腹部加压联合胸外按压对窒息猪复苏效果的研究

An experimental study on the effects of interposed abdominal compression cardiopulmonary resuscitation in a swine model of asphyxia

目的比较标准胸外按压(standard cardiopulmonary resuscitation,STD-CPR)和腹部加压联合胸外按压(interposedabdominal compression cardiopulmonary resuscitation,IAC-CPR)的方法对窒息性心脏骤停猪血流动力学的影响,对窒息性心脏骤停的复苏效果和复苏方法进行初步评估。方法健康实验用近交系五指山小型猪18只,通过气管夹闭法制作8 min窒息型心脏骤停模型。采用数字表法随机分为2组,每组9只,分别实施STD-CPR和IAC-CPR,记录基础状态、CPR期间和复苏后15 min心率(heart rate,HR)、主动脉收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP)、中心静脉压(central venouspressure,CVP)、动脉血氧饱和度(arterial oxygen saturation,SaO2),计算主动脉平均动脉压(mean arterial pressure,MAP)、冠状动脉灌注压(coronary perfusion pressure,CPP),观察2组动物的自主循环恢复率(return of spontaneous circulation,ROSC)和复苏后合并症。结果 STD-CPR组与IAC-CPR组比较,MAP(46.30±13.49)mmHg vs(54.04±13.07)mmHg(P>0.05,1 mmHg=0.133 kPa),差异无统计学意义;CPP(20.44±19.63)mmHg vs(29.56±11.57)mmHg,差异有统计学意义。2组动物的自主循环恢复率,差异无统计学意义。2组实验动物都出现了明显胸腹部的合并症,包括肺出血、肺梗死、肋骨骨折、癫痫发作、腹部脏器的缺血坏死。结论在心肺复苏初期,腹部加压联合胸外按压的方法可以有效地改善CPP,但并不能改善ROSC成功率。

Objective To compare the hemodynamic influences of standard cardiopulmonary resuscitation （STD - CPR） and interposed abdominal compression cardiopulmonary resuscitation （IAC -CPR） in a swine model of asphyxia cardiac arrest, and evaluate the effectiveness of IAC - CPR and the recovery method of asphyxic cardiac arrest. Methods Eighteen Wuzhishan inbred mini pigs underwent asphyxia by occlusion of the tracheal intubation at the end of expiration followed by eardiopulmonary resuscitation after 8 minutes without intervention. Then the pigs were randomly divided into two groups, with 9 pigs in each group and conducted STD - CPR and IAC -CPR respectively. Heart rate （HR）, aorta systolic blood pressure （SBP）, diastolic blood pressure （DBP）, central venous pressure （CVP）, arterial oxygen saturation （SAO2%） were recorded at the baseline, CPR and ROSC 15 minutes. The aortal mean arterial pressure （MAP） and coronary perfusion pressure （CPP） were calculated and the return of spontaneous circulation （ROSC） rate and complication after ROSC were monitored. Results There were no significant differences in MAP between two groups： （46. 30 ± 13.49） mmHg vs. （54. 04 ± 13.07 ） mmHg, （ P 〉 0. 05 ）. The CPP in STD - CPR group was lower than in IAC - CPR group ： （20.44 ± 19. 63）mmHg vs （29. 56±11.57）mmHg, （P 〈0. 05）. There were no significant differences in ROSC rate. The pigs in two groups all had chest and abdomen complications, including pulmonary hemorrhage, pulmonary infarction, rib fractures, epileptic seizure and abdominal viscera ischemic necrosis. Conclusion IAC - CPR could effectively improve the CPP, but could not improve the ROSC rate.