急诊体外循环动脉灌注管位置对心肺复苏效果的影响

Influence of different positioning arterial cannulation for emergency cardiopulmonary bypass on cardiopulmonary resuscitation

目的 探讨急诊体外循环 (ECPB)动脉灌注管位置对肺门部火器伤后心脏骤停犬心肺复苏 (CPR)的影响。方法 杂种犬 14只随机均分为两组 ,麻醉后用小口径步枪射击犬右肺门区 ,心脏骤停后 10min开始复苏。A、B两组分别采用股动脉、颈动脉插管建立ECPB ,同时给予人工呼吸、胸内心脏按压、静注肾上腺素治疗。观察动物CPR情况。结果 A、B两组动物均全部复苏成功 ,B组恢复自主循环时间明显短于A组 (P <0 0 5 ) ;复苏 1min时B组平均动脉压 (MAP)显著高于A组 (P<0 0 5 ) ,PaO2 显著高于A组 (P <0 0 1) ,PaCO2 显著低于A组 (P <0 0 5 ) ;复苏 3min时B组PaO2 显著高于A组 (P <0 0 5 ) ,Pa CO2 显著低于A组 (P <0 0 5 )。自主循环恢复后 10min两组间MAP、PaO2 、PaCO2 均无统计学差异。辅助循环停止后 ,两组动物自主循环基本保持稳定。结论 ECPB能有效地应用于心脏骤停的CPR ,动脉灌注管靠近升主动脉根部有助于提高急诊体外循环心肺复苏的治疗效果。

Objective To determine the effect of different positioning arterial cannulation for emergency cardiopulmonary bypass(ECPB)on cardiopulmonary resuscitation(CPR)after cardiac arrest.Methods Fourteen dogs were randomly divided into 2 group.The dogs were shot in the right lung near the hilus after anesthesia.10 minutes after cardiac arrest,group A and group B established ECPB through the femoral artery and femoral veinl,carotid artery and fenoral vein respestively.At the same time,all dogs received stand CPR advanced life support(ALS).Mean arterial pressure,PaO 2 and PaCO 2 were monitored during and after CPR.Results Spontaneous circulation was reestablished in all dogs.Dogs in group B spent less time on reestablishing spontaneous circulation than those in group A( P <0 05).By 1 minute after CPR, MAP was significantly higher in group B compared with group A( P <0 05),and there were significantly higher PaO 2( P <0.01)and lower PaCO 2( P <0 05)in group B than those in group A.By 3 minutes after CPR,group B has significantly higher PaO 2( P <0 05)and lower PaCO 2( P <0 05)than group A.However,there were no significantly difference in MAP,PaO 2 and PaCO 2 between the two group by 10 minutes after recovering of spontaneous circulation.Conclusion Positioning arterial cannulation near ascending aorta in ECPB has a beneficial effect on enhancing the effect of CPB.