周哲人,高路

• 1:西安交通大学医院内科

摘要(Abstract)：

目的以电击致犬心室颤动建立的心搏骤停动物模型为研究对象,研究在心肺复苏(CPR)模式下犬潮气末二氧化碳分压(PETCO2)和冠状动脉灌注压(CPP)的变化及相关性。方法选健康杂种犬36只随机分为三组:4 min胸外复苏组、4 min开胸复苏组、8 min开胸复苏组。每组12只犬,雌、雄各半,致颤前及复苏过程中对PETCO2及CPP进行监测。根据自主循环恢复(ROSC)情况,比较复苏成功和复苏失败犬的CPP和PETCO2。结果 4 min胸外心肺复苏(CCCPR)时CPP与PETCO2的Pearson相关系数为0.992,P<0.05,CPP与PETCO2呈线性正相关。4 min开胸心肺复苏(OCCPR)时CPP与PETCO2的Pearson相关系数为0.937,P<0.05,CPP与PETCO2呈线性正相关。8 min OCCPR时CPP与PETCO2的Pearson相关系数为0.952,P<0.05,CPP与PETCO2呈线性正相关。4 min胸外复苏组ROSC 8只(66.7%),4 min开胸复苏组ROSC 12只(100%),8 min开胸复苏组ROSC 7只(58.3%)。在按压复苏1、2、5、10、15、20 min时,自主循环恢复组与失败组的CPP和PETCO2分别比较,两组之间差异均有统计学意义(P<0.05)。结论心肺复苏期间CPP与PETCO2关系密切,呈线性正相关,因此可以用PETCO2参数评价心肺复苏的预后效果。

关键词(KeyWords)： 心肺复苏;潮气末二氧化碳分压;冠状动脉灌注压

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 周哲人,高路

参考文献(References)：

• [1]Niemann JT,Criley JM,Posborough JP,et al.Predictive indices of successful cardiac resuscitation after prolonged arrest and experimental cardiopulmonary resuscitetion.Ann Emerg Med,1985,14:521-528.
• [2]Hazinski MF.Highlights of the 2010 American Heart Association GuideLines for CPR and ECC.USA:American Heart Association,2010:1.
• [3]European Resuscitation Council.Part 3:adult basic life support.Circulation,2000,102:1-22.
• [4]Kern KB,Ewy GA,Voorhees WD,et al.Myocardial perfusion pressure:a predictor of 24-hour survival during prolonged cardiac arrest in dogs.Resuscitation,1988,16:241-250.
• [5]Paradis NA,Martin GB,Rivers EP.Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation.J Am Med Assoc,1990,263:1106-1113.
• [6]Kolar M,Krizmaric M,Klemen P,et a1.Partial pressure of end-tidal carbon dioxide successful predicts cardiopulmonary resuscitation in the fi eld:a prospective observational study.Crit Care,2008,12:R115.
• [7]GRMEC?,KLEMEN P.Does the end-tidal carbon dioxide(EtCO2)concentration have prognostic value during out-of-hospital cardiac arrest?Eur J Emerg Med,2001,8:263-269.
• [8]Grmee S,tab K,Tusek-Bune K.Difference in end-tidal CO2between asphyxia cardiac arrest and ventricular fibrillation/pulsc—less ventrieular tachycardia cardiac arrest in the prehospital setting.Grit Care,2003,7:139-144.
• [9]张善亮,邵凤民,罗布芝,等.心肺复苏中动静脉血气分析的临床探讨.中国急救医学,1993,13:22.
• [10]马善符,郑世良,黄科昌,等.心肺复苏时呼气末CO2监测的临床意义.潍坊医学院学报,1997,19:286-287.
• [11]陈英杰,陈运立,吴贤仁,等.心肺复苏期间潮气末二氧化碳监测及临床意义.河北医学,2004,10:56-58.
• [12]顾勤,朱章华.PET CO2评价心肺复苏预后的有用指标.急诊医学,2000,9:24-25.
• [13]Paradis NA,Martin GB,Rivers EP.Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation.J Am Med Assoc,1990,263:1106-1113.
• [14]Sanders AB,Ewy GA,Bragg S,et al.Expired PCO2 as a prognostic indicator of successful resuscitation from cardiac arrest.Ann Emerg Med,1985,14:948-952.