Tomaszewski C A, Meador S A
Resuscitation. 1987 Jun;15(2):97-112. doi: 10.1016/0300-9572(87)90021-9.
Recent studies have shown the potential adverse effects of venous volume loading on blood flow during closed chest cardiopulmonary resuscitation (CPR). To examine the effect of arterial and venous infusions, we employed a published computer simulation of the circulation during CPR. This model uses computer simulated electrical networks to model the heart and great vessels. CPR was modeled with compressions at a rate of 80/min and a force of 80 mmHg. Fluid infusions, simulated as current pulses into the abdominal aorta and superior vena cava, were given to measure their effect on myocardial and cranial blood flow. With 600 ml/min infusions into the abdominal aorta, there was a 12% peak increase in myocardial flow and a 3.8% peak increase in cranial flow. Every 100 ml/min increase in infusion from 0 to 900 ml/min produced a 1.4 ml/min linear increase in myocardial flow and a 4.2 ml/min linear increase in cranial flow. In agreement with previous CPR model studies, simulated vasoconstriction of abdominal and lower extremity vessels resulted in increased myocardial and cranial flows. As resistance of these vessels was increased, abdominal aortic infusions resulted in greater flow augmentations. In contrast to arterial results, infusions at 600 ml/min into the vena cava resulted in a 2.2% decrease in myocardial flow and a 0.62% decrease in cranial flow. Rise and fall times for initiation and cessation of flow augmentations were equal to four compression cycles. We conclude that these findings demonstrate the theoretical benefits of rapid arterial infusions during CPR with increases in myocardial and cranial blood flow. This method may provide an early temporary adjunct to myocardial perfusion during CPR.
近期研究表明，在闭胸心肺复苏（CPR）期间，静脉容量负荷对血流存在潜在不良影响。为了研究动脉和静脉输注的效果，我们采用了已发表的CPR期间循环的计算机模拟模型。该模型使用计算机模拟的电网络来模拟心脏和大血管。CPR模拟为以80次/分钟的速率和80 mmHg的压力进行按压。通过模拟向腹主动脉和上腔静脉注入电流脉冲来进行液体输注，以测量其对心肌和颅脑血流的影响。当以600 ml/分钟的速度向腹主动脉输注时，心肌血流峰值增加12%，颅脑血流峰值增加3.8%。从0至900 ml/分钟，输注速度每增加100 ml/分钟，心肌血流线性增加1.4 ml/分钟，颅脑血流线性增加4.2 ml/分钟。与先前的CPR模型研究一致，模拟腹主动脉和下肢血管收缩会导致心肌和颅脑血流增加。随着这些血管阻力增加，腹主动脉输注导致的血流增加更大。与动脉输注结果相反，以600 ml/分钟的速度向上腔静脉输注会导致心肌血流减少2.2%，颅脑血流减少0.62%。血流增加开始和停止的上升和下降时间等于四个按压周期。我们得出结论，这些发现证明了CPR期间快速动脉输注在增加心肌和颅脑血流方面的理论益处。该方法可能为CPR期间心肌灌注提供早期临时辅助手段。
