目的 探讨胸外按压和经膈肌下抬挤心肺复苏（cardiopulmonary resuscitation，CPR）方法对开腹术中心搏骤停猪通气和循环的影响。方法 健康家猪14只，麻醉后气管插管，行开腹术后用窒息法建立猪心搏骤停模型，随机分组后进行胸外按压和经膈肌下抬挤CPR，测定并比较两种方法复苏时心搏骤停猪的潮气量(VT)、呼气末二氧化碳分压（PETCO2）、经皮血氧饱和度（SpO2）、按压期动脉压（AOS）、放松期动脉压(AOD)、右房压（RAP）和冠状动脉灌注压(CPP)。结果 与胸外按压CPR比较，经膈肌下抬挤CPR法所测得的VT较大，差异有统计学意义［53.8±4.02）vs（40.61±2.58），P<0.01］；经膈肌下抬挤CPR比胸外按压产生更高的CPP，差异有统计学意义［（39.37±1.79）vs（25.66±1.73），P<0.01］。结论 经膈肌下抬挤CPR比标准CPR产生较高的冠脉灌注压和肺通气。
Abstract
Objective To compare the hemodynamic response and ventilation after standard cardiopulmonary resuscitation (S-CPR) and cardiac massage under the diaphragmatic muscle （D-CPR）during laparotomy in cardiac arrest of swine. Methods Fourteen healthy domestic pigs were anesthetized and intubated. After preoperotive preparation and the hemodynamics was stable for 5 minutes, the readings of aortic systolic pressure(AOS), aortic diastolic pressure(AOD), and right atrial pressure（RAP） were recorded consecutively. Pigs were randomized to receive either S-CPR (n=7) or D-CPR (n=7). Cardiac arrest was induced with overdosed bupivacaine. After 2 min of untreated time, they were resuscitated, and hemodynamic variables, PETCO2, VT and ECG were continuously recorded. Coronary perfusion pressure (CPP) was calculated as arterial diastolic pressure minus right atrial diastolic pressure. Results D-CPR during cardiac massage, compared with S-CPR, resulted in a significant increase in VT, DAP and CPP. Conclusions D-CPR can provide higher arterial pressure and ventilation; D-CPR is superior to S-CPR.
关键词
胸外按压 /
经膈肌下抬挤 /
潮气量 /
冠脉灌注压
Key words
cardiopulmonary resuscitation /
diaphragmatic muscle /
tidal volume /
coronary perfusion pressure
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(2012-06-17
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