Sanders A B, Kern K B, Atlas M, Bragg S, Ewy G A
J Am Coll Cardiol. 1985 Jul;6(1):113-8. doi: 10.1016/s0735-1097(85)80261-8.
The effect of the duration of inadequate coronary perfusion pressure on resuscitation from cardiac arrest was examined in 32 mongrel dogs with a mean weight of 22 +/- 5 kg. In all dogs, the heart was electrically fibrillated and closed chest compression with assisted ventilation was performed for 15 minutes. At this time, all dogs had an inadequate coronary perfusion pressure (mean 7 +/- 9 mm Hg) and were randomized to a control group (group 1) with continued closed chest compression or to one of the three groups with open chest cardiac massage. These three groups differed only in the duration of continued closed chest compression before initiation of open chest massage (15, 20 and 25 minutes, respectively, in groups 2, 3 and 4). The control group (group 1) had no significant increase in coronary perfusion pressure, and only one of the eight dogs could be resuscitated. The three groups with open chest cardiac massage had a significant increase in coronary perfusion pressure (from 5 +/- 9 to 51 +/- 26 mm Hg, p less than 0.05), but the rate of successful resuscitation depended on the duration of inadequate coronary perfusion pressure before cardiac open chest massage. In group 2, six of eight dogs were resuscitated (p less than 0.05 compared with the control group); in group 3, three of eight dogs were resuscitated and in group 4 none of the eight dogs was resuscitated. The resuscitation rate was significantly (p less than 0.05) greater in group 2 than in group 4. These findings indicate that techniques that improve coronary perfusion pressure during cardiopulmonary resuscitation must be applied before extensive myocardial cellular dysfunction occurs if the probability of successful resuscitation is to be improved.
在32只平均体重为22±5千克的杂种狗身上，研究了冠状动脉灌注压不足的持续时间对心脏骤停复苏的影响。对所有的狗进行心脏电除颤，并进行15分钟的胸外按压及辅助通气。此时，所有狗的冠状动脉灌注压均不足（平均为7±9毫米汞柱），然后被随机分为两组，一组为对照组（第1组），继续进行胸外按压；另一组为三组中的一组，进行开胸心脏按摩。这三组的区别仅在于开始开胸按摩前持续胸外按压的时间（第2、3和4组分别为15、20和25分钟）。对照组（第1组）的冠状动脉灌注压没有显著升高，8只狗中只有1只能够复苏。进行开胸心脏按摩的三组冠状动脉灌注压显著升高（从5±9毫米汞柱升至51±26毫米汞柱，p<0.05），但复苏成功率取决于开胸按摩前冠状动脉灌注压不足的持续时间。在第2组中，8只狗中有6只复苏（与对照组相比，p<0.05）；在第3组中，8只狗中有3只复苏；在第4组中，8只狗均未复苏。第2组的复苏率显著高于第4组（p<0.05）。这些发现表明，如果要提高复苏成功率，在广泛的心肌细胞功能障碍发生之前，必须应用能改善心肺复苏期间冠状动脉灌注压的技术。
