LUCAS持续胸腔按压20分钟对猪冠状动脉的影响

发布时间：2019-02-13 16:03

【摘要】：背景与目的：资料显示,欧洲每年死于心跳骤停的人数约为375000,而这一数据在美国也高达275000,大部分的患者死于院外。即使是抢救成功的患者,一年存活率也低于5%。中国目前没有确切的数据,但是随着饮食习惯以及生活方式的改变,死于心跳骤停的中国人也在逐年增加。心跳骤停的抢救手段为迅速而且有效的心肺复苏。自主的心跳如不能及时恢复,则需要延长胸外按压时间以维持有效的冠状动脉及脑部的血液循环,然而那些需要延长胸外按压的患者死亡率随着按压时间的延长而增高。有研究揭示传统的人工胸外按压过程中心脏输出量只能达到正常值的20%-30%,并且人工胸外按压实施者在按压开始后约一分钟时按压效率便开始下降,四分钟后其按压效率便下降到仅为初始按压效率的30%。另外在搬运患者过程中进行有效的人工胸外按压是非常困难的,然而胸外心脏按压的中断,即使很短时间的中断也会导致重要器官失去灌注,而这些器官的灌注不足可以直接导致自主循环恢复和电除颤的成功率下降。因此,近几十年来,各种机械的自动胸外按压系统被不断研发出来。LUCAS心肺复苏机(简称LUCAS)是一部能够提供5cm深度按压及主动上提胸腔的胸外按压装置。大量的动物实验及临床资料显示,从血液循环和重要器官灌注的角度来看,LUCAS对心跳骤停患者的按压效果明显优于人工按压。但是LUCAS的机械按压对冠状动脉有无明显影响目前尚无相关研究。因此,本实验的目的是研究LUCAS持续胸外按压对猪冠状动脉功能的影响。材料与方法：体重约32kg的健康瑞典家猪16头,采用随机分组的原则分成两组：实验组和对照组,每组8头。实验组动物全麻后电刺激诱导室颤,1min后用LUCAS心肺复苏机行持续胸外按压20min,然后电除颤,除颤成功后维持麻醉状态30min,然后正中开胸并中心静脉推注2mol/L氯化钾(KCl),停跳心脏,心脏停跳成功后,取冠状动脉前降支远段1/3血管并行器官浴槽实验(organ bath)。对照组动物采用同样方法全麻,维持相同的麻醉时间,然后正中开胸并中心静脉推注KCL,取冠状动脉前降支远段1/3血管并进行organ bath实验。结果：实验组和对照组的最大冠状动脉内皮依赖性舒张(EDRmax)分别为：(96±0.94)%、(98±0.93)%,两者的差别不具有统计学意义(p0.05);舒张至50%最大收缩时P物质浓度的负对数(pEC50)分别为：7.13±0.14、7.10±0.13,两者相比也不具有统计学意义(p0.05)；冠状动脉环内径分别为1.31±0.15mm、1.27±0.19mm,两者之间的差别没有统计学意义(p0.05)。结论： LUCAS持续胸外按压20min对猪心冠状动脉内皮功能没有显著影响。
[Abstract]:Background & objective: data show that the number of deaths from cardiac arrest in Europe is about 375,000 a year, and the figure is 275,000 in the United States, with most of the patients dying outside the hospital. Even for successful patients, the one-year survival rate was lower than 5. There are no exact figures for China, but deaths from sudden cardiac arrest are increasing year by year as eating habits and lifestyle changes. Rapid and effective cardiopulmonary resuscitation (CPR) is the rescue method for cardiac arrest. If the spontaneous heartbeat does not recover in time, it is necessary to prolong the time of chest compression to maintain effective coronary artery and brain blood circulation. However, the mortality rate of those patients who need to prolong chest compression increases with the time of compression. Studies have revealed that cardiac output can only reach 20 to 30 percent of the normal value during conventional artificial chest compression, and that the pressure efficiency begins to decline about a minute after the start of the artificial chest compression. After four minutes, the pressing efficiency is reduced to only 30% of the initial pressing efficiency. In addition, it is very difficult to carry out effective external artificial chest compression in the course of transporting patients. However, the interruption of extrathoracic cardiac compression, even for a very short period of time, can lead to the loss of perfusion of important organs. Inadequate perfusion of these organs can directly lead to the recovery of autonomic circulation and the reduction of the success rate of electrical defibrillation. Therefore, in recent decades, various kinds of mechanical automatic external chest compression system has been developed. LUCAS cardiopulmonary resuscitation machine (LUCAS) is a device which can provide 5cm deep pressing and active chest lifting. A large number of animal experiments and clinical data show that from the point of view of blood circulation and vital organ perfusion, the effect of LUCAS on patients with cardiac arrest is better than that of artificial compression. However, there is no study on the effect of mechanical compression of LUCAS on coronary artery. Therefore, the purpose of this study was to study the effect of LUCAS continuous extrathoracic compression on coronary artery function in pigs. Materials and methods: sixteen healthy Swedish domestic pigs weighing about 32kg were randomly divided into two groups: experimental group and control group, 8 pigs in each group. After general anesthesia, ventricular fibrillation (VF) was induced by electrical stimulation in experimental group. After 1min, LUCAS cardiopulmonary resuscitation machine was used for 20 min, then electrical defibrillation was performed. After defibrillation was successful, anesthesia was maintained for 30 min, then median thoracotomy was opened and 2mol/L potassium chloride (KCl), was injected into the central vein. After cardiac arrest, the distal segment of the anterior descending coronary artery was taken from the coronary artery and the organ bath test (organ bath). Was performed on the distal segment of the anterior descending coronary artery. The control group was treated with the same general anesthesia and maintained the same anesthesia time. Then KCL, was injected into the central vein of the central vein and the anterior descending branch of coronary artery was taken for 1 / 3 of the distal segment of the coronary artery and the organ bath experiment was carried out. Results: the maximal endothelium-dependent (EDRmax) of the experimental group and the control group were (96 卤0.94)% and (98 卤0.93)%, respectively. The difference between the two groups was not statistically significant (p0.05). The negative logarithm (pEC50) of substance P concentration was 7.13 卤0.147.10 卤0.13 when diastolic to 50% maximal contraction, and there was no significant difference between the two groups (p0.05). The diameter of coronary ring was 1.31 卤0.15 mm and 1.27 卤0.19 mm, respectively. There was no significant difference between them (p0.05). Conclusion: LUCAS has no significant effect on coronary endothelial function of porcine heart.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R459.7

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