heart beat and were treated with percutaneously puncrure; The B group had no heart beat and was treated with percutaneously puncrure; The C group also had no heart beat and was treated with cannula by cut open . The feasibility of the method of emergency cardio-pulmonary bypass by percutaneously puncrure and the influence on the CPR were evaluated. This method was also applied on 6 patients at bedsides to evaluate the effect who were with cardiac arrest and normal CPR had no effect on them.Results The emergency cardio pulmonary bypass by percutaneously puncrure was setup successfully both on human body and animal by arterio-venous cannula to femoral arterial and venous or internal jugular vein and the ROSC of CPR was improved significantly.Conclusion Percutaneous puncturing peripheral blood vessel was designed for rapid emergencal extracorporeal circulation and the ROSC of CPR was remarkably improved.