胺碘酮原液和稀释液对心室颤动转复作用及血流动力学的影响

Effects of undiluted and diluted amiodarone on defibrillation and haemodynamics in a ventricular fibrillation pig model

目的 通过猪心室颤动（VF）模型,观察胺碘酮原液、稀释液以及单纯标准CPR对心肺复苏效果的影响.方法 21头北京长白猪,应用程控刺激仪诱导VF,VF 3 min后,将动物随机（随机数字法）分为3组.①单纯CPR组：只进行单纯标准CPR;②胺碘酮原液组：予胺碘酮原液5 mg/kg快速（＜3 s）静推,生理盐水20 mL冲管,观察30 s后开始CPR;③胺碘酮稀释液组：予胺碘酮5 mg/mg溶于20 mL生理盐水用30 s缓慢静推,20 mL生理盐水冲管,观察30 s后开始CPR.VF 5 min若猪未恢复自主循环（ROSC）,给予电击除颤,并再次给予CPR,依此类推如15 min后猪仍未ROSC则宣布猪死亡.结果 CPR组及胺碘酮原液组复苏成功率高于胺碘酮稀释液组[85.7%vs.71.4%vs.42.9%],但差异均无统计学意义（P＞0.05）.标准CPR组除颤能量（450±150）J高于胺碘酮原液组（200±77）J（P=0.009）及稀释液组（330±125）J,P=0.170.标准CPR组除颤次数（3±1）多于胺碘酮原液组（1.3±0.5）,P＜0.05.ROSC 10 min时胺碘酮原液组的平均动脉压（MAP）和冠脉灌注压（CPP）明显低于稀释液组和CPR组（P＜0.05）,而ROSC 0.5 h以后胺碘酮原液组和稀释液组之间MAP和CPP差异无统计学意义（P＞0.05）.结论 心肺复苏时应用胺碘酮原液可以减少除颤次数和能量;较标准CPR和快速推注胺碘酮原液,胺碘酮稀释液缓慢推注有增加死亡率的可能.

Objective Amiodarone was diluted to release the side effect of hypotension in clinic, but this maybe unsuitable during cardiopulmonary resuscitation （CPR）. This study was designed to observe the effects of undiluted amiodarone, diluted amiodarone, and CPR alone on ventricular fibrillation （VF） in a pig model. Methods VF was induced in 21 pigs. The animals were randomly （random mumber） divided into 3 groups after VF 3 min.① CPR group （ n= 7）： standard CPR; ② undiluted amiodarone group （ n= 7）： undiluted amiodarone （5 mg/kg）bolus within 3 s, then 20 mL saline flush into the peripheral vein, CPR was started after observed 30 s; ③ diluted amiodarone group （ n = 7）： amiodarone was dissolved in 20 mL saline and bolus with 30 s. Defibrillation was attempted at VF 5 min. Results The restoration of spontaneous circulation （ROSC） of CPR and undiluted amiodarone groups were higher than diluted group （85.7% vs. 71.4% vs. 42.9%）, but the differences were not significant （all P 〉0.05）. The defibrillation energy and times of CPR group were higher than that of undiluted amiodarone （P= 0.009） and diluted group （ P = 0. 170）. The mean arterial pressure of undiluted amiodarone were lower than diluted and CPR groups at ROSC 10 min （all P 〈0.05）, but the differences of undiluted and diluted groups were not significant after ROSC 0.5 h. Conclusions In this study, undiluted amiodaronecan effectively reduced the defibrillation times and energy. Although diluted amiodaronecan release the side effect of hypotension which was transient, it didn＇t significantly improved cardiac electric activity and delayed to start CPR.