摘要
目的 通过比较插入式腹主动脉按压心肺复苏（IAAC-CPR）与传统胸外按压心肺复苏（CC-CPR）对心搏骤停（CA）兔复苏过程中血流动力学及神经系统改变情况,初步评价IAAC-CPR的心肺脑复苏效果及其影响脑灌注和复苏预后的机制.方法 健康新西兰大白兔28只,体质量在2.0～2.5 kg,雌雄不拘,按随机数字表法,分为CC-CPR组（实施传统胸外按压）和IAAC-CPR组（于胸外按压放松期,施行腹主动脉按压）,每组14只.冰氯化钾联合气管夹闭建立CA模型,由建模前5 min开始持续监测动物心电图（ECG）、主动脉收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）及脑皮质血流（CBF）情况直至实验结束;分别记录复苏前基础值（1次/min）,复苏30 s、60 s、90 s及120 s的MAP与SBP及脑皮质血流;并于建模前基础时点、自主循环恢复（ROSC）后2h、6h留取血液标本.比较两组动物的平均动脉压（MAP）、收缩压（SBP）、脑皮质血流（CBF）、血清S100B蛋白含量、ROSC率、复苏成功率、24 h存活率及24 h神经功能评分的差异.比较两组间差异时,均数比较采用独立样本t检验,率的比较用x2检验确切概率法.结果 复苏30 s、60 s、90 s、120 s内,IAAC-CPR组MAP、SBP及CBF均高于CC-CPR组,其中MAP值（mm Hg,1 mm Hg =0.133 kPa）为[30 s：（46.4±9.4） vs.（31.4±8.7,60）s：（55.8±13.8）vs.（34.0±11.5）; 90s：（61.2±11.5）vs.（38.2±10.1）; 120 s：（63.6±11.8） vs.（40.2±10.2）;95％ CI,30s：-21.73～-12.41,60 s：-28.03～-16.26,90s：-25.27～-14.87,120 s：-25.38～-13.19;t值2：30 s：-7.536,60 s：-7.734,90 s：-7.943,120s：-6.505; P＜0.05,P＜0.01];SBP值（mm Hg）为[30s：（62.6±9.2）vs.（43.4±15.1）; 60s：（75.4±14.0）vs.（50.4±13.8）; 90s：（78.4±12.6）vs.（59.4±16.2）,120s：（82.8±10.3）vs.（64.3±15.9）;95％ CI,30 s：-28.91～-9.51,60 s：-35.82～-14.18,90s：-30.28～-7.71,120s：-28.93～-8.07;t值2：30s：-4.071,60s：-4.751,90s：-3.460,120s：-3.647;P值,30s：P＜0.05,P＜0.01,60s：P＜0.05,P＜0.01,90s：P=0.02,P＜0.05,120s：P=0.01,P＜0.05]; CBF值为[30 s：（16.1±6.0）vs.（7.8±2.2）; 60s：（91.6±11.8）vs.（57.3±23.2）; 90s：（259.9±74.9） vs.（163.6±50.3）; 120s：（301.5±60.5）vs.（208.4 ±23.8）;95％ CI,30 s：-14.82～-1.70,60 s：-61.24～-7.49,90s：-189.45～-3.29,120s：-160.12 ～-26.03;t值2：30 s：-2.904,60 s：-2.948,90s：-2.387,120s：-3.201;P值,30 s：P=0.020,P＜0.05,60 s：P=0.018,P＜0.05,90 s：P =0.044,P＜0.05,120s：P=0.013,P＜0.05].两组基础点血清S100B蛋白水平差异无统计学意义（P =0.781,P＞0.05）,ROSC后2h、6 h IAAC-CPR组血清S100B蛋白水平（pg/mL）低于CC-CPR组,分别为：[2h：（148.7±19.9）vs.（176.0±17.5）;6 h：（237.7±17.7）vs.（267.0±14.8）; 95％CI,2 h：4.53 ～50.05,6 h：9.29 ～49.26;t值,2 h：2.519,6 h：3.164;P值,2h：P =0.022,P＜0.05,6 h：P=0.007,P＜0.05）.ROSC率及24 h生存率差异无统计学意义,复苏成功率及24 h神经功能评分IAAC-CPR组优于CC-CPR组（复苏成功率：80％vs.60％,x2值：5.250：P=0.022,P＜0.05; 24 h神经功能评分：（3.3±1.49）vs.（4.4±0.94）;t值,t=2.429; 95％CI,0.18 ～2.11;P值：P=0.024,P＜0.05）.所有动物实验后尸检未见腹腔内器官损伤.结论 在心搏骤停兔的复苏过程中,IAAC-CPR可产生较高的平均动脉压（MAP）、收缩压（SBP）及脑皮质血流（CBF）,从而减轻了CA所致循环中断造成的脑组织等重要脏器损伤,提高复苏成功率及24 h动物神经功能评分,其心肺脑复苏效果优于CC-CPR.
