【摘要】：背景與目的： 資料顯示,歐洲每年死于心跳驟停的人數(shù)約為375000,而這一數(shù)據(jù)在美國(guó)也高達(dá)275000,大部分的患者死于院外。即使是搶救成功的患者,一年存活率也低于5%。中國(guó)目前沒(méi)有確切的數(shù)據(jù),但是隨著飲食習(xí)慣以及生活方式的改變,死于心跳驟停的中國(guó)人也在逐年增加。心跳驟停的搶救手段為迅速而且有效的心肺復(fù)蘇。自主的心跳如不能及時(shí)恢復(fù),則需要延長(zhǎng)胸外按壓時(shí)間以維持有效的冠狀動(dòng)脈及腦部的血液循環(huán),然而那些需要延長(zhǎng)胸外按壓的患者死亡率隨著按壓時(shí)間的延長(zhǎng)而增高。有研究揭示傳統(tǒng)的人工胸外按壓過(guò)程中心臟輸出量只能達(dá)到正常值的20%-30%,并且人工胸外按壓實(shí)施者在按壓開(kāi)始后約一分鐘時(shí)按壓效率便開(kāi)始下降,四分鐘后其按壓效率便下降到僅為初始按壓效率的30%。另外在搬運(yùn)患者過(guò)程中進(jìn)行有效的人工胸外按壓是非常困難的,然而胸外心臟按壓的中斷,即使很短時(shí)間的中斷也會(huì)導(dǎo)致重要器官失去灌注,而這些器官的灌注不足可以直接導(dǎo)致自主循環(huán)恢復(fù)和電除顫的成功率下降。因此,近幾十年來(lái),各種機(jī)械的自動(dòng)胸外按壓系統(tǒng)被不斷研發(fā)出來(lái)。LUCAS心肺復(fù)蘇機(jī)(簡(jiǎn)稱LUCAS)是一部能夠提供5cm深度按壓及主動(dòng)上提胸腔的胸外按壓裝置。大量的動(dòng)物實(shí)驗(yàn)及臨床資料顯示,從血液循環(huán)和重要器官灌注的角度來(lái)看,LUCAS對(duì)心跳驟停患者的按壓效果明顯優(yōu)于人工按壓。但是LUCAS的機(jī)械按壓對(duì)冠狀動(dòng)脈有無(wú)明顯影響目前尚無(wú)相關(guān)研究。因此,本實(shí)驗(yàn)的目的是研究LUCAS持續(xù)胸外按壓對(duì)豬冠狀動(dòng)脈功能的影響。 材料與方法： 體重約32kg的健康瑞典家豬16頭,采用隨機(jī)分組的原則分成兩組：實(shí)驗(yàn)組和對(duì)照組,每組8頭。實(shí)驗(yàn)組動(dòng)物全麻后電刺激誘導(dǎo)室顫,1min后用LUCAS心肺復(fù)蘇機(jī)行持續(xù)胸外按壓20min,然后電除顫,除顫成功后維持麻醉狀態(tài)30min,然后正中開(kāi)胸并中心靜脈推注2mol/L氯化鉀(KCl),停跳心臟,心臟停跳成功后,取冠狀動(dòng)脈前降支遠(yuǎn)段1/3血管并行器官浴槽實(shí)驗(yàn)(organ bath)。對(duì)照組動(dòng)物采用同樣方法全麻,維持相同的麻醉時(shí)間,然后正中開(kāi)胸并中心靜脈推注KCL,取冠狀動(dòng)脈前降支遠(yuǎn)段1/3血管并進(jìn)行organ bath實(shí)驗(yàn)。 結(jié)果： 實(shí)驗(yàn)組和對(duì)照組的最大冠狀動(dòng)脈內(nèi)皮依賴性舒張(EDRmax)分別為：(96±0.94)%、(98±0.93)%,兩者的差別不具有統(tǒng)計(jì)學(xué)意義(p0.05);舒張至50%最大收縮時(shí)P物質(zhì)濃度的負(fù)對(duì)數(shù)(pEC50)分別為：7.13±0.14、7.10±0.13,兩者相比也不具有統(tǒng)計(jì)學(xué)意義(p0.05)；冠狀動(dòng)脈環(huán)內(nèi)徑分別為1.31±0.15mm、1.27±0.19mm,兩者之間的差別沒(méi)有統(tǒng)計(jì)學(xué)意義(p0.05)。 結(jié)論： LUCAS持續(xù)胸外按壓20min對(duì)豬心冠狀動(dòng)脈內(nèi)皮功能沒(méi)有顯著影響。
[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 鹵0.94)% and (98 鹵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 鹵0.147.10 鹵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 鹵0.15 mm and 1.27 鹵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.
【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】：2013
【分類號(hào)】：R459.7

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