体外腹主动脉末端阻断对室颤猪复苏效果及脐在定位阻断位置中的价值

发布时间：2018-01-30 09:04

本文关键词： 体外腹主动脉末端阻断心肺复苏经皮电刺激诱导脐髂嵴顶点　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的探讨体外腹主动脉末端阻断对室颤性心脏骤停(CA)猪复苏效果的影响及脐在定位腹主动脉阻断位置中的价值。研究方法(1)西藏小型猪18只随机分为两组:①常规CPR组(C-CPR),②体外腹主动脉末端阻断+常规CPR组(DAAO-CPR)。采用27V直流电经皮电刺激3s诱发心室颤动(VF),经非干预间期4min后建立CA模型。C-CPR组实施常规复苏即徒手胸外按压+呼吸气囊给氧,DAAO-CPR组在常规复苏基础上辅以体外腹主动脉末端阻断,即体外腹主动脉阻断仪置于脐部正中线偏左0.5cm处,随即调节按压头予以压迫阻断腹主动脉末端,以猪右侧股动脉搏动消失作为阻断成功的标志。观察两组复苏初期冠状动脉灌注压(CPP)等血流动力学指标,记录自主循环恢复(ROSC)时间、ROSC率及72h存活率;TUNEL法检测的ROSC72h心肌细胞凋亡情况;ELISA法测定ROSC6h内cTnI血清学指标的变化;采用脑功能评分(CPC)评估ROSC后24hCA猪脑功能情况。(2)CT影像下,以腹主动脉分叉为基点,观测108例患者脐、髂嵴顶点与腹主动脉分叉的垂直距离和上下位置关系。研究结果(1)复苏初期,除CVP之外两组血流动力学指标均呈逐渐升高趋势,其中C-CPR 组 30s、60s、120s SBP 均显著低于 DAAO-CPR 组(P0.05),而 90s、150s、180s两组SBP差异无统计学意义(P0.05);C-CPR组各个时间点DBP均显著低于 DAAO-CPR 组(P0.05);除 90s 外,C-CPR 组 30s、60s、120s、150s、180s MAP显著低于DAAO-CPR组(P0.05);两组各个时间点CVP差异无统计学意义(P0.05);除 30s 外,C-CPR 组 60s、90s、120s、150s、180s CPP 显著低于 DAAO-CPR 组(P0.05);与 C-CPR 组比较,DAAO-CPR 组 ROSC所需时间更短(P0.05);两组ROSC率和72h存活率差异比较均无统计学意义(P0.05),DAAO-CPR组数值较 C-CPR组高(75.4%VS71.4%);ROSC 后72hDAAO-CPR组心肌细胞凋亡率低于C-CPR组(P0.05);ROSC后3h、6h DAAO-CPR组血清 cTnI 水平显著低于 C-CPR组(P0.05);ROSC 后 24hDAAO-CPR 组 CPC 评分低于 C-CPR 组(P0.05)。(2)脐(62.0%)多投影于腹主动脉分叉以上,髂嵴顶点(65.7%)则多在腹主动脉分叉以下,两者与腹主动脉的位置关系差异比较有统计学意义(P0.01)。在腹主动脉分叉以上,脐至腹主动脉分叉的垂直距离(BU)大于髂嵴顶点至腹主动脉分叉的垂直距离(BC)(P0.05);腹主动脉分叉以下,BU和BC差异比较无统计学意义(P0.05)。研究结论(1)在CA猪复苏初期,采用DAAO-CPR方法可以优化CPP等血流动力学指标,缩短ROSC所需时间,减轻心肌细胞损伤和凋亡,利于脑功能损伤恢复。(2)脐多投影于腹主动脉分叉上方,以脐为体表标志点,更易完全阻断血流,且可选择阻断的范围更为广泛,是进行体外腹主动脉“末端”阻断的重要体表解剖标志。
[Abstract]:Objective to investigate the effect of the end of abdominal aorta occlusion on the resuscitation of ventricular fibrillation cardiac arrest (CACA) pigs in vitro and the value of umbilical cord in locating the position of abdominal aorta occlusion. Eighteen Tibetan miniature pigs were randomly divided into two groups: 1: 1 conventional CPR group (C-CPR). 2in vitro abdominal aortic end occlusion was used to induce ventricular fibrillation (VF) in routine CPR group by 27 V direct current stimulation for 3 s. CA model. C-CPR group was established after the non-intervention interval for 4 minutes. The routine resuscitation was performed. On the basis of routine resuscitation, DAAO-CPR group was supplemented with external aortic end occlusion, that is, the external abdominal aorta blocker was placed at 0.5 cm left of the median line of the umbilical cord. The right femoral artery pulsation was taken as the sign of successful occlusion. The coronary artery perfusion pressure (CPP) was observed in the early stage of resuscitation. The ROSC rate and 72 h survival rate were recorded. Apoptosis of ROSC72h cardiomyocytes was detected by TUNEL assay. The changes of cTnI serological indexes in ROSC6h were determined by ELISA method. Brain function score (CPC) was used to evaluate the brain function of pigs in 24 hours after ROSC. The abdominal aorta bifurcation was used as the base point to observe the umbilical cord of 108 patients. The relationship between the vertex of iliac crest and the vertical distance and upper and lower position of abdominal aorta bifurcation. The results were as follows: (1) in the early stage of resuscitation, the hemodynamic indexes of the two groups except CVP showed a tendency to increase gradually. The SBP of C-CPR group was significantly lower than that of DAAO-CPR group (P 0.05) and 90 s / 150 s. There was no significant difference in SBP between the two groups at 180s (P 0.05). The DBP of C-CPR group was significantly lower than that of DAAO-CPR group at each time point (P 0.05). Except 90 s, the MAP of C-CPR group was significantly lower than that of DAAO-CPR group (P 0.05). There was no significant difference in CVP between the two groups at different time points (P 0.05). Except for 30s, the CPP of C-CPR group was significantly lower than that of DAAO-CPR group (P 0.05). Compared with C-CPR group, the ROSC time of DAAO-CPR group was shorter than that of C-CPR group (P 0.05). There was no significant difference in ROSC rate and 72h survival rate between the two groups. The value of DAAO-CPR group was higher than that of C-CPR group (75.4 vs 71.4). The apoptosis rate of cardiomyocytes in DAAO-CPR group was lower than that in C-CPR group at 72 h after ROSC. The level of serum cTnI in DAAO-CPR group was significantly lower than that in C-CPR group at 6 h after ROSC. The CPC score of DAAO-CPR group at 24 hours after ROSC was lower than that of C-CPR group (P 0.05). Most of them were below the bifurcation of the abdominal aorta, and the difference between them and the position of the abdominal aorta was statistically significant (P 0.01) and above the bifurcation of the abdominal aorta. The vertical distance from umbilical to abdominal aorta was greater than that from the apex of iliac crest to the bifurcation of abdominal aorta. There was no significant difference in BU and BC between BU and BC below the bifurcation of abdominal aorta (P 0.05). Conclusion 1) in the early stage of resuscitation of CA pigs. The DAAO-CPR method can optimize the hemodynamic indexes such as CPP, shorten the time required for ROSC, and reduce the injury and apoptosis of cardiomyocytes. It is beneficial to the recovery of brain function injury. 2) the umbilical cord is projected on the top of the abdominal aorta bifurcation. It is easier to block the blood flow completely by using the umbilical cord as the body surface marker, and the range of blocking can be more extensive. It is an important body surface anatomic marker for the end of abdominal aorta in vitro.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.78

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