辅以增强型体外反搏和吸气阻力阀的主动按压放松心肺复苏术血流动力学的初步研究

Hemodynamics of Active Compression-Decompression CPR with Enhanced External Counterpulsation and the Inspiratory Impedance Threshold Valve

目的:提出一种改良的以胸骨按压为主体的双泵复苏术,并验证该复苏方法的血流动力学效果。方法和材料:5只健康杂种犬通过右心室起搏导管电极诱颤,室颤后4min内无任何干预,4min后开始进行心肺复苏。通过自身对照,比较辅以增强型体外反搏和吸气阻力阀的主动按压放松心肺复苏术(AEI-CPR)和辅以吸气阻力阀的主动按压放松心肺复苏术(AI-CPR)的血流动力学效果,并分t=210ms、255ms、300ms和345ms四个时相探讨辅以增强型体外反搏和吸气阻力阀的主动按压放松心肺复苏术的体外反搏最佳时相。结果:与AI-CPR相比,AEI-CPR使主动脉舒张压从(21.295±1.514)mmHg升高到(35.933±1.981)mmHg,P=0.048;右房舒张压从(4.281±0.983)mmHg升高到(10.568±1.598)mmHg,P=0.041;CPP从(18.289±3.625)mmHg升高到(29.753±4.035)mmHg,P=0.041;ETCO2从(12.902±5.213)mmHg升高到(16.694±4.102)mmHg,P<0.05。体外反搏的最佳充气时相在255ms,此时CPP最大。结论:实验结果初步表明辅以增强型体外反搏和吸气阻力阀的主动按压放松心肺复苏术(AEI-CPR)能提高主动脉舒张压、CPP和ETCO2,改善心肌灌注;最佳的反搏时相在胸部按压后期。

Objective： We have developed a novel method of cardiopulmonary resuscitation of active compression- decompression CPR combined with enhanced external counterpulsation plus the inspiratory impedance threshold valve （AEI-CPR）,and researched the hemodynamic effect and determined the optimal counterpulsation phase through the experiment. Methods： Five healthy and mongrel dogs was induced into the ventricular fibrillation through the pacing pole in the right ventricle. After 4 minutes with untreated ventricular fibrillation,AEI-CPR and AI-CPR were performed alternately,and all the indicators were recorded,in comparison with AI-CPR,AEI-CPR was highlighted. Results：Tbe aortic diastolic pressure in AEI-CPR was enhanced （21.295±1.514）mmHg vs 35.933±1.981 mmHg, P=0.O48）,the right atrial pressure was increased （4.281±0.983 mmHg vs 10.568＋1.598 mmHg,P=-0.041）,CPP was improved （18.289±3.625 mmHg vs 29.753±4.035 mmHg,P=0.041）,and ETCO2 was also significantly different between AI-CPR and AEI-CPR （12.902±5.213 mmHg vs 16.694±4.102 mmHg,P 〈 0.05）. The results showed that the optimal counterpulsation phase was 255 ms. Conclusions： We concluded that AEI-CPR could increase the aortic diastolic pressure and CPP, and improve the resuscitation efficacy.