头高脚低位心肺复苏与仰卧位心肺复苏对脑氧合和脑代谢的影响 - 一项前瞻性、随机猪研究。
Effects of head-up vs. supine CPR on cerebral oxygenation and cerebral metabolism - a prospective, randomized porcine study.
机构信息
Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Austria.
Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Austria.
出版信息
Resuscitation. 2018 Jul;128:51-55. doi: 10.1016/j.resuscitation.2018.04.038. Epub 2018 May 1.
BACKGROUND
Recent studies have shown that during cardiopulmonary resuscitation (CPR) head-up position (HUP) as compared to standard supine position (SUP) decreases intracranial pressure (ICP) and increases cerebral perfusion pressure (CPP). The impact of this manoeuvre on brain oxygenation and metabolism is not clear. We therefore investigated HUP as compared to SUP during basic life support (BLS) CPR for their effect on brain oxygenation and metabolism.
METHODS
Twenty pigs were anaesthetized and instrumented. After 8 min of cardiac arrest (CA) pigs were randomized to either HUP or SUP and resuscitated mechanically for 20 min. Mean arterial pressure (MAP), ICP, CPP, cerebral regional oxygen saturation (rSO) and brain tissue oxygen tension (PO) were measured at baseline, after CA and every 5 min during CPR. Cerebral venous oxygen saturation (SO) was measured at baseline, after CA and after 20 min of CPR. Cerebral microdialysis parameters, e.g. lactate/pyruvate ratio (L/P ratio) were taken at baseline and the end of the experiment.
RESULTS
ICP was significantly lower in HUP compared to SUP animals after 5 min (18.0 ± 4.5 vs. 24.1 ± 5.2 mmHg; p = 0.033) and 20 min (12.0 ± 3.4 vs. 17.8 ± 4.3 mmHg; p = 0.023) of CPR. Accordingly, CPP was significantly higher in the HUP group after 5 min (11.2 ± 9.5 vs. 1.0 ± 9.2 mmHg; p = 0.045) and 20 min (3.4 ± 6.4 vs. -3.8 ± 2.8 mmHg; p = 0.023) of CPR. However, no difference was found in rSO, PO, SO and L/P ratio between groups after 20 min of CPR.
CONCLUSION
In this animal model of BLS CPR, HUP as compared to SUP did not improve cerebral oxygenation or metabolism.
背景
最近的研究表明，与标准仰卧位（SUP）相比，心肺复苏（CPR）时头高位（HUP）可降低颅内压（ICP）并增加脑灌注压（CPP）。但是，这种操作对脑氧合和代谢的影响尚不清楚。因此，我们研究了基本生命支持（BLS）CPR 期间 HUP 与 SUP 的比较，以了解其对脑氧合和代谢的影响。
方法
将 20 头猪麻醉并进行仪器操作。心脏骤停（CA）8 分钟后，将猪随机分为 HUP 或 SUP 组，并进行机械复苏 20 分钟。在基线，CA 后和 CPR 期间每 5 分钟测量平均动脉压（MAP），ICP，CPP，脑区域性氧饱和度（rSO）和脑组织氧分压（PO）。在基线，CA 后和 CPR 20 分钟后测量脑静脉氧饱和度（SO）。在基线和实验结束时采集脑微透析参数，例如乳酸/丙酮酸比（L/P 比）。
结果
与 SUP 动物相比，HUP 动物在 CPR 后 5 分钟（18.0±4.5 vs. 24.1±5.2 mmHg；p=0.033）和 20 分钟（12.0±3.4 vs. 17.8±4.3 mmHg；p=0.023）时 ICP 显著降低。相应地，HUP 组在 CPR 后 5 分钟（11.2±9.5 vs. 1.0±9.2 mmHg；p=0.045）和 20 分钟（3.4±6.4 vs. -3.8±2.8 mmHg；p=0.023）时 CPP 显著升高。但是，在 CPR 20 分钟后，两组之间 rSO、PO、SO 和 L/P 比没有差异。
结论
在本研究中，与 SUP 相比，BLS CPR 时的 HUP 并未改善脑氧合或代谢。
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