摘要
目的 对心搏骤停心肺复苏（CPR）后自主循环恢复（ROSC）模型猪采用多巴胺升压,观察不同灌注条件对氧代谢的影响及神经功能恢复结果.方法 心室纤颤（VF）前将猪右股静脉连接连续心排血量监测仪,左颈内静脉置管并放置电极到右心室,分别行主动脉、颈动脉置管,采用电击致12头实验猪心搏骤停,VF 4 min后进行CPR,达到ROSC,按随机数字表法均分为高灌注组和正常灌注组.两组在4 h内均给予15 ml·kg-1·h-1生理盐水补液;高灌注组同时给予多巴胺持续静脉泵入升压,使平均动脉压（MAP）维持在复苏后基础血压的130%左右.于ROSC基础状态（0 h）及ROSC后0.5、1、2、4 h记录各组动物血流动力学参数并计算氧代谢各指标;24 h进行神经系统功能评价.结果 与正常灌注组比较,高灌注组ROSC 0.5、1、2、4 h氧输送量（DO2）、氧消耗量（VO2）明显升高[DO2（ml/min）：556±43比375±25、660±56比381±53、674±53比362±44、685±44比400±38,VO2（ml/min）：288±35比191±13、260±37比204±38、223±27比169±21、212±19比163±15,P＜0.05或P＜0.01];ROSC 1、2、4 h氧摄取率（ERO 2）明显下降[（39±4）%比（53±3）%、（33±2）%比（47±1）%、（31±3）%比（41±3）%,均P＜0.05];颈动脉血氧分压（PaO2）明显升高,但颈动脉血氧饱和度（SaO2）无差异;ROSC 0.5、1、2、4 h混合静脉血氧分压（PvO2,mm Hg,1 mm Hg=0.133 kPa）明显升高（38±4比33±1、42±2比36±2、40±2比36±2、43±2比38±1,P＜0.05或P＜0.01）;ROSC 1、2、4 h混合静脉血氧饱和度（SvO2）和混合静脉血-颈动脉血乳酸含量差（PCLac）均升高[SvO2：0.60±0.04比0.45±0.03、0.66±0.02比0.52±0.01、0.68±0.03比0.58±0.03,PCLac（mmol/L）：1.2±0.2比0.7±0.4、1.0±0.3比0.6±0.2、1.1±0.2比0.5±0.2,P＜0.05或P＜0.01];颈动脉氧含量（CAO2）升高,颈动-静脉氧含量差（CAvO2）、脑组织氧摄取率（C-ERO2）下降,颈动-静脉血乳酸含量差（VALac）升高.ROSC 24 h高灌注组6头猪均达到脑功能评分（CPC）1级;正常灌注组存活4头,其中3头达到CPC 2级,1头达到CPC 1级（P＜0.05）.结论 在VF致心搏骤停模型猪ROSC后应用多巴胺升压,可以提高主动脉灌注压,改善全身和大脑灌注,对氧代谢、早期脑复苏有益.
Objective To investigate the impact of different hemoperfusion conditions on oxygen metabolism and the neurological function of swine with restoration of spontaneous circulation （ROSC） after cardiac arrest （CA） following cardiopulmonary resuscitation （CPR） with blood pressure boosted with dopamine.Methods Swan-Ganz catheter was inserted through the right femoral vein, and linked with a continuous cardiac output monitor before ventricular fibrillation （VF）.An electrode cable was placed in the right ventricle through left internal jugular vein.Then different catheters were positioned in the aorta and carotid artery successively to consecutively record the indexes of hemodynamics.VF was induced in 12 pigs by programmed electrical stimulation equipment.All animals underwent 4 minutes of untreated VF before CPR by two professional doctors of emergency department.Then all the 12 successfully resuscitated pigs were randomly divided into hypertransfusion group and normal perfusion group with random digits table.Every pig in both groups was given an infusion of normal saline of 15 ml· kg-1 · h-1 within 4 hours.But in the hypertransfusion group, dopamine was administered to pigs to raise the mean arterial pressure （MAP） to about 130% of the baseline.All the pigs were monitored for 4 hours.The hemodynamics and oxygen metabolism parameters were recorded at ROSC 0, 0.5, 1, 2 and 4 hours.At last, animals were evaluated at 24 hours after resuscitation and a swine cerebral performance category （CPC） score was given.Results Compared with normal perfusion group, the hypertransfusion group showed higher oxygen delivery （DO2）and oxygen consumption （VO2） at ROSC 0.5, 1, 2 and 4 hours[DO2（ml/min）： 556±43 vs.375±25,660±56 vs.381±53, 674±53 vs.362±44, 685±44 vs.400±38; VO2（ml/min）： 288±35 vs.191±13,260±37 vs.204±38, 223±27 vs.169±21, 212±19 vs.163±15, P〈0.05 or P〈0.01]; the oxygen extraction ratio （ERO2） was decreased at ROSC 1, 2, 4 hours[（39±4）% vs.（53±3）%, （33±2）% vs.（47±1）%, （31±3）% vs.（41±3）%, all P〈0.05]; carotid artery blood oxygen partial pressure （PaO2）was increased, but saturation of blood oxygen （SaO2） was not increased; mixed venous blood oxygen partial pressure （P-Vo2, mm Hg, 1 mm Hg=0.133 kPa） was increased at ROSC 0.5, 1, 2 and 4 hours （38±4 vs.33±1, 42±2 vs.36±2, 40±2 vs.36±2, 43±2 vs.38±1, P〈0.05 or P〈0.01）; mixed venous blood oxygen saturation （S-Vo2） and the difference between arterial and venous blood lactate （PCLac） were both increased at ROSC 1, 2, 4 hours[S-Vo2 ： 0.60±0.04 vs.0.45±0.03, 0.66±0.02 vs.0.52±0.01, 0.68±0.03vs.0.58±0.03; PCLac （mmol/L）： 1.2±0.2 vs.0.7t0.4, 1.0±0.3 vs.0.6±0.2, 1.1±0.2 vs.0.5±0.2, P〈0.05 or P〈0.01]; arterial blood oxygen content （CAO2） was increased, the difference of oxygen content between arterial and venous blood （CAvO2） and cerebral oxygen extraction ratio （C-ERO2）were decreased, the difference between arterial and venous blood lactate （VALac） was increased.CPC score class 1 was found in 6 pigs in the hypertransfusion group at ROSC 24 hours, CPC score class 2 was found in 3 pigs and 1 pig had CPC score class 1 among 4 pigs in normal perfusion group （P〈0.05）.Conclusion In this swine model of CPR for VF, dopamine administration could elevate the perfusion pressure of the aorta in the successfully resuscitated animals.Systemic perfusion, cerebral perfusion and oxygen metabolism were improved too.So dopamine was beneficial in early cerebral resuscitation.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2010年第11期656-659,共4页
Chinese Critical Care Medicine
基金
国家自然科学基金项目（30972863）
首都医学发展科研基金资助项目（2005-1006）
关键词
心搏骤停
心肺复苏
多巴胺
氧代谢
猪
Cardiac arrest
Cardiopulmonary resuscitation
Dopamine
Oxygen metabolism
Pig
