【摘要】：心臟驟停(Cardiac arrest,CA)是臨床最急危的重癥之一,隨著醫(yī)療服務(wù)體系的優(yōu)化和心肺復(fù)蘇的普及推廣,CA發(fā)生后,自主循環(huán)恢復(fù)(Return of spontaneous circulation,ROSC)率有一定的提高。ROSC后早期快速、簡(jiǎn)便、準(zhǔn)確的獲得血流動(dòng)力學(xué)相關(guān)指標(biāo),可指導(dǎo)優(yōu)化臨床治療。由于心臟驟停臨床過(guò)程的特殊性,臨床研究受多種因素干擾,建立合理科學(xué)簡(jiǎn)便的動(dòng)物模型,對(duì)深入研究其病理生理過(guò)程很有必要。脈搏指示連續(xù)心輸出量(Pulse indicator continuous cardiac output,Pi CCO)監(jiān)測(cè)儀是一種簡(jiǎn)便、微創(chuàng)、監(jiān)測(cè)血流動(dòng)力學(xué)參數(shù)的工具,但是作為一項(xiàng)有創(chuàng)監(jiān)測(cè)目前在心臟驟停自主循環(huán)恢復(fù)后的應(yīng)用仍然受諸多客觀因素制約。床旁超聲在急危重癥的應(yīng)用越發(fā)普及,通過(guò)超聲檢查亦可簡(jiǎn)便快捷的獲得一些心臟功能相關(guān)的動(dòng)力學(xué)指標(biāo),查閱國(guó)內(nèi)外相關(guān)文獻(xiàn),并未發(fā)現(xiàn)關(guān)于Pi CCO和超聲對(duì)比監(jiān)測(cè)心臟驟停自主循環(huán)恢復(fù)早期血流動(dòng)力學(xué)的研究。本研究用室顫法建立家兔CA模型,分別用Pi CCO和心臟超聲監(jiān)測(cè)家兔心臟驟停模型復(fù)蘇早期的心臟功能變化,評(píng)估二者部分測(cè)量指標(biāo)的一致性和相關(guān)性。篩選適宜的檢查方法,為臨床上指導(dǎo)CA患者ROSC后的血流動(dòng)力學(xué)優(yōu)化治療提供參考。目的探討室顫法家兔心臟驟停模型復(fù)蘇早期心臟功能變化,并用Pi CCO與心臟超聲測(cè)量相關(guān)指標(biāo),評(píng)估其相關(guān)性。方法30只健康家兔經(jīng)皮電刺激室顫法制備心臟驟停模型,觀察復(fù)蘇前后家兔生命體征及心電圖的變化,記錄自主循環(huán)恢復(fù)時(shí)間,記錄復(fù)蘇成功率及家兔6h存活率。于造模開(kāi)始前(基礎(chǔ)狀態(tài))(t0)、ROSC即刻(t1)、ROSC 15min(t2)、ROSC60min(t3)、ROSC 120min(t4)、ROSC 6h(t5),記錄Pi CCO測(cè)得心排血量(Cardiac output,CO)、全心舒張末血容量指數(shù)(Global end diastolic volume index,GEDVI、脈搏連續(xù)心輸出量(Pulse continuous cardiac output,PCCO)、外周血管阻力指數(shù)(Systemic vascular resistance index,SVRI);心臟超聲測(cè)得的每搏出量(stroke volume,SV)、左室前后徑(Left Ventricular diameter,LVd)右室前后徑(Right Ventricular diameter,RVd)、左室射血分?jǐn)?shù)(Left Ventricular Ejection Fractions,LVEF),比較相對(duì)應(yīng)指標(biāo)的相關(guān)性,自主循環(huán)恢復(fù)6h后處死家兔,取心臟病理標(biāo)本進(jìn)行HE染色,觀察心臟驟停模型自主循環(huán)恢復(fù)早期的心臟病理變化。結(jié)果1.模型的復(fù)蘇結(jié)果給予5s的30V交流電刺激后,30只家兔均可誘發(fā)VF,但很快恢復(fù)室上性心律,再給予加大交流電刺激及延長(zhǎng)電刺激時(shí)間后,實(shí)驗(yàn)家兔均成功誘導(dǎo)CA,CA成功率100%,CA誘導(dǎo)的時(shí)間為68.5±9.1s,此時(shí)心電圖表現(xiàn)為VF(25,83%)、PEA(3,10%)、ASY(2,7%),CA持續(xù)5min后開(kāi)始進(jìn)行CPR時(shí),30只家兔中,21只家兔的心電圖仍表現(xiàn)為VF(21,70%),有2只家兔的心電圖由VF轉(zhuǎn)為PEA,2只由VF轉(zhuǎn)為ASY。CPR后,4只家兔(CPR時(shí)心電圖分別為2只PEA、2只ASY,)未復(fù)蘇成功,成功率為86.67%(26/30),自主循環(huán)恢復(fù)時(shí)間為210.9±21.32s。1只家兔自主循環(huán)恢復(fù)后30min,心電圖轉(zhuǎn)為VF,給予再次復(fù)蘇,復(fù)蘇未成功。其他只家兔均存活至ROSC6h,6h生存率96.15%(25/26)。造模前MAP為87.97±1.34mm Hg,降至20mm Hg時(shí)間為70.8±6.2S,開(kāi)始CPR時(shí)MAP為10.66±3.67 mm Hg。心肺復(fù)蘇后MAP變化明顯,ROSC即刻為112.52±16.75 mm Hg,15 min后下降維持在68.21±6.68 mm Hg。造模前心率(HR)為212.76±8.34次/分,ROSC即刻為253.16±11.23次/分,而后維持在較高水平。2.兩種監(jiān)測(cè)方法結(jié)果t0、t1、t2、t3、t4、t5時(shí)利用Pi CCO熱稀釋法測(cè)量的CO與心臟超聲測(cè)量的CO呈顯著正相關(guān),利用脈搏輪廓法與心臟彩超測(cè)量的CO呈正相關(guān)。測(cè)得的GEDVI與LVd,GEDVI與RVd均有較高的相關(guān)性。t0、t1、t2、t3、t4、t5時(shí),Pi CCO熱稀釋法與心臟超聲測(cè)得的CO偏倚均在可接受的誤差范圍之內(nèi),Pi CCO熱稀釋法與心臟超聲測(cè)得的CO值具有一致性。t1、t2、t3、t5,表示Pi CCO脈搏輪廓法與心臟超聲測(cè)得的CO在一致性好。t4時(shí),Pi CCO脈搏輪廓法測(cè)得的CO值心臟超聲測(cè)量值偏向平均差異值直線一側(cè),此時(shí)Pi CCO脈搏輪廓法測(cè)得的CO與心臟超聲測(cè)得的CO在一致性差。3.心肌病理表現(xiàn)家兔心室肌肉病在光學(xué)顯微鏡下可見(jiàn):心肌纖維排列紊亂,發(fā)生局部壞死。部分細(xì)胞橫紋消失,細(xì)胞質(zhì)紅染,,部分細(xì)胞質(zhì)內(nèi)可見(jiàn)空泡,存在炎性細(xì)胞浸潤(rùn)和紅細(xì)胞滲出。結(jié)論1.家兔心臟驟停自主循環(huán)恢復(fù)60min后心臟收縮射血功能降低,有效循環(huán)血量減少。2.心臟超聲可實(shí)時(shí)、動(dòng)態(tài)地進(jìn)行心臟功能監(jiān)測(cè),指導(dǎo)心臟驟停自主循環(huán)恢復(fù)早期血流動(dòng)力學(xué)的優(yōu)化,改善預(yù)后。
[Abstract]:Cardiac arrest (CA) is one of the most critical clinical symptoms. With the optimization of medical service system and the popularization of cardiopulmonary resuscitation, the rate of automatic circulation recovery (ROSC) has been improved after the occurrence of CA. Due to the particularity of the clinical process of cardiac arrest, clinical research is interfered by many factors. It is necessary to establish a reasonable, scientific and simple animal model for further study of its pathophysiological process. As a tool for monitoring hemodynamic parameters, it is still restricted by many objective factors. Bedside ultrasonography is becoming more and more popular in critical