Yang Jun, Zhao Lian-Xing, Li Chun-Sheng, Tong Nan, Xiao Hong-Li, An Le
Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing 100020, China.
Department of Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China.
Chin Med J (Engl). 2017 Jun 20;130(12):1475-1480. doi: 10.4103/0366-6999.207481.
Study of lung function in survivor from cardiac arrest (CA) caused by pulmonary thromboembolism (PTE) was rare. The aim of this study was to investigate the variations of postresuscitation lung function after thrombolysis treatment in a CA porcine model caused by PTE.
After 2 min of untreated CA, pigs of 10-12 weeks with a weight of 30 ± 2 kg (n = 24) were treated with recombinant human tissue plasminogen activator (50 mg). Cardiopulmonary resuscitation (CPR) and ventilation were initiated after drug administration. Pulmonary function and arterial blood gas parameters were measured at baseline, return of spontaneous circulation (ROSC) immediately, and 1 h, 2 h, 4 h, and 6 h after ROSC.
The dynamic lung compliance decreased significantly at ROSC immediately and 1 h after ROSC compared to baseline (21.86 ± 2.00 vs. 26.72 ± 2.20 ml/mmHg and 20.38 ± 1.31 vs. 26.72 ± 2.20 ml/mmHg, respectively; P < 0.05; 1 mmHg = 0.133 kPa). Compared with baseline, airway resistance increased significantly at ROSC immediately and 1 h after ROSC (P < 0.05). Respiratory index also increased after ROSC and showed significant differences among baseline, ROSC immediately, and 2 h after ROSC (P < 0.05). Oxygen delivery decreased at ROSC immediately compared to baseline (P < 0.05). The oxygenation index decreased significantly at any time after ROSC compared to baseline (P < 0.05). Extravascular lung water index and pulmonary vascular permeability index (PVPI) showed significant differences at ROSC immediately compared to baseline and 1 h after ROSC (P < 0.05); PVPI at ROSC immediately was also different from 6 h after ROSC (P < 0.05). Ventilation/perfusion ratios increased after ROSC (P < 0.05). Histopathology showed fibrin effusion, bleeding in alveoli, and hemagglutination in pulmonary artery.
Lung function remains abnormal even after CPR with thrombolysis therapy; it is essential to continue anticoagulation and symptomatic treatment after ROSC.
对肺血栓栓塞症（PTE）所致心脏骤停（CA）幸存者的肺功能研究较为罕见。本研究旨在探讨PTE所致CA猪模型溶栓治疗后复苏后肺功能的变化。
在未治疗的CA持续2分钟后，对10 - 12周龄、体重30±2 kg的猪（n = 24）给予重组人组织型纤溶酶原激活剂（50 mg）。给药后开始心肺复苏（CPR）和通气。在基线、即刻自主循环恢复（ROSC）时以及ROSC后1小时、2小时、4小时和6小时测量肺功能和动脉血气参数。
与基线相比，即刻ROSC时和ROSC后1小时动态肺顺应性显著降低（分别为21.86±2.00 vs. 26.72±2.20 ml/mmHg和20.38±1.31 vs. 26.72±2.20 ml/mmHg；P < 0.05；1 mmHg = 0.133 kPa）。与基线相比，即刻ROSC时和ROSC后1小时气道阻力显著增加（P < 0.05）。ROSC后呼吸指数也升高，并在基线、即刻ROSC时和ROSC后2小时之间存在显著差异（P < 0.05）。与基线相比，即刻ROSC时氧输送降低（P < 0.05）。与基线相比，ROSC后任何时间氧合指数均显著降低（P < 0.05）。与基线和ROSC后1小时相比，即刻ROSC时血管外肺水指数和肺血管通透性指数（PVPI）存在显著差异（P < 0.05）；即刻ROSC时的PVPI与ROSC后6小时也不同（P < 0.05）。ROSC后通气/灌注比增加（P < 0.05）。组织病理学显示纤维蛋白渗出、肺泡出血和肺动脉内血凝。
即使在溶栓治疗的CPR后肺功能仍异常；ROSC后继续抗凝和对症治疗至关重要。
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