CAJ | 학술논문

目的研究CPR的病理生理过程,探讨叹息样呼吸对CPR过程中血流动力学的影响.方法 12头北京长白猪,体质量(30±1)kg,麻醉后气管插管,机械通气,连续记录实时呼吸参数.股动脉置管测量主动脉压(AOP),并抽取动脉血;肺动脉漂浮导管置测最右心房压(RAP)及心输出量(CO).以程控电刺激制作室颤(VF)模型.VF4 min后进行标准30:2 CPR 12 min,记录相关参数.结果 CPR过程中pH,PaCO2及乳酸逐渐升高,而PaO2逐渐降低,但PaO2在整个实验过程中均大于50mmHg.10只动物出现叹息样呼吸,但随时间推移逐渐减弱;未出现叹息样乎吸的2只动物均未复苏成功.标准心外按压在多数动物均可产生大干死腔量(VD)的被动通气,但其潮气量随时间推移逐渐减少.因此人工通气在总分钟通气量中所占比例逐渐增加.CO、冠脉灌注压(CPP)与叹息样呼吸分钟通气量(MVg)呈正相关(r分别等于0.736,0.721,P＜0.01);RAP与MVg呈负相关(r=-0.744,P＜0.01).结论标准CPR能够维持机体12min的氧合;心外按压能够产生大于VD的被动通气;叹息样呼吸可以通过增加CO、CPP及降低RAP产生对自主循环的恢复产生有益的生理作用.
목적 연구CPR적병리생리과정,탐토우식양호흡대CPR과정중혈류동역학적영향.방법 12두북경장백저,체질량(30±1)kg,마취후기관삽관,궤계통기,련속기록실시호흡삼수.고동맥치관측량주동맥압(AOP),병추취동맥혈;폐동맥표부도관치측최우심방압(RAP)급심수출량(CO).이정공전자격제작실전(VF)모형.VF4 min후진행표준30:2 CPR 12 min,기록상관삼수.결과 CPR과정중pH,PaCO2급유산축점승고,이PaO2축점강저,단PaO2재정개실험과정중균대우50mmHg.10지동물출현우식양호흡,단수시간추이축점감약;미출현우식양호흡적2지동물균미복소성공.표준심외안압재다수동물균가산생대간사강량(VD)적피동통기,단기조기량수시간추이축점감소.인차인공통기재총분종통기량중소점비례축점증가.CO、관맥관주압(CPP)여우식양호흡분종통기량(MVg)정정상관(r분별등우0.736,0.721,P＜0.01);RAP여MVg정부상관(r=-0.744,P＜0.01).결론 표준CPR능구유지궤체12min적양합;심외안압능구산생대우VD적피동통기;우식양호흡가이통과증가CO、CPP급강저RAP산생대자주순배적회복산생유익적생리작용.
Objective Gasp was defined as a pathology respiration during cardiac arrest. This study was to investigate its effect on hemodynamics during CPR. Method Twelve domestic pigs, weighening (30 ± 1) kg,were anaesthetized. After tracheal intubation and mechanical ventilation, continuous respiratory variables were recorded. An artery catheter was inserted for reference blood samples and measuring aortic artery pressure (AOP).Right atrial pressure (RAP) and cardiac output (CO) were detected by Swan-Ganz catheter. Ventricular fibrillation (VF) was induced by programmed electrical stimulation instruments. After 4 minutes untreated VF, standard 30:2 CPR was done for 12 minutes and the parameters were recorded. Results pH, PaCO2 and lactic acid increased and PaO2 decreased progressively during CPR, whereas PaO2 was up to 50mmHg during the whole protocol. Gasps were observed in 10 animals, but weaken gradually; the left 2 animals with no gasp did not restore of spontaneous circulation (ROSC). Standard CPR could produce passive ventilation more than dead space (VD), but its tidal volume decreased gradually, which led to the percentage of rescue ventilation increased progressively. Positive correlations were found between CO, coronary perfusion pressure (CPP) and minute ventilation of gasps (MVg) (r was 0.736 and 0.721 respectively, both P ＜0.01); negative correlation were found between RAP and MVg (r= -0. 744, P ＜ 0.01). Conclusions Standard CPR could maintain 12 minutes oxygenation of body; compressions could produce enough passive ventilation more than VD; gasps were benefit to ROSC by increasing CO, CPP and decreasing RAP.