illness. Through ultrasonography, some cardiac function-related dynamic indexes can be obtained easily and quickly. In this study, a rabbit model of CA was established by ventricular fibrillation, and the changes of cardiac function in the early stage of resuscitation were monitored by Pi CCO and echocardiography respectively. Objective To investigate the changes of cardiac function in rabbits with ventricular fibrillation and cardiac arrest in early stage of resuscitation, and to evaluate the correlation between Pi CCO and echocardiography. Cardiac arrest model was established by ventricular fibrillation. The vital signs and electrocardiogram of rabbits were observed before and after resuscitation. The recovery time of spontaneous circulation, the success rate of resuscitation and the survival rate of rabbits at 6 hours were recorded. Cardiac output (CO), global end diastolic volume index (GEDVI), pulse continuous cardiac output (PCCO), peripheral vascular resistance index (SVRI), stroke volume (SV), left ventricular anterior and posterior diastolic diameter (Le) FT Ventricular diameter (LVd), right ventricular diameter (RVd) and left ventricular ejection fractions (LVEF) were compared. Rabbits were sacrificed 6 hours after recovery of spontaneous circulation. Heart samples were stained with HE to observe the early recovery of spontaneous circulation in cardiac arrest model. Result 1. The resuscitation of the model could induce VF in 30 rabbits after 5 seconds of 30 V AC stimulation, but the supraventricular rhythm could be restored quickly. After increasing AC stimulation and prolonging electrical stimulation time, CA was successfully induced in all rabbits. The success rate of CA was 100%, and the induction time of CA was 68.5 [9.1 s]. At this time, ECG showed VF (25. Of the 30 rabbits, 21 still showed VF (21,70%), 2 changed from VF to PEA, 2 from VF to ASY. After CPR, 4 rabbits (2 PEA and 2 ASY respectively at CPR) failed to recover successfully (86.67% (26/30), and spontaneous circulation was restored successfully (26/30). The other rabbits survived to 6 hours of ROSC, and the 6-hour survival rate was 96.15%(25/26). The MAP before modeling was 87.97 (+1.34 mm Hg) and decreased to 70.8 (+6.2 S) for 20 mm Hg. At the beginning of CPR, the MAP was 10.66 (+3.67 mm Hg). The heart rate (HR) was 212.76+8.34 beats/minute before modeling, and the ROSC was 253.16+11.23 beats/minute immediately before modeling, and then maintained at a higher level. There was a significant positive correlation between pulse profile and CO measured by color Doppler echocardiography. There was a high correlation between GEDVI and LVd, GEDVI and RVd. Consistency. t1, t2, t3, t5, indicating that Pi CCO pulse contour method and cardiac ultrasound measured CO in good consistency. t4, Pi CCO pulse contour method measured CO value of cardiac ultrasound measured bias to the linear side of the average difference, at this time Pi CCO pulse contour method measured CO and cardiac ultrasound measured CO in poor consistency. 3. Myocardial pathological performance of rabbit ventricular myocardium The myocardial fibers were disordered and necrosis was observed under the light microscope. Some of the myocardial fibers disappeared, the cytoplasm was red stained, vacuoles were found in some cytoplasm, inflammatory cell infiltration and erythrocyte exudation were observed. Conclusion 1. The systolic and ejective function of the heart was decreased and the effective circulatory blood volume was decreased 60 minutes after the recovery of autonomic circulation after cardiac arrest in rabbits. Less. 2. Echocardiography can monitor cardiac function in real time and dynamically, guide the optimization of hemodynamics and improve prognosis in the early recovery of autonomic circulation after cardiac arrest.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R459.7;R-332

