Kette F, Weil M H, Gazmuri R J
Department of Medicine, University of Health Sciences, Chicago Medical School, IL 60064.
JAMA. 1991 Oct 16;266(15):2121-6.
--To investigate the effects of hypertonic buffer solutions on coronary perfusion pressure (CPP) and resuscitability during experimental closed-chest cardiac resuscitation.
--Randomized, placebo-controlled trial.
--Mammalian research laboratory.
--Forty-four domestic pigs.
--Cardiac arrest was induced by ventricular fibrillation in mechanically ventilated pigs anesthetized with pentobarbital sodium. Precordial compression was started at the third minute of untreated ventricular fibrillation and maintained for an interval of 8 minutes. A hypertonic solution of sodium bicarbonate, Carbicarb (an equimolar mixture of sodium bicarbonate and sodium carbonate [International Medication Systems, Ltd]), or sodium chloride or an isotonic solution of sodium chloride was infused into the right atrium over a 1-minute interval starting at the sixth minute of ventricular fibrillation. Restoration of spontaneous circulation was attempted by DC transthoracic countershock after 11 minutes of ventricular fibrillation.
--Plasma osmolality, CPP, and cardiac resuscitability.
--Infusion of hypertonic buffer and sodium chloride solutions increased plasma osmolality from an average of 280 to 330 mOsm/kg. This was accompanied by a significant decrease in the aortic pressures and CPPs generated during precordial compression. No such changes occurred after infusion of isotonic sodium chloride. Restoration of spontaneous circulation, as in earlier studies, was contingent on the levels of CPP prior to attempted defibrillation. Accordingly, none of 13 animals in which the CPP declined to less than 10 mm Hg after infusion of the hypertonic solutions were successfully resuscitated. This contrasted with nine animals that received isotonic sodium chloride and served as controls. Coronary perfusion pressure consistently exceeded 10 mm Hg in these control animals, and spontaneous circulation was restored in each instance.
--Hypertonic solutions and specifically buffer solutions administered in the absence of vasopressor agents may adversely affect cardiac resuscitation efforts by reducing CPP below critical thresholds.
研究高渗缓冲溶液对实验性闭胸心脏复苏期间冠状动脉灌注压（CPP）及复苏成功率的影响。
随机、安慰剂对照试验。
哺乳动物研究实验室。
44头家猪。
用戊巴比妥钠麻醉并机械通气的猪，通过室颤诱导心脏骤停。在未经处理的室颤第3分钟开始胸外按压，并持续8分钟。从室颤第6分钟开始，在1分钟内将碳酸氢钠高渗溶液、卡比卡（碳酸氢钠和碳酸钠的等摩尔混合物[国际药物系统有限公司]）、氯化钠高渗溶液或氯化钠等渗溶液注入右心房。室颤11分钟后，尝试通过直流电经胸除颤恢复自主循环。
血浆渗透压、CPP及心脏复苏成功率。
输注高渗缓冲溶液和氯化钠溶液使血浆渗透压从平均280 mOsm/kg升至330 mOsm/kg。这伴随着胸外按压期间主动脉压和CPP显著降低。输注等渗氯化钠后未出现此类变化。如早期研究一样，自主循环的恢复取决于除颤尝试前的CPP水平。因此，输注高渗溶液后CPP降至低于10 mmHg的13只动物中，无一成功复苏。这与9只接受等渗氯化钠作为对照的动物形成对比。这些对照动物的冠状动脉灌注压持续超过10 mmHg，且每只均恢复了自主循环。
在无血管升压药的情况下给予高渗溶液，尤其是缓冲溶液，可能会使CPP降至临界阈值以下，从而对心脏复苏产生不利影响。
