兔微创气管插管模型的建立及其心肺脑复苏效果比较

发布时间：2018-03-05 04:00

本文选题：气管　切入点：心脏停搏　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景与目的对于健康成人,心脏骤停仍是导致猝死的主要原因,几乎占心源性死亡的一半。尽管相关研究很多但解决的问题很少,而院外心脏骤停(Out of hospital Cardiac Arrest,OHCA)生存率为2~11%。院内心脏骤停(In hospital Arrest,IHCA)生存率虽然较高,但也在15~22%。此外,严重的神经功能缺损发病率为30~60%,OHCA病人为10~20%。幸存者中仅3%~7%能恢复到以前的生活功能状况,其余生活质量及活动功能低劣,普遍呈昏迷或瘫痪状态。这种情况不论是对家庭还是社会医疗资源都产生了严重的负担。所以,心跳、呼吸骤停后的脑复苏就显得非常重要。目前的研究表明,脑复苏的关键在于早期脑保护。在院内施行心肺脑复苏时,气管插管是临床麻醉和复苏急救中有效通气最常用的方法,可以使患者缺氧或无氧血液变成含氧丰富的血液,通过有效的心外按压可将血液输送到全身各个脏器,尤其是大脑、心、肺、肾等。但是由于解剖和病理生理等因素,即使是严格训练的麻醉科医师,插管失败率仍达0.5%~3.5%,那么,对于各科专科医师更是一种挑战。呼吸心博骤停,关键是要及时给予有效的组织供氧,因为脑组织对缺氧环境的耐受能力最差。停止心跳后10s,脑内的可利用氧就会耗竭,大约5 min脑细胞中的ATP将耗竭。为了达到有效供氧,打开气道、保持气道通畅是基础生命支持(basic life surport,BLS)最有效的措施。在心肺脑复苏过程中,应该开放气道,保证呼吸道通畅,并及时恢复有效通气是抢救成功的关键。心肺脑复苏后发生的多器官功能损害即心脏骤停后综合征(pcas)是复苏后死亡的最主要原因之一。研究pcas模型常用心、肺、脑功能指标反映其功能变化。而心脏骤停后,采用那种气管插管方式效果最好,不同的气管插管方式是否对心肺脑复苏效果造成影响,目前研究甚少。本研究以兔心脏骤停模型为研究对象,分别比较麻醉后直接气管插管,麻醉后切开逆行气管插管和麻醉后微创气管插管后观察动脉血压变化、复苏后心、肺、脑指标变化情况和生存时间。但现有的气管插管其创伤大,气道管理困难,复苏后动物存活时间短。鉴于此,我们在原模型的气管插管基础上进行了改良,探索建立一种更加符合实际的兔气管插管心脏骤停模型。目的探索一种损伤小的兔气管插管方式,及其对心肺脑复苏效果的比较,提高心脏骤停模型质量以及为脑复苏打下坚实的基础。资料与方法选择大耳白兔30只,按随机数字表法分为三组:麻醉后直接气管插管(a组)、麻醉后切开逆向气管插管(b组)、麻醉后微创气管插管(c组),每组10只。静脉注射氯化琥珀胆碱后,在呼气末夹闭气管插管。当达到心搏骤停标准后,维持5min,然后开始进行常规心肺复苏,观察复苏前后动脉血压变化、心搏骤停后综合征发生情况(心、肺、脑)和存活时间。结果心搏骤停a、b、c组心肺复苏成功率分别为50%、60%、80%(p0.01);动物存活时间中位数(四分位数)分别为23.4h(11.6~35.8h)、62.7h(29.4~88.6h)、79.5h(40.9~118.2h)(p0.01)。结论兔心搏骤停后气管插管持续时间以微创气管插管为适宜,此模型心肺复苏成功率及复苏成功后生存率均较高,脑复苏成功,且模型稳定,可重复性好,可作为心脏骤停研究的动物模型;可为脑复苏提供可靠的动物模型基础。
[Abstract]:Background and objective for healthy adults, resulting in cardiac arrest is still the main cause of death, accounting for almost half of cardiac death. Although many related research problems but rarely, and out of hospital cardiac arrest (Out of hospital Cardiac Arrest, OHCA 2~11%.) survival rate of in-hospital cardiac arrest (In hospital, Arrest, IHCA) to survive although the rate is higher, but also in the 15~22%. in addition, the incidence of severe neurologic impairment in patients with OHCA 10~20%. 30~60%, only 3%~7% survivors can return to the state before the rest of life function, quality of life and activity function is generally inferior, coma or paralysis. This situation both had a serious burden on family or social medical resources. So, heart rate, respiratory arrest after cerebral resuscitation is very important. The present study shows that the key lies in the early cerebral cerebral resuscitation in hospital underwent heart protection. When cerebral resuscitation clinical anesthesia and tracheal intubation, is the most commonly used method of effective ventilation resuscitation, can make patients with hypoxia or anaerobic blood into oxygen rich blood through effective compressions to pump blood through the body of various organs, especially the brain, heart, lung, kidney and so on. But because of the anatomic and pathological and physiological factors, even trained anesthesiologists, intubation failure rate is still up to 0.5%~3.5%, then, is more a challenge for all physicians. Respiratory cardiac arrest, the key is to provide timely and effective oxygen delivery to the tissues, because brain tissue tolerance to hypoxia environment is the worst. Stop the heart after 10s in the brain, will use