多普勒血流探测法评价心肺复苏时血流动力学效果的可行性研究

Feasibility of evaluating hemodynamic effects based on the parameters measured by the Doppler ultrasonic blood stream detector during cardiopulmonary resuscitation

目的探讨用多普勒血流探测所测参数评价心肺复苏时血流动力学效果的可行性。方法健康杂种犬12只,采用电击致犬室颤的动物模型,心跳停止及复苏前后进行主动脉内压(AOP)、中心静脉压(CVP)、犬右颈总动脉多普勒血流参数的连续有创同步监测记录,从所测参数中筛选出与主动脉舒张压(ADP)、冠脉灌注压(CPP)关系密切的参数,分析两者的相关性。结果室颤前,犬右颈总动脉多普勒血流参数特征是:收缩期最大血流速度(Vs)为(85±25)cm/s,舒张期血流速度(Vd)为(27±15)cm/s;二者比值(S/D)为4.2±2.2;闭胸复苏时,Vs为(86±31)cm/s(P>0.05),Vd为(7.9±5.7)cm/s(P<0.001),S/D为14.2±6.5(P<0.001)。静脉注射肾上腺素后,Vd随着ADP、CPP的增大而增大,S/D随着ADP、CPP的增大而减小。直线相关分析显示,Vd与ADP相关系数为0.172(P>0.05);Vd与CPP相关系数为0.204(P>0.05);S/D与ADP相关系数为-0.109(P>0.05);S/D与CPP相关系数为-0.191(P>0.05)。尚不能认为Vd、S/D与ADP、CPP的相关性成立。结论多普勒血流参数中,Vd、S/D与ADP、CPP的关系密切,但其相关性尚不具有统计学意义。

Objective To explore the feasibility of evaluating hemodynamic effects based on the parameters measured by the Doppler ultrasonic blood flow detector during cardiopulmonary resuscitation.Methods Twelve healthy hybrid dogs were selected.The animal models of ventricular fibrillation were induced by electric shock on the chest.Before and after cardiac arrest and resuscitation,the intra-aortic pressure（AOP）,central venous pressure（CVP） and blood flow parameters detected by the Doppler ultrasonic blood flow detector were monitored continuously and synchronously.The parameters related to aortic diastolic pressure（ADP） and coronary perfusion pressure（CPP） were screened out from all the parameters measured by the Doppler ultrasonic detector;the correlation between them was analyzed.Results The normal values of the dogs＇ right common carotid artery blood flow velocity before ventricular fibrillation were as follows： peak systolic flow velocity（Vs） was 85±25cm/s,diastolic flow velocity（Vd） was 27±15cm/s,and the ratio of them（S/D） was 4.2±2.2.During closed-chest resuscitation,Vs was 86±31cm/s（P0.05）,Vd was 7.9±5.7cm/s（P0.001）,and S/D was 14.2±6.5（P0.001）.After intravenous injection of adrenalin,Ad increased whereas S/D decreased with ADP and CPP.Linear regression analysis showed that the regression coefficient between Ad and ADP,between Vd and CPP as well as between S/D and ADP was 0.172（P0.05）,0.204（P0.05）,and-0.109（P0.05）,respectively.Yet thecorrelation of Vd and S/D with ADP and CPP could not be considered significant.Conclusion Among the Doppler blood flow parameters,Vd and S/D are closely related to ADP and CPP.However,our study shows that this correlation is not significant.