摘要
目的比较短时程亚低温对长时间室颤家猪短期复苏预后的影响。方法采取体质量34—36kg左右健康雄性种猪14头，通过右心室致颤电极诱发室颤并维持11min，之后采取人工胸外按压及球囊面罩通气，按压通气比为30：2，每2min轮换操作者。复苏6min后给予120J双向波除颤，若未能获得自主循环恢复（retum of spontaneous circulation，ROSC），继续给予心肺复苏及必要时电除颤。连续复苏12min仍无ROSC认为复苏失败。对ROSC家猪，随机（随机数字法）分为常温组（normothermia group，NT）及复合降温组（combined hypothermia group，CH）。CH组立即给予4℃生理盐水静脉输注并联合体表物理降温，在120min内将核心体温降至32～34℃并维持2h后主动复温，2h将体温升至基础体温水平。记录两组家猪致颤前基础状态下血流动力学、血气及乳酸。记录ROSC后心输出量、心率、核心体温变化。每24h评估动物神经功能直至观察终点。组间比较采用Fisher检验或方差分析，以P〈0．05为差异有统计学意义。结果两组动物基础状态下体质量、平均动脉压、心输出量、pH、呼气末二氧化碳水平、血乳酸水平差异均无统计学意义（P〉0．05）。在复苏过程中，两组动物在总复苏时间、首次除颤成功率、ROSC比例、首次除颤ROSC比例、总除颤次数及肾上腺素用量差异均无统计学意义（P〉0．05）。存活时间上，CH组明显长于NT组[（96．00±0．00）h vs．（49．71±43．65）h，P=0．031]，同时NT组96h生存率亦高于NT组，差异有统计学意义（P〈0．05）。神经功能方面，CH组在复苏后96h内各时间段均优于NT组，差异有统计学意义（P〈0．05）。结论即使2h短时程的亚低温，也可以明显改善11min室颤家猪的短期复苏预后。
Objective To investigate the resuscitation outcome after a short period of mild hypothermia in porcine model of prolonged ventrieular fibrillation （VF）. Methods Fourteen male healthy domestic swine weighting 34 to 36 kg were used. VF was induced electrically and maintained untreated for 11 mins, followed by manual cardiopulmonary resuscitation （CPR） procedure. Two investigators initiated chest compression and bag-valve mask ventilation in pattern of 2 min rotation. A biphasic wave of 120 J electric defibrillation （ED） was attempted 6 mins after CPR. If there was no return of spontaneous circulation （ROSC）, CPR was restored and ED was delivered when necessarily. Resuscitation was considered unsuccessful if absence of ROSC for 12 mins. However, if ROSC occurred, animals were randomly （random number） diveded into normothermia （NT） group and hypothermia treatment （CH） group. Animals in CH group were immediately cooled by using intravenous infusion of ice-cold saline and surface cooling. Core temperature was reduced to 32 -34 degrees centigrade within 120 rains and maintained at this level for 2 h. Active rewarming was completed within 2 h until baseline body temperature was reached. Data of hemodynamic variables, blood-gas analysis and blood lactate before VF of two groups were recorded. Meawhile, cardiac output （CO）, heart rate and Tc after ROSC were recorded. Neurological defect scores （NDS） were evaluated every 24 h until 96 h after ROSC. Variables were compared using either Fisher test or repeated measures analysis of variance, followed by Bonferroni for multiple comparisons. A two-sided P value 〈 0. 05 was regarded statistically significant. Results There was no significant difference in body weight, mean arterial pressure, CO, pH, pressure of end-tidal carbon dioxide （ETCO2） and lactate between groups before VF. In the period of CPR, there were also no significant difference in total resuscitation time, first shock success rate, ROSC rate, shock ROSC rate, total number
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2016年第1期22-27,共6页
Chinese Journal of Emergency Medicine
基金
国家自然科学基金青年科学基金（81000823）
东莞市社会科技发展项目（2014108101013）
关键词
心肺复苏
亚低温
短时程
复苏预后
Cardiopulmonary resuscitation
Mild hypothermia
Short duration
Resuscitation outcome