oxygen depletion, about 5 min of brain cells in the ATP will be depleted. In order to achieve effective supply of oxygen, open the airway, maintain airway patency is the basic life support (basic life, surport, BLS) the most effective measures. In the process of cardiopulmonary resuscitation, should open the airway, ensure airway patency, and timely recovery of effective ventilation is the key to success. Multiple organ dysfunction after cardiopulmonary cerebral resuscitation of cardiac arrest syndrome (PCAs) is one of the major causes of death after resuscitation. PCAs model of common heart, lung and brain the function indexes of its function. But after cardiac arrest, the effect that the best way of tracheal intubation, different tracheal intubation effects on cardiopulmonary resuscitation effect, little current research. In this study, a rabbit model of sudden cardiac arrest as the object of study, were compared directly after anesthesia and tracheal intubation, arterial blood pressure changes after anesthesia, incision and retrograde tracheal intubation and anesthesia after tracheal intubation after minimally invasive observation, after the recovery of heart, lung, brain index changes and survival time. But the existing endotracheal intubation trauma, airway management difficulties Difficult, after the recovery of animal survival time is short. In view of this, we modified the original model in tracheal intubation on the basis, explore the establishment of a more practical model of cardiac arrest in rabbit tracheal intubation. Objective to explore a way of damage small rabbit tracheal intubation, and the effect of cardiopulmonary resuscitation, improve cardiac arrest model of quality as well as the brain complex solid foundation. Soda materials and methods 30 rabbits were randomly divided into three groups: anesthesia directly after tracheal intubation (group A), anesthesia after tracheal intubation and reverse (group B), anesthesia after minimally invasive tracheal intubation (C group), each group 10. Intravenous injection of succinylcholine chloride after clamping the endotracheal intubation at the end of expiration. When reaching the standard after cardiac arrest, maintain 5min, and then start the conventional cardiopulmonary resuscitation, the changes of arterial blood pressure were observed before and after resuscitation, the occurrence of cardiac arrest syndrome after ( Heart, lung, brain) and the survival time of cardiac arrest. The results of a, B, C group the success rate of cardiopulmonary resuscitation were 50%, 60%, 80% (P0.01); the median survival time of the animal (four percentile) were 23.4h (11.6~35.8h), 62.7h (29.4~88.6h), 79.5h (40.9~118.2h) (P0.01). Conclusion the rabbit cardiac arrest after tracheal intubation duration with minimally invasive tracheal intubation is suitable, survival rates were higher in the model of cardiopulmonary resuscitation success rate and after successful resuscitation, cerebral resuscitation, and the model is stable and reproducible, can be used as animal models of cardiac arrest; can provide the basis for a reliable animal model for cerebral resuscitation.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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