带闭环控制的双泵复苏术对心脏骤停猪升主动脉压和冠脉灌注压的影响
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摘要
目的:提出一种带闭环控制的改良的以胸骨按压为主体的双泵复苏术,并验证该复苏方法对心脏骤停家猪升主动脉压和冠脉灌注压的影响。方法:8头健康实验猪通过右心室起搏导管电极诱颤,室颤后6 min内无任何干预,6 min后开始进行心肺复苏。比较辅以带闭环控制的增强型体外反搏和吸气阻力阀的主动按压放松心肺复苏术(AEI-CPR)和胸骨按压为主体的双泵复苏术(ED-CPR),并记录复苏过程中升主动脉压(PAO)、右房压(PRA)、冠脉灌注压(CPP)等指标。结果:与ED-CPR相比,AEI-CPR可使主动脉收缩压最大值提高到(103.83±5.87)mm Hg(P<0.05);冠脉灌注压最大值提高到(75.92±10.70)mm Hg(P<0.01)。结论:实验结果表明带闭环控制的改良的以胸骨按压为主体的双泵复苏术能提高升主动脉收缩压及冠脉灌注压,复苏效果好,明显提高心肌灌注。
Objective:To develop an improved closed loop control of dual-pump resuscitation with chest compres-sion as a main body,and to observe its influence of ascending aortic pressure and coronary perfusion pressure in cardiacarrest porcine. Methods:Eight healthy experimental porcine were induced by pacing catheter electrodes into rightventricular without any intervention within 6 minutes after ventricular fibrillation,and cardiopulmonary resuscitationstarted 6 minutes later. The hemodynamic effects of the closed loop control of dual-pump resuscitation with chestcompression as an main body(ED-CPR),were compared with the active presses supplemented with enhanced externalcounterpulsation and inspiratory resistance valves,then record the ascending aortic pressure(PAO),right atrialpressure(PRA),coronary perfusion pressure(CPP)and other indicators. Results:Compared with ED-CPR,AEI-CPRincreased the maximum of systolic pressure of the ascending aortic to(103.83±5.87)mm Hg(P<0.05). The maximum ofcoronary perfusion pressure values increased to(75.92±10.70)mm Hg(P<0.01). Conclusion:The improved closedloop control of dual-pump resuscitation device could increase the ascending aortic pressure and coronary perfusionpressure,and improve the resuscitation efficacy.
Objective:To develop an improved closed loop control of dual-pump resuscitation with chest compres-sion as a main body,and to observe its influence of ascending aortic pressure and coronary perfusion pressure in cardiacarrest porcine. Methods:Eight healthy experimental porcine were induced by pacing catheter electrodes into rightventricular without any intervention within 6 minutes after ventricular fibrillation,and cardiopulmonary resuscitationstarted 6 minutes later. The hemodynamic effects of the closed loop control of dual-pump resuscitation with chestcompression as an main body(ED-CPR),were compared with the active presses supplemented with enhanced externalcounterpulsation and inspiratory resistance valves,then record the ascending aortic pressure(PAO),right atrialpressure(PRA),coronary perfusion pressure(CPP)and other indicators. Results:Compared with ED-CPR,AEI-CPRincreased the maximum of systolic pressure of the ascending aortic to(103.83±5.87)mm Hg(P<0.05). The maximum ofcoronary perfusion pressure values increased to(75.92±10.70)mm Hg(P<0.01). Conclusion:The improved closedloop control of dual-pump resuscitation device could increase the ascending aortic pressure and coronary perfusionpressure,and improve the resuscitation efficacy.
引文
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[2]Radeschi G,Mina A,Berta G,et al.Sandroni.Incidence and outcome of in-hospital cardiac arrest in Italy:a multicentre observational study in the Piedmont Region[J].Resuscitation,2017,119:48.
[3]M,Ringh,J,Hollenberg,T,Palsgaard-Moeller,L,et al.Folke.The challenges and possibilities of public access defibrillation[J].Journal of internal medicine,2018,283(3):238.
[4]Bram J,Geller,Benjamin S,Abella.Evolving Strategies in Cardiac Arrest Management[J].Cardiology clinics,2018,36(1):73.
[5]袁衡新,杨俊华,袁志军.基于32位Windows的双泵复苏装置的控制系统[J].中国医学物理学杂志,2002,19(2):122.
[6]袁衡新,杨俊华,潘竞学,等.辅以体外反搏的胸骨按压心肺复苏装置[J].中国医学物理学杂志,2003,20(1):43.
[7]文才,李恒,翟小竹,等.长时程电诱发心室纤颤致心搏骤停与心肺复苏家猪模型的建立[J].中华危重病急救医学,2017,29(6):536.
[8]Kouwenhoven WB,Jude JR,Knickerbocker GG.Closed chest cardiac massage[J].JAMA,1960,9(173):1064.
[9]Yuan HX,Zheng ZS,et al:The Hemodynamic Study of a New type of CPR:the Chest Compression Combined with External Diaphragm Pacing and Enhanced External Counterpulsation[J].Ann Emerg Med,1996,27(1):139.
[10]袁衡新,蒋龙元,徐文莉,袁善桃,何国舟.辅以增强型体外反搏和吸气阻力阀的主动按压放松心肺复苏术血流动力学的初步研究[J].岭南急诊医学杂志,2007,12(5):326.