Tucker K J, Redberg R F, Schiller N B, Cohen T J
Department of Medicine, University of California, San Francisco.
J Am Coll Cardiol. 1993 Nov 1;22(5):1485-93. doi: 10.1016/0735-1097(93)90561-e.
This study was designed to test the hypothesis that active compression-decompression cardiopulmonary resuscitation increases transmitral flow and end-decompression left ventricular volume over levels achieved with standard manual cardiopulmonary resuscitation.
Recently, cardiopulmonary resuscitation incorporating active compression and decompression of the chest has been demonstrated to improve hemodynamic status in a canine model and in humans after cardiac arrest.
The active compression-decompression device was applied midsternum in five consecutive patients and results compared sequentially (in random order) with those of standard manual cardiopulmonary resuscitation. Both techniques were performed at 80 compressions/min with a 1.5- to 2-in. (3.8 to 5.1 cm) compression depth and a 50% duty cycle. Transesophageal echocardiographic data obtained in each patient included the velocity-time integral of transmitral pulsed Doppler recordings and two-dimensional images of the left ventricle in the long-axis view. Planimetric volume measurements of the left ventricle were obtained at both end-compression and end-decompression.
No difference was observed in end-compression volume between the two techniques (p = 0.81). Increased end-decompression volume (active compression-decompression technique 81.3 +/- 12.5 vs. standard technique 69.4 +/- 10.8, p < 0.05), stroke volume (active compression-decompression technique 32.6 +/- 6.8 vs. standard technique 17.6 +/- 5.2, p < 0.05) and velocity-time integral of transmitral flow (active compression-decompression technique 15.8 +/- 4.3 vs. standard technique 7.8 +/- 2.3, p < 0.05) were found in the active compression-decompression group. The transmitral velocity-time integral was highly correlated with left ventricular stroke volume (r = 0.90).
Improved transmitral flow, end-decompression left ventricular volume and stroke volume are seen with active compression-decompression resuscitation, suggesting a biphasic cardiothoracic cycle of flow. Active decompression of the chest appears to be a beneficial adjunct to standard cardiopulmonary resuscitation.
本研究旨在验证以下假设，即主动按压-减压心肺复苏术相比于标准徒手心肺复苏术，能增加二尖瓣血流及减压末期左心室容积。
最近，在犬类模型及心脏骤停后的人类研究中，已证实结合胸部主动按压和减压的心肺复苏术可改善血流动力学状态。
连续对5例患者在胸骨中部应用主动按压-减压装置，并将结果依次（按随机顺序）与标准徒手心肺复苏术的结果进行比较。两种技术均以每分钟80次按压进行，按压深度为1.5至2英寸（3.8至5.1厘米），占空比为50%。在每位患者中获取的经食管超声心动图数据包括二尖瓣脉冲多普勒记录的速度-时间积分以及左心室长轴视图的二维图像。在按压末期和减压末期均获取左心室的平面容积测量值。
两种技术在按压末期容积方面未观察到差异（p = 0.81）。主动按压-减压组的减压末期容积增加（主动按压-减压技术81.3±12.5 vs. 标准技术69.4±10.8，p < 0.05），每搏输出量（主动按压-减压技术32.6±6.8 vs. 标准技术17.6±5.2，p < 0.05）以及二尖瓣血流速度-时间积分（主动按压-减压技术15.8±4.3 vs. 标准技术7.8±2.3，p < 0.05）均有所增加。二尖瓣速度-时间积分与左心室每搏输出量高度相关（r = 0.90）。
主动按压-减压复苏术可改善二尖瓣血流、减压末期左心室容积及每搏输出量，提示存在双相心肺循环血流。胸部主动减压似乎是标准心肺复苏术的有益辅助手段。
