应用心肺复苏仪对心搏骤停患者心脑缺血性损伤的影响

The effect of resuscitator CPR on cardio - cerebral ischemic injury of cardiac arrest patients

目的比较徒手和心肺复苏（CPR）仪行CPR对心搏骤停患者心脑缺血性损伤的影响，探讨CPR仪在CPR中的应用价值。方法采用前瞻性、双盲、随机对照的临床研究方法，将87例心搏骤停患者按数字表法随机分成两组，分别进行徒手CPR（n=42）及心肺复苏仪（n=45）CPR，记录两组患者自主循环恢复（ROSC）率、复苏时间、存活时间及死亡率。对46例ROSC维持〉24h的患者血清心型脂肪酸结合蛋白、血清肌钙蛋白I含量及血清S100蛋白、神经元特异性烯醇化酶的含量进行监测；比较两组CPR方法对患者心脑缺血性损伤的影响。结果两组患者血清心型脂肪酸结合蛋白、血清肌钙蛋白I、血清S100蛋白、神经元特异性烯醇化酶较健康志愿者明显升高，CPR仪CPR组明显低于徒手CPR组；徒手CPR组复苏持续时间小于CPR仪CPR组；CPR仪组患者ROSC持续〉24h例数明显多于徒手CPR组，差异有统计学意义；但患者的ROSC率和死亡率差异无统计学意义。结论应用心肺复苏仪行CPR更能持久、有效地使心、脑血管再灌注，减轻心脑组织细胞缺血性损伤，但不能提高CPR成功率和降低死亡率。

Objective To compare the effect of barehanded CPR and resuscitator CPR on cardiac arrest cardio - cerebral ischemic injury, and investigate the value of application resuscitator on CPR. Methods The prospective, double blinded and randomized controlled clinical trail was designed. 87 cardiac arrest patients were randomly divided into two groups according to table of random number, barehanded CPR and resuscitator CPR were carried out respectively. The rate of ROSC and mortality of the patients in two groups were recorded and the duration of CPR and survival time were also recorded. The content of myocardial damage markers serum heart fatty acid - binding protein （ H - FABP） and cardial troponin I （ cTnI）, the content of serum S100 protein and neuron specific enolase （NSE） in patients of ROSC more than 24 h were measured; the effect of two resuscitation methods on cardio - cerebral ischemic injury of cardiac arrest patients were compared. Results Compared with healthy volunteers, H - FABP, cTn I, S100 protein and NSE in patients of two groups raised obviously, but resuscitator CPR group was significantly lower than barehanded CPR group, the duration of CPR in resuscitator CPR group is longer than in barehanded CPR group, and the persistent period of ROSC is shorter in barehanded CPR group, the difference had statistical significance. Unfortunately the rate of ROSC and mortality of the patients in two groups have no difference. Conclusion Resuscitator CPR can reperfusion cardio- cerebral vessels more lastingly and effectively, and alleviate cardio- cerebral histiocyte ischemic injury, but cant improve the rate of ROSC and decrease the mortality of the cardiacarrest patients.