经膈肌下抬挤心脏方法对心脏停搏兔复苏的实验研究

目的 比较标准胸外按压心肺复苏(S-CPR)与经膈肌下心脏按压心肺复苏(D-CPR)对复苏循环效应的影响;评价D-CPR用于CPR的可行性.方法 健康新西兰白兔20只,经呼气末窒息8 min造成心脏停搏(CA)模型.随机分两组,每组10只,分别实施S-CPR和D-CPR;于窒息前平静5 min后开始连续记录升主动脉收缩压(AOS)和舒张压(AOD)、经皮血氧饱和度(Sp02)、右心房收缩压(RASP)和舒张压(RADP)、心电图(ECG)等直至实验结束;计算升主动脉平均动脉压(MAP)、冠状动脉灌注压(CPP);分别观察两组动物的自主循环恢复(ROSC)率及6 h存活率.结果 S-CPR组有5只、D-CPR组有8只动物获得ROSC(ROSC率分别为50%和80%,P=20.05);S-CPR组6 h存活率为40%,D-CPR组为50%.D-CPR组复苏1 rain和5 rain时AOS、AoD、MAP和CPP均高于S-CPR组(P均<0.05);D-CPR组复苏1 rain时MAP、CPP分别是其基础值的54.1%、33.4%.5 min时为60.0%、41.8%,而S-CPR组复苏1 min时AOS、AOD为基础值的37.3%、16.5%,5 min时为38.5%、17.1%#且D-CPR组ROSC后动物血流动力学较S-CPR组变化平稳.结论 D-CPR方法可产生较高的动脉血压和心排血量,并能增加实验动物的ROSC率和短期存活率.D-CPR方法优于S-CPR.

An experimental study on cardiopulmonary resuscitation by cardiac massage under diaphragmatic muscle for rabbit with cardiac arrest

Objective To compare the hemodynamic effect of standard-cardiopulmonary resuscitation (S-CPR) and of CPR by cardiac massage under the diaphragmatic muscle (D-CPR), and to evaluate the feasibility of D-CPR. Methods Twenty healthy New Zealand rabbits were randomly divided into two groups, one group receiving S-CPR (n= 10) and the other group receiving D-CPR (n=10). Cardiac arrest was induced by asphyxiation at the end expiration for 8 minutes. After the hemodynamic situation was stable for 5 minutes before asphyxiation, the readings of ascending aorta systolic pressure (AOS) and diastolic pressure (AOD), transcutaneous oxygen saturation (SpO2), right atrial systolic pressure (RASP), right atrial diastolic pressure (RADP), and electrocardiogram were recorded consecutively to the end of the experiment. The mean arterial pressure (MAP) of ascending aorta and coronary perfusion pressure (CPP) were calculated, The rate of restoration of spontaneous circulation (ROSC) and the survival rate in a short duration of 6 hours were observed. Results Five rabbits in S-CPR group and 8 in D-CPR group were successfully resuscitated and obtained ROSC (50%, 80%, P=20. 05). Six hours survival rate was 400% in S-CRP group and 500% in D-CPR group. The comparisons between the two groups on AOS, AOD, MAP and CPP respectively showed that at 1 minute and 5 minutes during resuscitation the respective variables were higher in the D-CPR group than that in the S-CPR group (all P<0. 05). Compared to the bemodynamics before asphyxiation, the MAP and CPP in the D-CPR group increased 54. 1% and 33.4% of basic value at 1 minute, and they were 60. 0% and 41.8% at 5 minutes, while the AOS and AOD in the S-CPR group only increased by an average of 37. 3% and 16.5% at 1 minute, and they were 38. 5% and 17. 1% at 5 minutes, respectively. After ROSC, the hemodynamic variations of the D-CPR rabbits were more stable than those of S-CPR rabbits. Conclusion D-CPR can provide higher arterial pressure, cardiac output, rate of ROSC and survival rate in a short period than S-CPR can induce, so that D-CPR is superior to S-CPR.