按压自主同步通气模式对猪心肺复苏效果影响的研究

The study on the effect of automatic compression synchronous ventilation mode on cardiopulmonary resuscitation in pigs

目的建立猪心脏骤停复苏模型,探讨新型的按压自主同步通气(automatic compression synchronous ventilation,ACSV)对猪心肺复苏效果的影响。方法选取雄性白猪12头,体重(38±3)kg,应用随机数字表法分为ACSV组和间歇正压通气(intermittent positive pressure ventilation,IPPV)组,每组6头。以经右心室电极释放交流电诱发室颤6 min+按压8 min制备猪心脏骤停-复苏模型,机械胸外按压深度5 cm、频率100次/min。ACSV组设置潮气量3 mL/kg、频率100次/min;IPPV组为潮气量7 mL/kg、频率10次/min。于复苏前及复苏1、4、7 min时抽取动脉血进行血气分析。复苏期间监测冠脉灌注压(coronary perfusion pressure,CPP)、呼气末二氧化碳分压(end-respiratory carbon dioxide,ETCO_(2))和颈动脉血流流速(carotid blood flow,CBF)等指标。于复苏前及复苏后1、2和4 h,通过压力监测导管记录每搏输出量(stroke volume,SV)及全心射血分数(global ejection fraction,GEF),并在各时间点及复苏后24 h采集静脉血标本检测心肌肌钙蛋白(cardiac troponin I,cTnI)、神经元特异性烯醇化酶(neuron specific enolase,NSE)、丙氨酸氨基转移酶(alamine aminotransferase,ALT)、肌酐(creatinine,Cr)、肠型脂肪酸结合蛋白(intestinal fatty acid binding protein,IFABP)等。结果(1)复苏期间ACSV组的CPP、ETCO_(2)、CBF等指标均略高于IPPV组,但组间差异无统计学意义。(2)复苏期间两组的pH、PaCO_(2)、HCO_(3)^(-)、乳酸等指标比较,组间差异均无统计学意义。ACSV组的PaO_(2)显著高于IPPV组,在4 min和7 min时组间比较差异有统计学意义。(3)两组动物复苏成功率均为83.3%,复苏前后SV及GEF值相比较,组间差异无统计学意义。(4)复苏后ACSV组的cTnI、NSE、ALT、Cr、IFABP等指标低于IPPV组,其中cTnI在复苏后24 h、ALT在复苏后2 h和24 h时、IFABP在复苏后4 h和24 h时,组间比较差异均有统计学意义(均P<0.05)。结论本研究初步提示新型的ACSV能显著提高猪心肺复苏期间的氧供水平,同时保持按压效率不受影响,避免过度通气,并且能减轻复苏后多器官的损伤,值得进一步研究。

Objective To establish pig cardiac arrest resuscitation model,and explore the effect of automatic compression synchronous ventilation(ACSV)on cardiopulmonary resuscitation in pigs.Methods Twelve male white pigs with body weight of(38±3)kg were divided into ACSV group and intermittent positive pressure ventilation(IPPV)group with 6 pigs in each group by random number table method.A porcine cardiac arrest and resuscitation model was prepared with ventricular fibrillation induced by alternating current release via right ventricular electrode for 6 min and compression for 8 min.Mechanical chest external compression depth 5 cm,frequency 100 times/min.The tidal volume of ACSV group was 3 mL/kg and the frequency was 100 times/min.In the IPPV group,the tidal volume was 7 mL/kg and the frequency was 10 times/min.Arterial blood was drawn before resuscitation and at 1,4 and 7min during resuscitation for blood gas analysis.Coronary perfusion pressure(CPP),end-respiratory carbon dioxide(ETCO_(2))and carotid blood flow(CBF)were monitored during resuscitation.Stroke volume(SV)and global ejection fraction(GEF)were recorded by pressure monitoring catheter before and 1,2 and 4 h after resuscitation.Venous blood samples were collected at each time point and 24 h after resuscitation to detect cardiac troponin I(cTnI),neuron specific enolase(NSE),alamine aminotransferase(ALT),creatinine(Cr),and intestinal fatty acid binding protein(IFABP).Results(1)During resuscitation,CPP,ETCO_(2)and CBF in ACSV group were slightly higher than those in IPPV group,but the differences between groups were not statistically significant.(2)There was no significant difference in pH,PaCO_(2),HCO_(3)^(-)and lactic acid between the two groups during resuscitation.The PaO_(2)in ACSV group was higher than that in IPPV group,and the difference was statistically significant at 4 and 7 min.(3)The success rate of resuscitation in both groups was 83.3%,and there was no significant difference in SV and GEF before and after resuscitation.(4)After resuscitation,cTnI,NSE,ALT,Cr,iFABP and other indexes in ACSV group were lower than those in IPPV group,and there were statistically significant differences in cTnI at 24 h after resuscitation,ALT at 2 h and 24 h after resuscitation,and IFABP at 4 h and 24 h after resuscitation(all P<0.05).Conclusions This study preliminarily suggested that the novel ACSV could significantly improve the oxygen supply level during cardiopulmonary resuscitation in pigs,while keeping the compression efficiency unchanged,avoiding hyperventilation,and reducing multiple organ damage after resuscitation,which is worthy of further study.