Badylak S F, Kern K B, Tacker W A, Ewy G A, Janas W, Carter A
Resuscitation. 1986 Jul;13(4):249-64. doi: 10.1016/0300-9572(86)90079-1.
We compared the pathologic changes following open-chest cardiopulmonary resuscitation (OCCPR) vs. closed chest cardiopulmonary resuscitation (CCCPR) in 28 healthy mongrel dogs subjected to experimentally induced ventricular fibrillation (VF). VF was induced in 29 dogs. No treatment was given for 3 min, then mechanical CCCPR was given for the next 12 min. External defibrillation (80 joules) was then attempted twice. One dog was resuscitated. The remaining 28 dogs were divided into 2 groups of 14 each. Group A received continued CCCPR and group B received OCCPR. All dogs received advanced cardiac life support and were followed until resuscitated or dead. All dogs were autopsied and gross pathology scores and histopathology scores were determined for each animal, and for each of 19 separate tissues within each animal. The mean gross pathology scores for the following tissues were significantly greater for dogs that received OCCPR vs. those that received CCCPR: skin (3.4 vs. 1.2; P less than 0.001), subcutaneous tissue (3.7 vs. 0.6; P less than 0.001), chest wall muscle (3.7 vs. 0.5; P less than 0.001), and pleura (1.9 vs. 0.1; P less than 0.001). The mean total gross pathology score was also greater in dogs that received OCCPR vs. those that received CCCPR (17.2 vs. 7.7; P less than 0.001). The mean histopathology scores for the following tissues were significantly greater for dogs that received OCCPR vs. those that received CCCPR: skin (2.5 vs. 0.0; P less than 0.001), subcutaneous tissue (2.2 vs. 0.1; P less than 0.001), muscle (2.3 vs. 0.1; P less than 0.001), pleura (1.6 vs. 0.0; P less than 0.001), pericardium (1.4 vs. 0.2; P less than 0.01), epicardium (2.5 vs. 0.2; P less than 0.001), myocardium (2.5 vs. 0.3; P less than 0.001), and endocardium (1.9 vs. 0.5; P less than 0.01). The mean total histopathology score was also greater in dogs that received OCCPR vs. those that received CCCPR (20.1 vs. 7.4; P less than 0.001). The histopathology score for brain tissue was greater for the CCCPR group than for the OCCPR group (1.9 vs. 0.4; P less than 0.05). This study showed that OCCPR in dogs following VF caused more severe pathologic changes than CCCPR. These changes were attributed to thoracotomy-induced chest wall injury and to internal defibrillation induced myocardial injury. However, OCCPR caused less severe microscopic brain lesions than CCCPR.
我们比较了28只健康杂种犬在实验性诱发心室颤动（VF）后接受开胸心肺复苏（OCCPR）与闭胸心肺复苏（CCCPR）后的病理变化。29只犬被诱发心室颤动。3分钟内未进行任何治疗，随后进行12分钟的机械CCCPR。然后尝试两次体外除颤（80焦耳）。1只犬复苏成功。其余28只犬分为两组，每组14只。A组接受持续CCCPR，B组接受OCCPR。所有犬均接受高级心脏生命支持，并随访至复苏或死亡。所有犬均进行尸检，确定每只动物以及每只动物体内19个不同组织的大体病理学评分和组织病理学评分。接受OCCPR的犬以下组织的平均大体病理学评分显著高于接受CCCPR的犬：皮肤（3.4对1.2；P<0.001）、皮下组织（3.7对0.6；P<0.001）、胸壁肌肉（3.7对0.5；P<0.001）和胸膜（1.9对0.1；P<0.001）。接受OCCPR的犬的平均总大体病理学评分也高于接受CCCPR的犬（17.2对7.7；P<0.001）。接受OCCPR的犬以下组织的平均组织病理学评分显著高于接受CCCPR的犬：皮肤（2.5对0.0；P<0.001）、皮下组织（2.2对0.1；P<0.001）、肌肉（2.3对0.1；P<0.001）、胸膜（1.6对0.0；P<0.001）、心包（1.4对0.2；P<0.01）、心外膜（2.5对0.2；P<0.001）、心肌（2.5对0.3；P<0.001）和心内膜（1.9对0.5；P<0.01）。接受OCCPR的犬的平均总组织病理学评分也高于接受CCCPR的犬（20.1对7.4；P<0.001）。CCCPR组脑组织的组织病理学评分高于OCCPR组（1.9对0.4；P<0.05）。本研究表明，犬心室颤动后接受OCCPR比接受CCCPR引起更严重的病理变化。这些变化归因于开胸手术引起的胸壁损伤和体内除颤引起的心肌损伤。然而，OCCPR引起的脑微观病变比CCCPR轻。
