CAJ | 학술논문

目的：探讨插入式腹主动脉按压心肺复苏（IAAC-CPR）对心搏骤停兔心肺脑复苏的效果。方法健康新西兰大白兔10只，雌雄不拘，按随机数字表法分为传统胸外按压心肺复苏（CC-CPR）组和IAAC-CPR组，每组5只。经颈静脉快速推注冰氯化钾并夹闭气管导管制备心搏骤停模型；心搏骤停3 min后开始实施心肺复苏（CPR），CC-CPR组为呼吸机辅助通气+胸外按压；IAAC-CPR组为呼吸机辅助通气+胸外按压+腹主动脉按压。观察CPR过程中血流动力学和脑皮质血流的变化；记录自主循环恢复（ROSC）时间，观察动物24 h生存情况、24 h神经功能评分及腹部器官情况等。结果 IAAC-CPR组复苏后30、60、90、120 s时脑血流量（CBF，PU值）及平均动脉压（MAP，mmHg，1 mmHg＝0.133 kPa）均明显高于CC-CPR组（CBF 30 s：16.1±6.0比7.8±2.2，60 s：91.6±11.8比57.3±23.2，90 s：259.9±74.9比163.6±50.3，120 s：301.5±60.5比208.4±23.8；MAP 30 s：46.4±9.4比31.4±8.7，60 s：55.8±13.8比34.0±11.5，90 s：61.2±11.5比38.2±10.1，120 s：63.6±11.8比40.2±10.2；均P＜0.05）。与CC-CPR组比较，IAAC-CPR组ROSC所需时间明显缩短（s：182.0±59.0比312.6±86.6，t＝2.787，P＝0.024），24 h神经功能评分明显下降（分：2.4±1.7比4.6±0.6，t＝2.974，P＝0.023）；而复苏成功率（80.0%比60.0%，χ2＝0.000，P＝1.000）、24 h存活率升高（80.0%比40.0%，χ2＝0.417，P＝0.519），但差异无统计学意义。ROSC后24 h尸解动物均未发现肝脏损伤。结论在心搏骤停兔复苏早期，IAAC-CPR较CC-CPR取得了更好的脑血流灌注，明显减轻了心搏骤停兔的神经系统功能损伤，且无腹部器官损伤。
목적：탐토삽입식복주동맥안압심폐복소（IAAC-CPR）대심박취정토심폐뇌복소적효과。방법건강신서란대백토10지，자웅불구，안수궤수자표법분위전통흉외안압심폐복소（CC-CPR）조화IAAC-CPR조，매조5지。경경정맥쾌속추주빙록화갑병협폐기관도관제비심박취정모형；심박취정3 min후개시실시심폐복소（CPR），CC-CPR조위호흡궤보조통기+흉외안압；IAAC-CPR조위호흡궤보조통기+흉외안압+복주동맥안압。관찰CPR과정중혈류동역학화뇌피질혈류적변화；기록자주순배회복（ROSC）시간，관찰동물24 h생존정황、24 h신경공능평분급복부기관정황등。결과 IAAC-CPR조복소후30、60、90、120 s시뇌혈류량（CBF，PU치）급평균동맥압（MAP，mmHg，1 mmHg＝0.133 kPa）균명현고우CC-CPR조（CBF 30 s：16.1±6.0비7.8±2.2，60 s：91.6±11.8비57.3±23.2，90 s：259.9±74.9비163.6±50.3，120 s：301.5±60.5비208.4±23.8；MAP 30 s：46.4±9.4비31.4±8.7，60 s：55.8±13.8비34.0±11.5，90 s：61.2±11.5비38.2±10.1，120 s：63.6±11.8비40.2±10.2；균P＜0.05）。여CC-CPR조비교，IAAC-CPR조ROSC소수시간명현축단（s：182.0±59.0비312.6±86.6，t＝2.787，P＝0.024），24 h신경공능평분명현하강（분：2.4±1.7비4.6±0.6，t＝2.974，P＝0.023）；이복소성공솔（80.0%비60.0%，χ2＝0.000，P＝1.000）、24 h존활솔승고（80.0%비40.0%，χ2＝0.417，P＝0.519），단차이무통계학의의。ROSC후24 h시해동물균미발현간장손상。결론재심박취정토복소조기，IAAC-CPR교CC-CPR취득료경호적뇌혈류관주，명현감경료심박취정토적신경계통공능손상，차무복부기관손상。
Objective To explore the effect of the interrupted abdominal aorta compression after cardiopulmonary resuscitation (IAAC-CPR)on cardiopulmonary cerebral resuscitation in a rabbit model of cardiac arrest (CA). Methods According to the random number table,10 New Zealand rabbits of both genders were equally divided into the chest compression-cardiopulmonary resuscitation (CC-CPR) group or IAAC-CPR group ,with 5 rabbits in each group. CA model was reproduced by injection of iced-potassium chloride into the jugular vein and obstruction of trachea to produce asphyxia. CA was maintained for 3 minutes before cardiopulmonary resuscitation (CPR). CC-CPR was performed with assisted ventilation+chest compression,while IAAC-CPR was performed by the way of assisted ventilation + chest compressions + compressions on abdominal aorta. The hemodynamics and cerebral cortex blood flow were observed during resuscitation. Time of return of spontaneous circulation (ROSC),24-hour survival rates,and scores of neurological function,and situation of abdominal organs were recorded. Results At 30, 60,90 and 120 seconds after CPR,the cerebral blood flow (CBF,PU value)and mean arterial pressure(MAP, mmHg,1 mmHg=0.133 kPa)of IAAC-CPR group were significantly higher than those of CC-CPR group(CBF 30 seconds:16.1±6.0 vs. 7.8±2.2,60 seconds:91.6±11.8 vs. 57.3±23.2,90 seconds:259.9±74.9 vs. 163.6± 50.3,120 seconds:301.5 ±60.5 vs. 208.4 ±23.8;MAP 30 seconds:46.4 ±9.4 vs. 31.4 ±8.7,60 seconds:55.8 ± 13.8 vs. 34.0±11.5,90 seconds:61.2±11.5 vs. 38.2±10.1,120 seconds:63.6±11.8 vs. 40.2±10.2,all P<0.05). Compared with CC-CPR group,in IAAC - CPR group,the time necessary for ROSC was obviously shortened (seconds:182.0 ±59.0 vs. 312.6 ±86.6,t=2.787,P=0.024),24-hour nerve function score was significantly lowered(2.4±1.7 vs. 4.6±0.6,t=2.974,P=0.023). The successful recovery rate(80.0%vs. 60.0%,χ2=0.000, P =1.000)and 24-hour survival rate (80.0% vs. 40.0%,χ2=0.417,P =0.519)were significantly increased,but without statistical significance. No liver damage was found at 24 hours after ROSC. Conclusion In the early recovery of CA in rabbit,IAAC-CPR can result in better cerebral blood flow perfusion as compared with CC-CPR,and it significantly reduced damage to the nervous system function without producing abdominal organ damage.