Fleisher G, Caputo G, Baskin M
Department of Pediatrics, Harvard Medical School, Boston, MA.
Crit Care Med. 1989 Mar;17(3):251-4. doi: 10.1097/00003246-198903000-00010.
We compared the administration of sodium bicarbonate via a catheter inserted in the external jugular and extending to the junction with the subclavian vein (group 1) and a peripheral hindpaw vein (group 2) in puppies. During spontaneous cardiac activity, the increases in pH (0.12 +/- 0.04 in group 1 vs. 0.08 +/- 0.04 in group 2) and PCO2 (11 +/- 2.8 torr in group 1 vs. 6 +/- 3.2 torr in group 2) in blood from the right atrium 10 sec after the injection of bicarbonate differed significantly. However, the increases in pH (0.31 +/- 0.07 in group 1 vs. 0.30 +/- 0.15 in group 2) and PCO2 (86 +/- 33 torr in group 1 vs. 72 +/- 35 torr in group 2) in blood from the right atrium during closed chest CPR were similar in the two groups. We found that the sodium bicarbonate reached the central circulation more rapidly when administered in the external jugular vein as compared to a peripheral site, but this difference was small and did not reach the level of significance during CPR. Our findings do not provide evidence of any advantage to obtaining central venous access (a potentially complicated procedure) in children with cardiac arrest in regard to the delivery of medications to the heart.
我们比较了幼犬经插入颈外静脉并延伸至与锁骨下静脉交界处的导管（第1组）和后肢外周静脉（第2组）给予碳酸氢钠的情况。在心脏自主活动期间，注射碳酸氢钠10秒后右心房血液中的pH值升高（第1组为0.12±0.04，第2组为0.08±0.04）和PCO₂升高（第1组为11±2.8托，第2组为6±3.2托）存在显著差异。然而，在闭胸心肺复苏期间，两组右心房血液中的pH值升高（第1组为0.31±0.07，第2组为0.30±0.15）和PCO₂升高（第1组为86±33托，第2组为72±35托）相似。我们发现，与外周部位相比，经颈外静脉给予碳酸氢钠时到达中心循环的速度更快，但这种差异很小，在心肺复苏期间未达到显著水平。我们的研究结果没有提供证据表明，对于心脏骤停儿童，在将药物输送到心脏方面，获得中心静脉通路（一种潜在的复杂操作）有任何优势。