Objective To determine the effects of interposed abdominal aorta compression as a novel approach on cardiopulmonary resuscitation （CPR） in rabbits with cardiac arrest （CA）.Methods Twentyeight healthy New Zealand rabbits with 2.0-2.5 kg body weight were randomly （random number） divided into two groups in equal number （n =14）.And they were resuscitated either by external chest compression CPR （CC-CPR） or by interposed abdominal aorta compression for cardiopulmonary resuscitation （IAAC-CPR）,in which the abdominal aorta was compressed intermittently at the same rate of external chest compression.The model of CA was made by injection of iced potassium chloride combined with occlusion of trachea.Electrocardiogram （ECG）,hemodynamic variables including mean arterial pressure （MAP）,aorta systolic blood pressure （SBP）,and cerebral blood flow （CBF） were monitored continuously from 5 minutes before cardiac arrest to the end of experiment.MAP,SBP and CBF were calculated and compared at 30 s,60 s,90 s and 120 s of resuscitation between both groups.Blood samples were taken before modeling,and 2 h and 6h after the restoration of spontaneous circulation （ROSC）.The rate of ROSC and successful resuscitation,24-hour survival rate,24-hour neurological deficit score and changes of S100B in serum were recorded and compared.The ultramicro-structures of myocardium,lung and brain tissues were observed with HE staining.The data were analyzed by using t-test or Fisher＇s exact probability test.Results Compared with CC-CPR,the MAP （mmHg）,SBP and CBF values in the IAAC-CPR group were significantly increased within 2 minutes of resuscitation,MAP：[30 s：（46.4 ± 9.4） vs.（31.4 ± 8.7,60） s：（55.8±13.8） vs.（34.0±11.5）; 90s：（61.2±11.5） vs.（38.2±10.1）; 120s：（63.6±11.8）vs.（40.2±10.2）; 95％CI,30 s：-21.73--12.41,60s：-28.03--16.26,90 s：-25.27--14.87,120s：-25.38--13.19; t：30 s：-7.536,60 s：-7.734,90 s：-7.943,120 s：-6.505; P＜0.05,P＜0.01]; SBP （mmHg）：[30s：（62.6±9.2） vs.（43.4±15.1）; 60s：（75.4±14.0） vs.（50.4±13.8）; 90s：（78.4±12.6） vs.（59.4±16.2）,120s：（82.8±10.3）vs.（64.3 ±15.9）; 95％CI,30 s：-28.91--9.51,60 s：-35.82--14.18,90 s：-30.28--7.71,120s：-28.93--8.07; tvalue：30s：-4.071,60 s：-4.751,90 s：-3.460,120 s：-3.647; Pvalue,30s：P＜0.05,P＜0.01,60 s：P＜0.05,P＜0.01,90s：P=0.02,P＜0.05,120s：P=0.01,P＜0.05]; CBF [30s：（16.1±6.0） vs.（7.8±2.2）; 60s：（91.6±11.8） vs.（57.3±23.2）; 90s：（259.9±74.9） vs.（163.6±50.3）; 120s：（301.5±60.5） vs.（208.4±23.8）; 95％CI,30s：-14.82--1.70,60s：-61.24--7.49,90s：-189.45--3.29,120s：-160.12--26.03; t2：30 s：-2.904,60 s：-2.948,90 s：-2.387,120 s：-3.201; Pvalue,30s：P=0.020,P＜0.05,60 s：P=0.018,P＜0.05,90 s：P =0.044,P＜0.05,120 s：P=0.013,P ＜ 0.05].At 2 h and 6 h after ROSC,the level of S100B protein in serum was significantly lower in the IAAC-CPR group [2 h：（148.7 ± 19.9） vs.（176.0 ± 17.5） ; 6 h：（237.7 ± 17.7） vs.（267.0 ±14.8）,95％CI,2 h：4.53-50.05,6 h：9.29-49.26; 2 h：t=2.519,6 h：t=3.164; 2 h：P=0.022,P ＜ 0.05,6 h：P =0.007,P ＜ 0.05）.Rate of successfully recovery and the 24 h neurological score of IAAC-CPR group were better than the CC-CPR group （Rate of successfully recovery：80％ vs.60％,x2 =5.250 ; P =0.022,P ＜ 0.05 ; 24 h neurological score：（3.3 ± 1.49） vs （4.4 ± 0.94） ; t =2.429; 95％CI,0.18-2.11 ; P =0.024,P ＜0.05）.Myocardial damage was found in both groups.The changes of ultramicro-structure in myocardium,lung and brain tissues of CC-CPR group were more extensive than those of IAAC-CPR group.Obvious damage of abdominal organs was not observed.Conclusion Compared with the CC-CPR,the cardiopulmonary cerebral resuscitation with IAAC-CPR is more effective in the incipient stage of cardiopulmonary resuscitation.IAAC-CPR elevates the MAP,SBP and CBF more noticeable and increases the successful rate of resuscitation,decreasing the injuries in CA models of rabbit.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2014年第10期1114-1119,共6页
Chinese Journal of Emergency Medicine
基金
全军医学科技“十二五”课题计划（BWS11J077）
武警总部级一类课题（WZ2011010）
国家实用新型专利（ZL200920160376.3）
关键词
心搏骤停
心肺脑复苏
插入式腹主动脉按压
传统胸外按压心肺复苏
平均动脉压
脑皮质血流
S100B蛋白
神经系统功能评分
Cardiac arrest
Cardiopulmonary cerebnal resuscitation
Interposed abdominal aorta compression-cardiopulmonary resuscitation
Chest compression-cardiopulmonary resuscitation
Mean arterial pressure
Cerebral blood flow
S100B protein
24-hour neurological function score
