抗凝溶栓药物对家兔复苏时血流动力学的影响

Effect of anticoagulation and thrombolysis on hemodynamics during cardiopulmonary resuscitation in rabbits

目的观察家兔心搏骤停(CA)后心肺复苏(CPR)的基本生命支持(BLS)阶段血流动力学变化特点及抗凝溶栓药物对其影响。方法24只家兔随机分为实验组和对照组,在交流电诱发CA后对照组只进行BLS,实验组在此基础上给予尿激酶和肝素进行干预,分别于诱发CA前(0min),CA后5、10、15、20、25和30min时测定颈内动脉血压和血流速度,于诱发CA前(0min),CA后3、6、9、12、15、18、21、24、27和30min时测定兔耳的微循环血流量,分析比较各时点的变化。结果CA发生后,动脉收缩压、舒张压和颈内动脉血流速度、兔耳微循环血流量均急剧下降,然后随时间延长逐渐降低;两组间收缩压、舒张压和颈内动脉血流速度变化的差异均无统计学意义(P=0.779、0.297和0.244)。两组间兔耳微循环血流量变化差异有统计学意义(P<0.001),CA发生后血流量下降曲线陡直,随后趋缓,约在9min时两条曲线相交,其后实验组的下降曲线趋于平坦,而对照组仍持续下降。结论在CPR的BLS阶段,溶栓、抗凝药物干预对交流电诱发CA动物的大动脉血压和血流速度变化无明显影响,但能在一定程度上延缓组织微循环血流灌注的恶化。

Objective To observe the dynamic changing of hemodynamics during basic life support （BLS） of cardiopulmonary resuscitation （CPR） by establishing the rabbit model of ventricular fibrillation, then research the influence of anticoagulation and thrombolysis to above targets by comparisons. Methods Twenty- four healthy rabbits were divided into control or experiment group randomly. After cardiac arrest （CA） , both groups were given BLS, but the experiment group was given heparin and urokinase by intravenous injection also. The dynamic changing of blood pressure and flow rate of internal carotid artery were recorded per 5 minutes, and microcirculatory blood flow of ear per 3 minutes before and after CA respectively. Results Systolic pressure （SP） , diastolic pressure （ DP ） , blood flow of internal carotid artery and microeirculation decreased sharply after CA （ P 〈 0.05 ） , then fell gradually in BLS phase along the extending of time （ P 〈 0.05 ）. The dynamic changes of SP, DP and blood flow of internal carotid artery had no statistic deference between the two groups （ P = 0. 779, 0. 297 and 0. 244 ） , and their changing curves were similar. Difference between microcirculatory blood flows changing of the two groups had statistic significance （P 〈 0. 001）. The two curves dropped sharply after CA, then stepped down, and intersected at about the 9th minute, whereafter the curve of experiment group tended to smoothness while the curve of the control still falling. Conclusions With regard to aortic blood pressure and flow rate, anticoagulation and thrombolysis were neutral, but can postpone deteriorating of microcirculatory perfusion during BLS in the rabbit＇s CA model.