在猪心搏骤停期间，倾斜会降低心输出量和左心室心肌血流。
Leaning during chest compressions impairs cardiac output and left ventricular myocardial blood flow in piglet cardiac arrest.
机构信息
University of Arizona Sarver Heart Center, Tucson, AZ, USA.
出版信息
Crit Care Med. 2010 Apr;38(4):1141-6. doi: 10.1097/CCM.0b013e3181ce1fe2.
OBJECTIVE
Complete recoil of the chest wall between chest compressions during cardiopulmonary resuscitation is recommended, because incomplete chest wall recoil from leaning may decrease venous return and thereby decrease blood flow. We evaluated the hemodynamic effect of 10% or 20% lean during piglet cardiopulmonary resuscitation.
DESIGN
Prospective, sequential, controlled experimental animal investigation.
SETTING
University research laboratory.
SUBJECTS
Domestic piglets.
INTERVENTIONS
After induction of ventricular fibrillation, cardiopulmonary resuscitation was provided to ten piglets (10.7 +/- 1.2 kg) for 18 mins as six 3-min epochs with no lean, 10% lean, or 20% lean to maintain aortic systolic pressure of 80-90 mm Hg. Because the mean force to attain 80-90 mm Hg was 18 kg in preliminary studies, the equivalent of 10% and 20% lean was provided by use of 1.8- and 3.6-kg weights on the chest.
MEASUREMENTS AND MAIN RESULTS
Using a linear mixed-effect regression model to control for changes in cardiopulmonary resuscitation hemodynamics over time, mean right atrial diastolic pressure was 9 +/- 0.6 mm Hg with no lean, 10 +/- 0.3 mm Hg with 10% lean (p < .01), and 13 +/- 0.3 mm Hg with 20% lean (p < .01), resulting in decreased coronary perfusion pressure with leaning. Microsphere-determined cardiac index and left ventricular myocardial blood flow were lower with 10% and 20% leaning throughout the 18 mins of cardiopulmonary resuscitation. Mean cardiac index decreased from 1.9 +/- 0.2 L . M . min with no leaning to 1.6 +/- 0.1 L . M . min with 10% leaning, and 1.4 +/- 0.2 L . M . min with 20% leaning (p < .05). The myocardial blood flow decreased from 39 +/- 7 mL . min . 100 g with no lean to 30 +/- 6 mL . min . 100 g with 10% leaning and 26 +/- 6 mL . min . 100 g with 20% leaning (p < .05).
CONCLUSIONS
Leaning of 10% to 20% (i.e., 1.8-3.6 kg) during cardiopulmonary resuscitation substantially decreased coronary perfusion pressure, cardiac index, and myocardial blood flow.
目的
在心肺复苏期间，推荐胸部按压时使胸壁完全回弹，因为倚靠时胸壁不完全回弹可能会降低静脉回流，从而减少血流量。我们评估了在小猪心肺复苏期间使用 10%或 20%倾斜的血液动力学效应。
设计
前瞻性、连续、对照的实验动物研究。
地点
大学研究实验室。
对象
家猪。
干预
在心室颤动诱导后，对 10 只小猪（10.7 +/- 1.2 公斤）进行心肺复苏 18 分钟，分为 6 个 3 分钟的阶段，不倾斜、10%倾斜或 20%倾斜，以维持主动脉收缩压在 80-90 毫米汞柱之间。由于初步研究中达到 80-90 毫米汞柱的平均力为 18 公斤，因此使用 1.8-和 3.6 公斤的重量在胸部上提供 10%和 20%的倾斜。
测量和主要结果
使用线性混合效应回归模型来控制心肺复苏期间随时间变化的血液动力学变化，平均右心房舒张压为 9 +/- 0.6 毫米汞柱，无倾斜，10 +/- 0.3 毫米汞柱（p <.01），20 +/- 0.3 毫米汞柱（p <.01），导致倾斜时冠状动脉灌注压降低。在整个心肺复苏 18 分钟内，使用 10%和 20%倾斜时，微球测定的心脏指数和左心室心肌血流均较低。平均心脏指数从无倾斜时的 1.9 +/- 0.2 L. M. min 下降至 1.6 +/- 0.1 L. M. min，使用 10%倾斜时，下降至 1.4 +/- 0.2 L. M. min，使用 20%倾斜时（p <.05）。心肌血流从无倾斜时的 39 +/- 7 mL. min. 100 g 下降至 10%倾斜时的 30 +/- 6 mL. min. 100 g 和 20%倾斜时的 26 +/- 6 mL. min. 100 g（p <.05）。
结论
在心肺复苏期间倾斜 10%至 20%（即 1.8-3.6 公斤）会显著降低冠状动脉灌注压、心指数和心肌血流。
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