室颤时冠脉灌注压和室颤波形对自主循环恢复的预测研究

Coronary perfusion pressure during ventricular fibrillation and waveform-based indicators for the return of spontaneous circulation

目的评估心肺复苏前室颤时的冠脉灌注压和室颤波形对自主循环恢复的预测价值。方法将20头家猪采用体外电击法制备动物室颤模型,室颤维持8min后依次给予2min心肺复苏和电除颤。将实验后的动物分为自主循环恢复组和自主循环未恢复组。记录室颤时的血流动力学以及室颤波的平均频率和振幅。结果自主循环恢复组的血流动力学、室颤波的平均频率和振幅明显高于自主循环未恢复组(P均<0.05);室颤时的冠脉灌注压和室颤波的平均频率和振幅对ROSC均有较高的预测价值(ROC曲线下面积:0.86,0.76,0.82)。室颤波的平均频率和振幅与冠脉灌注压呈正相关(r=0.67;r=0.71,P均<0.01)。结论心肺复苏前室颤时的冠脉灌注压和室颤波形可预测自主循环恢复。

Objective：To evaluate whether coronary perfusion pressure（CPP） during untreated ventricular fibrillation（VF） and the corresponding VF waveform could be used to predict the probability of return of spontaneous circulation（ROSC）.Methods：VF was electrically induced and sustained for 8 minutes followed by 2 minutes of cardiopulmonary resuscitation and defibrillation in 20 pigs.Hemodynamics,VF mean frequency（VFmf） and VF mean amplitude（VFma） during untreated VF were analyzed by a multipurpose polygraph.According to the outcomes,the animals were categorized into the ROSC or the no-ROSC group.Results：There were 7 animals in ROSC group and 13 in no-ROSC group.Among ROSC animals,hemodynamic variables were better and both VFmf and VFma were higher than those of the no-ROSC animals（P0.05）.CPP,VFmf and VFma during untreated VF could be used to predict the probability of ROSC（area of ROC curve： 0.86,0.76,and 0.82,respectively）.Both VFmf and VFma showed positive correlations with CPP（r=0.67,r=0.71,respectively;P0.01）.Conclusions：Both CPP and VF waveform during untreated VF are valuable indicators for ROSC.