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[间断性腹主动脉压迫对兔心脏骤停后心肺脑复苏的影响]

[Effects of interrupted abdominal aorta compression on cardiopulmonary cerebral resuscitation after cardiac arrest in rabbit].

作者信息

Dou Weiwei, Wang Lixiang, Liu Huiliang, Zhang Pengchuan, Guo Chengcheng, Liu Yahua, Ma Lizhi, Sun Kun, Ma Wenjun, Wang Qian, Guo Xiaodong

机构信息

Emergency Medical Center, General Hospital of Chinese Armed Police Forces, Beijing 100039, China, Corresponding author: Wang Lixiang, Email:

出版信息

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 Oct;26(10):718-21. doi: 10.3760/cma.j.issn.2095-4352.2014.10.008.

Abstract

OBJECTIVE

To explore the effect of the interrupted abdominal aorta compression after cardiopulmonary resuscitation (IAAC-CPR) on cardiopulmonary cerebral resuscitation in a rabbit model of cardiac arrest (CA).

METHODS

According to the random number table, 10 New Zealand rabbits of both genders were equally divided into the chest compression-cardiopulmonary resuscitation (CC-CPR) group or IAAC-CPR group, with 5 rabbits in each group. CA model was reproduced by injection of iced-potassium chloride into the jugular vein and obstruction of trachea to produce asphyxia. CA was maintained for 3 minutes before cardiopulmonary resuscitation(CPR). CC-CPR was performed with assisted ventilation + chest compression, while IAAC-CPR was performed by the way of assisted ventilation + chest compressions + compressions on abdominal aorta. The hemodynamics and cerebral cortex blood flow were observed during resuscitation. Time of return of spontaneous circulation (ROSC), 24-hour survival rates, and scores of neurological function, and situation of abdominal organs were recorded.

RESULTS

At 30, 60, 90 and 120 seconds after CPR, the cerebral blood flow (CBF, PU value) and mean arterial pressure (MAP, mmHg, 1 mmHg=0.133 kPa) of IAAC-CPR group were significantly higher than those of CC-CPR group (CBF 30 seconds: 16.1 ± 6.0 vs. 7.8 ± 2.2, 60 seconds: 91.6 ± 11.8 vs. 57.3 ± 23.2, 90 seconds: 259.9 ± 74.9 vs. 163.6 ± 50.3, 120 seconds: 301.5 ± 60.5 vs. 208.4 ± 23.8; MAP 30 seconds: 46.4 ± 9.4 vs. 31.4 ± 8.7, 60 seconds: 55.8 ± 13.8 vs. 34.0 ± 11.5, 90 seconds: 61.2 ± 11.5 vs. 38.2 ± 10.1, 120 seconds: 63.6 ± 11.8 vs. 40.2 ± 10.2, all P<0.05). Compared with CC-CPR group, in IAAC - CPR group, the time necessary for ROSC was obviously shortened (seconds: 182.0 ± 59.0 vs. 312.6 ± 86.6, t=2.787, P=0.024), 24-hour nerve function score was significantly lowered (2.4 ± 1.7 vs. 4.6 ± 0.6, t = 2.974, P = 0.023). The successful recovery rate (80.0% vs. 60.0%, χ² = 0.000, P=1.000) and 24-hour survival rate (80.0% vs. 40.0%, χ² = 0.417, P=0.519) were significantly increased, but without statistical significance. No liver damage was found at 24 hours after ROSC.

CONCLUSIONS

In the early recovery of CA in rabbit, IAAC-CPR can result in better cerebral blood flow perfusion as compared with CC-CPR, and it significantly reduced damage to the nervous system function without producing abdominal organ damage.

摘要

目的

探讨心肺复苏后间断性腹主动脉压迫(IAAC-CPR)对兔心脏骤停(CA)模型心肺脑复苏的影响。

方法

根据随机数字表,将10只新西兰兔(雌雄不限)平均分为胸外按压-心肺复苏(CC-CPR)组和IAAC-CPR组,每组5只。通过颈静脉注射冷氯化钾并阻塞气管造成窒息来复制CA模型。在进行心肺复苏(CPR)前,使CA持续3分钟。CC-CPR采用辅助通气+胸外按压进行,而IAAC-CPR则通过辅助通气+胸外按压+腹主动脉按压的方式进行。复苏过程中观察血流动力学和大脑皮质血流情况。记录自主循环恢复(ROSC)时间、24小时生存率、神经功能评分以及腹部器官情况。

结果

CPR后30、60、90和120秒时,IAAC-CPR组的脑血流量(CBF,PU值)和平均动脉压(MAP,mmHg,1 mmHg = 0.133 kPa)显著高于CC-CPR组(30秒时CBF:16.1±6.0 vs. 7.8±2.2,60秒时:91.6±11.8 vs. 57.3±23.2,90秒时:259.9±74.9 vs. 163.6±50.3,120秒时:301.5±60.5 vs. 208.4±23.8;30秒时MAP:46.4±9.4 vs. 31.4±8.7,60秒时:55.8±13.8 vs. 34.0±11.5,90秒时:61.2±11.5 vs. 38.2±10.1,120秒时:63.6±11.8 vs. 40.2±10.2,所有P<0.05)。与CC-CPR组相比,IAAC-CPR组ROSC所需时间明显缩短(秒:182.0±59.0 vs. 312.6±86.6,t = 2.787,P = 0.024),24小时神经功能评分显著降低(2.4±1.7 vs. 4.6±0.6,t = 2.974,P = 0.023)。成功恢复率(80.0% vs. 60.0%,χ² = 0.000,P = 1.000)和24小时生存率(80.0% vs. 40.0%,χ² = 0.417,P = 0.519)显著提高,但无统计学意义。ROSC后24小时未发现肝脏损伤。

结论

在兔CA早期恢复过程中,与CC-CPR相比,IAAC-CPR可使脑血流量灌注更好,且能显著减轻对神经系统功能的损害,同时不产生腹部器官损伤。

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