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[用于心肺脑复苏的急诊体外循环;(2). 生理变化]

[Emergency cardiopulmonary bypass (ECPB) for cardiopulmonary-cerebral resuscitation; (2). Physiologic changes].

作者信息

Hashiguchi A, Kano T, Sadanaga M, Ashimura K, Morioka T

机构信息

Department of Anesthesia, National Medical Center, Tokyo.

出版信息

Masui. 1993 Sep;42(9):1283-90.

PMID:8230715
Abstract

After normothermic ventricular fibrillation (Vf) cardiac arrest of 15 min, 15 female mongrel dogs received conventional cardiopulmonary resuscitation (CPR) for 3 min and then cardiopulmonary bypass through the femoral artery and veins (F-F bypass). Cardiac beat did not return in any dogs during the initial 3-min CPR. Spontaneous circulation was restored by defibrillation 5.2 +/- 3.8 (mean +/- SD) min after the initiation of the F-F bypass in all dogs except in one with bypass trouble. Life-threatening ventricular dysrhythmias appeared in 8 of the 14 dogs (57%). Eleven of the 14 dogs (79%) were successfully weaned from the F-F bypass. Spontaneous respiration and circulation remained stable for the subsequent 1-h observation period in 8 dog (57%). The values of cardiac output measured just before weaning from the bypass and 30 to 60 min after weaning were significantly lower than those before inducing Vf (n = 5). On the electroencephalogram, intermittent burst waves reappeared 90.0 +/- 24.7 min after the initiation of resuscitation and EEG showed continuous waves 130.7 +/- 28.1 min (n = 7) after the initiation of resuscitation. The values of blood glucose, lactate and potassium 5 to 15 min after the initiation of F-F bypass were significantly higher than those before induction of Vf, while the values of hemoglobin, hematocrit, platelet and serum protein decreased significantly (n = 14).

摘要

15只雌性杂种犬在经历15分钟的常温室颤心脏骤停后,接受了3分钟的传统心肺复苏(CPR),然后通过股动脉和静脉进行体外循环(F-F体外循环)。在最初3分钟的心肺复苏过程中,所有犬均未恢复心跳。除一只出现体外循环问题的犬外,所有犬在开始F-F体外循环后5.2±3.8(平均值±标准差)分钟通过除颤恢复了自主循环。14只犬中有8只(57%)出现危及生命的室性心律失常。14只犬中有11只(79%)成功脱离F-F体外循环。8只犬(57%)在随后1小时的观察期内自主呼吸和循环保持稳定。在脱离体外循环前及脱离后30至60分钟测得的心输出量值显著低于诱发室颤前(n = 5)。在脑电图上,复苏开始后90.0±24.7分钟出现间歇性爆发波,复苏开始后130.7±28.1分钟脑电图显示连续波(n = 7)。F-F体外循环开始后5至15分钟时的血糖、乳酸和钾值显著高于诱发室颤前,而血红蛋白、血细胞比容、血小板和血清蛋白值显著降低(n = 14)。

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