心肺转流术在犬心肺脑复苏中的应用

Use of Cardiopulmonary Bypass in Cardiopulmonary Cerebral Resuscitation in Dogs

目的 观察犬在高钾停搏 1 0分钟后行心肺转流术 ( CPB)复苏 ,并与常规心肺复苏 ( CPR)比较其自主循环恢复和脑复苏的效果。 方法 将杂种家犬 1 2只 ,以 1 0 % KCl静脉给药致心脏停搏 ( CA) 1 0分钟后随机分为两组 ,每组 6只。组 1 :用常规 CPR法复苏 ;组 2 :用自行研制的心肺转流装置复苏。两组于 CA前、CA1 0分钟、复苏后 5分钟、1 0分钟和 3 0分钟监测平均动脉压 ( MAP)、心率 ( HR)、心脏复跳时间、瞳孔大小、72小时存活率和动静脉血气并计算脑氧摄取率 ( CEO2 )和脑氧耗量 ( Ca-jv O2 )。 结果 组 1中 6只犬仅 2只在 CPR后 1 0分钟、1 5分钟恢复自主心跳 ,但不稳定 ,并在 60分钟内死亡 ;组 2均于 CPB后 6～ 1 0分钟恢复自主心跳 ,CPB1 0分钟后 MAP>80 mm Hg,明显高于组 1 ( P<0 .0 5) ,其自主循环恢复率为 1 0 0 % ,明显大于组 1 ( P<0 .0 5)。两组 CEO2 和 Ca-jv O2 在 CA1 0分钟、复苏后 5分钟和 1 0分钟均明显升高 ( P<0 .0 5) ,且复苏后 5分钟、1 0分钟和 3 0分钟时组 1明显高于组 2 ( P<0 .0 5)。组 2犬的瞳孔于复苏后第 9～ 1 9分钟开始缩小 ,3 0分钟后恢复至正常 ,全组均存活 72小时以上 ,72小时存活率为 1 0 0 % ,明显高于组 1 ( P<0 .0 5)。 结论 CA1 0分钟后 ,用 CPB复苏其自主循?

Objective To observe the effect of cardiopulmonary bypass (CPB) and routine external cardiopulmonary resuscitation (CPR) on recovery of spontaneous circulation and cerebral resuscitation in dogs with 10 minutes cardiac arrest(CA) by high serum potassium level. Methods Twelve dogs were submitted to 10 minutes CA induced by 10% KCl and were randomly divided into two groups. Group 1 ( n =6):resuscitation was carried out by CPR, group 2( n =6): resuscitation was carried out by CPB. All parameters including mean arterial pressure (MAP),heart rate (HR),time of heart rate recovery, pupils, the ratio of survivor at 72 hours ,arterial and jugular bulb blood gas were monitored, and cerebral oxygen extraction ratio(CEO 2) and arterial jugular bulb oxygen content difference(Ca jvO 2) were calculated at pre CA,10 minutes of CA and after resuscitation 5 minutes, 10 minutes, 30 minutes. Results Only 2 of 6 dogs in group 1 recovered, with unstable sinus rhythm at 10 and 15 minutes after resuscitation respectively, and all of them died in 60 minutes. In group 2,all of them recovered sinus rhythm in 6 10 minutes, MAP were more than 80 mmHg at 10 minutes after CPB and were all higher than those in group 1( P <0.05). Recovery of spontaneous circulation (100%) were significantly higher than those in group 1( P <0.05). CEO 2,Ca jvO 2 increased markedly in two groups at 10 minutes of CA, 5 minutes,10 minutes after resuscitation( P <0 05),and they were significantly lower in group 2 than those in group 1 at 5 minutes,10 minutes,30 minutes after resuscitation( P <0.05).In group 2,all dogs'pupils constricted during 9 19 minutes after resuscitation, and returned to normal after 30 minutes. All dogs in group 2 survived 72 hours, and the ratio of survivor at 72 hours was significantly higher than that in group 1 ( P <0.05). Conclusion In term of recovery of spontaneous circulation and cerebral resuscitation, CPB is more effective than routine CPR in dogs that exerted 10 minutes of CA.