主动按压减压结合高频喷射通气用于犬的心肺复苏

Cardiopulmonary resuscitation with active compression-decompression combined with high frequency jet ventilation in dogs

目的 评价主动按压减压结合高频通气 (ACD- H)用于心肺复苏的可行性。方法 ACD- H:按压减压与通气同时进行 ,按压与呼气同步 ,减压与吸气同步 ;而主动按压减压结合传统通气技术 (ACD- C) :按压减压连续 5次停 2秒进行一次通气。 9只犬吸入 10 5℃蒸气 4秒致伤后用以上方法复苏。结果 心搏骤停前观察 :ACD- H吸气流速峰值 7.32 L / m in,呼气流速峰值 9.5 0 L / min;潮气量 79.5 0 ml,每分通气量 7.9L / m in,Pa O2 2 2 .2 5 k Pa,Pa CO2 4.93k Pa,明显优于主动按压减压结合持续供氧 (ACD) ,也明显优于单纯的 HFJV及主动按压 (AC)。电致颤心搏骤停后 ,按压与提拉条件不变 ,观测循环指标 :动脉收缩压最低值 ACD- C为 0 ,ACD- H为 18.6 8k Pa,平均值 ACD- C为19.0 7k Pa,ACD- H为 2 2 .81k Pa,两者有非常显著差异 ;心排血量最低值 ACD- C为 0 ,ACD- H为 (0 .81± 0 .45 ) L / min,平均值 ACD- C为 (0 .6 5± 0 .14) L / m in,ACD- H为 (0 .92± 0 .33) L / m in,两者差异非常明显。结论 ACD- H用于心肺复苏 ,其效果尤于传统方法。

Objective To evaluate the effect of active compression decompression combined with high frequency jet ventilation (ACD H) on ventilative and hemodynamic efficacy during cardiopulmonary resuscitation. Methods During ACD H, active compression or decompression was synchronized with expiration or inspiration respectively,while in the active compression decompression combined with conventional ventilation (ACD C), the active compression decompression was performed for 5 successive times,followed by a break lasting 2 seconds for the bag ventilation once. Nine dogs burnt by inhalation of 105℃ steam for 4 seconds, served as the subjects.The respiratory parameters were compared following each of five ventilative patterns lasting 30 min :high frequency jet ventilation (HFJV), active compression combined with HFJV without decompression (AC H), active compression alone with continuous oxygen supply (AC),active compression decompression with continuous oxygen supply (ACD) and ACD H.The hemodynamics of ACD H was compared with that of ACD C.Results Before cardiac arrest, the peak values of inspiratory and expiratory velocities ,tidal volume and minute ventilation volume increased significantly ,and PaCO2 decreased markedly in comparison with those following HFJV,AC H,AC and ACD.(P<0.05 or 0.01).After electrical shock induced cardiac arrest, the lowest arterial pressure was 0 versus 18.68 kPa,the mean arterial pressure 19.07 versus 22.81 kPa during ACD C or ACD H ,with significant differences.The minimal cardiac output was 0 versus 0.81 ±0.45 L/min ,the mean cardiac output o.65±0.14 L/min versus 0.92±0.33 L/min with dramatical difference.Conclusion ACD H may effectively applied to cardiopulmonary resuscitation, which is superior to other conventional methods.