Angelos M G, DeBehnke D J, Leasure J E
Department of Emergency Medicine, Wright State University School of Medicine, Dayton, OH.
Crit Care Med. 1992 Sep;20(9):1302-8. doi: 10.1097/00003246-199209000-00018.
Previous studies have shown that Paco2 and end-tidal CO2 reflect coronary artery perfusion pressures during cardiac arrest. We investigated the relationship of coronary artery perfusion pressure to central arterial pH and Paco2 values during resuscitation from cardiac arrest in a canine model. Twenty-four mongrel dogs were block randomized to three different resuscitation groups after induction of ventricular fibrillation and cardiac arrest: a) standard cardiopulmonary resuscitation (CPR) and advanced life support (n = 8); b) cardiopulmonary bypass (n = 8); or c) open-chest CPR (n = 8). Central arterial blood gases and perfusion pressures were monitored during cardiac arrest and during resuscitation.
Prearrest blood gases and hemodynamic values were similar between groups. Sixteen dogs from all three groups were successfully resuscitated. Survivors had significantly higher coronary artery perfusion pressure (p = .03), Paco2 (p = .015), and lower pH (p = .01) values than nonsurvivors. There was no correlation of pH and Paco2 during mechanical external CPR. However, after institution of the different resuscitation techniques, pH and Paco2 each showed a statistically significant correlation (r2 = .50 and .33, respectively) with coronary artery perfusion pressure.
Central arterial pH and Paco2 monitoring during cardiac arrest may reflect the adequacy of tissue perfusion during resuscitation and may predict resuscitation outcome from ventricular fibrillation.
既往研究表明，在心脏骤停期间，动脉血二氧化碳分压（Paco2）和呼气末二氧化碳分压可反映冠状动脉灌注压。我们在犬类模型中研究了心脏骤停复苏期间冠状动脉灌注压与中心动脉pH值和Paco2值之间的关系。24只杂种犬在诱发室颤和心脏骤停后被随机分为三个不同的复苏组：a）标准心肺复苏（CPR）和高级生命支持（n = 8）；b）体外循环（n = 8）；或c）开胸CPR（n = 8）。在心脏骤停期间和复苏期间监测中心动脉血气和灌注压。
各组心脏骤停前的血气和血流动力学值相似。来自所有三组的16只犬成功复苏。存活者的冠状动脉灌注压（p = .03）、Paco2（p = .015）显著高于未存活者，pH值（p = .01）则低于未存活者。在机械体外CPR期间，pH值和Paco2之间无相关性。然而，在采用不同的复苏技术后，pH值和Paco2与冠状动脉灌注压均呈现出统计学显著相关性（分别为r2 = .50和.33）。
心脏骤停期间监测中心动脉pH值和Paco2可能反映复苏期间组织灌注的充分性，并可能预测室颤的复苏结果。