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 肖婷婷;帕力達(dá)·克立木;余丹;;木犀草素對(duì)大鼠腦缺血再灌注損傷及自體神經(jīng)干細(xì)胞的影響[J];中國(guó)生化藥物雜志;2017年03期

2 邢孔彬;;對(duì)心臟驟�；颊呤褂眯姆螐�(fù)蘇機(jī)進(jìn)行心肺復(fù)蘇的效果分析[J];當(dāng)代醫(yī)藥論叢;2017年03期

3 楊志燕;黃天寶;張國(guó)英;;急診科心肺復(fù)蘇預(yù)后及相關(guān)因素分析[J];重慶醫(yī)科大學(xué)學(xué)報(bào);2016年12期

4 洪太葉;;異丙酚對(duì)顱腦手術(shù)患者腦血流及代謝的影響[J];醫(yī)學(xué)理論與實(shí)踐;2016年21期

5 劉勝中;郭應(yīng)強(qiáng);;脈搏指示連續(xù)心輸出量監(jiān)測(cè)技術(shù)及其在心臟外科的應(yīng)用進(jìn)展[J];實(shí)用醫(yī)院臨床雜志;2016年06期

6 梁燕冰;廖品琥;;內(nèi)皮細(xì)胞蛋白C受體與膿毒癥關(guān)系的研究進(jìn)展[J];重慶醫(yī)學(xué);2016年27期

7 孫莉;張小鈴;張惠娟;;腦循環(huán)動(dòng)力學(xué)檢查對(duì)腦微循環(huán)障礙診斷的意義[J];中華醫(yī)學(xué)雜志;2016年23期

8 陳意飛;殷安康;李揚(yáng);;門(mén)急診區(qū)域突發(fā)心臟驟停的特點(diǎn)及救治基礎(chǔ)[J];中華衛(wèi)生應(yīng)急電子雜志;2016年03期

9 黃達(dá);梁劍峰;朱曦;安友仲;李剛;李青;駱勇;王東信;李雪迎;;心臟驟停復(fù)蘇后患者體溫對(duì)腦功能預(yù)后的影響[J];臨床麻醉學(xué)雜志;2016年06期

10 樊楚明;楊欣悅;任靖宇;張洪波;茹今;陳慶寧;;烏司他丁對(duì)膿毒癥大鼠血管內(nèi)皮細(xì)胞損傷保護(hù)作用及機(jī)制研究[J];中國(guó)臨床藥理學(xué)雜志;2016年08期

，

本文編號(hào)：2180185