主动脉弓输血在失血性心脏骤停兔复苏时对血流动力学的影响

doi:10.3969/j.issn.1002-1949.2018.05.014

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摘要目的比较失血性心脏骤停兔复苏过程中，主动脉弓快速输血与中心静脉快速输血对冠状动脉灌注压和复苏效果的不同影响。方法经股动、静脉联合快速放血构建失血性心脏骤停兔模型。45只新西兰兔随机分为三组（每组n=15）：①主动脉弓输血联合胸外按压组（AAT组）; ②中心静脉输血联合胸外按压组（CVT组）; ③单纯主动脉弓输血组（SAAT组）。维持15 min心脏骤停状态后给予复苏。复苏过程予以胸外按压联合经股动脉置管至主动脉弓快速自体血回输（AAT），或股静脉置管至下腔静脉的中心静脉快速输血（CVT）。SAAT组单纯给予主动脉弓快速输血、不联合胸外按压。全程连续记录血流动力学指标（SBP、DBP、MAP和CVP），取不同时间点计算冠状动脉灌注压（CPP）进行对比分析，并比较自主循环恢复（ROSC）后6 h生存情况。结果 45只新西兰兔平均失血（79.18±11.79）mL后成功构建失血性心脏骤停兔模型。复苏阶段，在输血的第1、2、3分钟时间点，各组CPP分别为AAT组(61.24±33.00)mm Hg，(75.97±33.72)mm Hg，(73.17±32.74)mm Hg；CVT组(23.72±16.53)mm Hg，(27.25±21.10)mm Hg，(30.22±19.13)mm Hg；SAAT组(50.32±21.45)mm Hg，(60.93±25.07)mm Hg，(65.65±25.26)mm Hg，组间差异有统计学意义(均P<0.001)。在ROSC后第10、20、30分钟时间点，各组CPP分别为AAT组(92.75±25.64)mm Hg，(90.53±26.07)mm Hg，(86.47±20.83)mm Hg；CVT组(62.36±13.14)mm Hg，(62.94±11.75)mm Hg，(61.06±15.22)mm Hg；SAAT组(81.94±16.16)mm Hg，(84.82±8.92)mm Hg，(84.69±10.57)mm Hg，差异有统计学意义（P=0.004，P=0.003，P=0.001）。各组动物ROSC率分别为AAT组（12/15）80.0%、CVT组（10/15）66.7%、SAAT组（12/15）80.0%，差异无统计学意义(P=0.618)。ROSC后6 h，中位生存时间分别为：AAT组(5.0±0.41)h、CVT组(3.0±0.78)h、SAAT组(4.0±0.34)h，差异有统计学意义(P=0.027)。结论失血性心脏骤停兔复苏时，经主动脉弓快速输血较经中心静脉快速输血产生更高的CPP，并提高了中位生存时间。

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关键词 ：失血, 心脏骤停 (CA), 主动脉, 输血, 冠状动脉灌注压（CPP）

基金资助:广东省科技计划项目（2014A020212192）

通讯作者: 武钢(1963-), 男，硕士生导师，副主任医师，副教授，急诊医学教研室主任，急诊科副主任， E-mail:wugang_wugang@126.com。

作者简介: 郑汝钢（1982-），男，硕士研究生，主治医师，现工作单位南方医科大学第五附属医院急诊科, E-mail:zhrugang@Foxmail.com。

引用本文:

郑汝钢，张旻海，菅洪健，梁国栋，钟涛，武钢. 主动脉弓输血在失血性心脏骤停兔复苏时对血流动力学的影响[J]. 中国急救医学, 2018, 38(5): 437-.
Zheng Ru-gang, Zhang Min-hai, Jian Hong-jian, Liang Guo-dong, Zhong Tao, Wu Gang. Effect of rapid blood transfusion through aortic arch on hemodynamics during resuscitation in rabbits with exsanguination cardiac arrest. Chinese Journal of Critical Care Medicine, 2018, 38(5): 437-.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.05.014 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I5/437

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