人体心脏按压存在压力传导梯度

Gradient of Force Transmitting of Cardiac Compression in Human Body during CPR

为了对人体心脏按压的压力传导机制作进一步研究，本文对7例危重病人（脑外伤4例，GCS均为3分，多发伤3例，平均ISS为22．3分）在高级生命支持下，心肺停止后进行常规抢救过程中，通过Swan-Ganz导管和有创股动脉压监测得到右房压（RAP），肺动脉压（PAP），股动脉压（FAP）。闭式胸外按压结果为：RAPe46．4±9．5／6．3±6．0；PAPe62．9±16．7／10．0±3．8；FAPe103．6±27．0／14．6±5．9，开胸按压时：RAPo21．7±3．0／9．0±5．6；PAPo29．9±4．2／11．9±4．6；FAPo46．9±5．0／17．6±8．9；单位为mmHg。通过比较发现：1．胸外按压产生的收缩压大于开胸按压（P＜0．005），而舒张压反而低于开胸条件下之值；2．力量是维持收缩压的主要因素，而频率是维持舒张压的主要因素；3．在胸外或开胸按压下，上述三处压力不等。FAP、PAP间接代表了左室压、右室压，它们之间存在着一个承受和传导压力的梯度：即左室压＞右室压＞右房压。这一发现有利于对心脏按压力量传导机制及其条件下血液动力学改变机制的认识和理解。

In order to find the mechanism of blood circulation during closed chest cardiac compression, 7 patients were observed with introduction of Swan - Ganz catheters during CPR. After cardiopulmonary arrest,right atrium pressure (RAP),pulmonary artery pressure (PAP) and femoral artery pressure (FAP)were measured in external cardiac com pression(ECC) and open chest cardiac massage (OCCM). The data: RAPe 46. 4 ± 9. 5/6. 3 ± 6. 0,PAPe62. 9 ± 16. 7/1O. 3 ± 3. 8, FAPe103. 6 ± 27. 0/16. 6 ± 5. 9, RAPo21. 7 ± 3. 0/9. 0 ± 5. 6,PAPo29. 9± 4. 2/11. 9 ± 4. 6 and FAPo46. 9± 5. 0/17. 6 ± 8. 5 mmHg were investigated. Authors found that(1) There was a significant difference in RAP,PAP and FAP either by ECC or OCCM. PAP and FAP represented right ventricular pressure (RVP) and left ventricular pressure(LVP). There was gradient in RAP,RVP and LVP,and RAP>RVP>LVP. (2)The force of cardiac massage in ECC was stronger than that in OCCM (P>0. 01). But diastolic pressure was lower by ECC than that by OCCM. (3)The force of cardiac compression is the main factor for maintaining the systolic pressure while the frequency of compression is the main factor for maintaining the diastolic pressure.