Xu Jun, Li Chen, Li Yan, Walline Joseph, Zheng Liangliang, Fu Yangyang, Yao Dongqi, Zhu Huadong, Liu Xiaohe, Chai Yanfen, Wang Zhong, Yu Xuezhong
Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Emergency Department, Tianjin Medical University General Hospital, Tianjin, China.
PLoS One. 2016 May 11;11(5):e0155212. doi: 10.1371/journal.pone.0155212. eCollection 2016.
Starting chest compressions immediately after a defibrillation shock might be harmful, if the victim already had a return of spontaneous circulation (ROSC) and yet was still being subjected to external compressions at the same time. The objective of this study was to study the influence of chest compressions on circulation during the peri-cardiac arrest period.
Prospective, randomized controlled study.
Animal experimental center in Peking Union Medical Collage Hospital, Beijing, China.
Healthy 3-month-old male domestic pigs.
44 pigs (28±2 kg) were randomly assigned to three groups: Group I (non-arrested with compressions) (n = 12); Group II (arrested with compressions only) (n = 12); Group III (ROSC after compressions and defibrillation) (n = 20). In Groups I and II, compressions were performed to a depth of 5cm (Ia and IIa, n = 6) or a depth of 3cm (Ib and IIb, n = 6) respectively, while in Group III, the animals which had just achieved ROSC (n = 18) were compressed to a depth of 5cm (IIIa, n = 6), a depth of 3cm (IIIb, n = 6), or had no compressions (IIIc, n = 6). Hemodynamic parameters were collected and analyzed.
Hemodynamics were statistically different between Groups Ia and Ib when different depths of compressions were performed (p < 0.05). In Group II, compressions were beneficial and hemodynamics correlated with the depth of compressions (p < 0.05). In Group III, compressions that continued after ROSC produced a reduction in arterial pressure (p < 0.05).
Chest compressions might be detrimental to hemodynamics in the early post-ROSC stage. The deeper the compressions were, the better the effect on hemodynamics during cardiac arrest, but the worse the effect on hemodynamics after ROSC.
如果患者已经恢复自主循环（ROSC），但仍同时接受外部按压，那么在除颤电击后立即开始胸外按压可能是有害的。本研究的目的是探讨心脏骤停期间胸外按压对循环的影响。
前瞻性随机对照研究。
中国北京协和医院动物实验中心。
健康的3月龄雄性家猪。
44头猪（28±2千克）被随机分为三组：第一组（未发生心脏骤停但接受按压）（n = 12）；第二组（仅接受按压的心脏骤停组）（n = 12）；第三组（按压和除颤后恢复自主循环）（n = 20）。在第一组和第二组中，分别进行深度为5厘米（第一组a和第二组a，n = 6）或深度为3厘米（第一组b和第二组b，n = 6）的按压，而在第三组中，刚恢复自主循环的动物（n = 18）被按压至深度5厘米（第三组a，n = 6）、深度3厘米（第三组b，n = 6）或不进行按压（第三组c，n = 6）。收集并分析血流动力学参数。
进行不同深度按压时，第一组a和第一组b之间的血流动力学存在统计学差异（p < 0.05）。在第二组中，按压是有益的，血流动力学与按压深度相关（p < 0.05）。在第三组中，恢复自主循环后继续按压会导致动脉压降低（p < 0.05）。
在恢复自主循环后的早期阶段，胸外按压可能对血流动力学有害。按压越深，对心脏骤停期间血流动力学的影响越好，但对恢复自主循环后血流动力学的影响越差。
