Rieder C F, Crawford B G, Iliopoulos J I, Thomas J H, Pierce G E, Hermreck A S
Surgery. 1985 Oct;98(4):824-30.
The present study compares the hemodynamic effectiveness of closed-chest cardiac massage (CCCM) with closed subdiaphragmatic massage (CSDM) and four open transdiaphragmatic cardiac massage techniques during cardiac arrest with an open abdomen. In 10 dogs CCCM resulted in the lowest cardiac index (CI), mean arterial pressure (MBP), and carotid blood flow (CBF) of all cardiac massage techniques tested. CSDM was not statistically superior to CCCM in the dog (p greater than 0.05) but did result in a 23% increase in CI and a 54% increase in CBF. Transdiaphragmatic retrocardiac massage through an incision in the diaphragm resulted in the highest CI, MBP, and CBF of all the four open transdiaphragmatic techniques and had significantly higher values than those for CCCM in the dog (p less than 0.05). In three cadaveric renal donors, all four open transdiaphragmatic techniques and CSDM were noted to be equal to or superior to CCCM. Three patients have been successfully resuscitated with diaphragmatic cardiac massage techniques for cardiac arrest while undergoing abdominal operations. These studies reveal that all subdiaphragmatic or transdiaphragmatic techniques for cardiac massage are hemodynamically equivalent to or superior to the standard CCCM without such complications as fractured ribs and should be considered the treatment of choice for cardiac arrest in the patient with an open abdomen.
本研究比较了在开腹心脏骤停期间，闭胸心脏按压（CCCM）与膈下闭胸按压（CSDM）以及四种开放式经膈心脏按压技术的血流动力学效果。在10只犬中，CCCM在所有测试的心脏按压技术中导致最低的心指数（CI）、平均动脉压（MBP）和颈动脉血流量（CBF）。在犬中，CSDM在统计学上并不优于CCCM（p大于0.05），但确实使CI增加了23%，CBF增加了54%。通过膈肌切口进行的经膈心脏后按压在所有四种开放式经膈技术中导致最高的CI、MBP和CBF，并且在犬中其值显著高于CCCM（p小于0.05）。在三名尸体肾供体中，所有四种开放式经膈技术和CSDM均被发现等同于或优于CCCM。三名患者在接受腹部手术期间因心脏骤停采用膈肌心脏按压技术成功复苏。这些研究表明，所有用于心脏按压的膈下或经膈技术在血流动力学上等同于或优于标准的CCCM，且无肋骨骨折等并发症，应被视为开腹患者心脏骤停的首选治疗方法。
