本文關(guān)鍵詞： 體外腹主動脈末端阻斷 心肺復(fù)蘇 經(jīng)皮電刺激誘導(dǎo) 臍 髂嵴頂點　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的探討體外腹主動脈末端阻斷對室顫性心臟驟停(CA)豬復(fù)蘇效果的影響及臍在定位腹主動脈阻斷位置中的價值。研究方法(1)西藏小型豬18只隨機(jī)分為兩組:①常規(guī)CPR組(C-CPR),②體外腹主動脈末端阻斷+常規(guī)CPR組(DAAO-CPR)。采用27V直流電經(jīng)皮電刺激3s誘發(fā)心室顫動(VF),經(jīng)非干預(yù)間期4min后建立CA模型。C-CPR組實施常規(guī)復(fù)蘇即徒手胸外按壓+呼吸氣囊給氧,DAAO-CPR組在常規(guī)復(fù)蘇基礎(chǔ)上輔以體外腹主動脈末端阻斷,即體外腹主動脈阻斷儀置于臍部正中線偏左0.5cm處,隨即調(diào)節(jié)按壓頭予以壓迫阻斷腹主動脈末端,以豬右側(cè)股動脈搏動消失作為阻斷成功的標(biāo)志。觀察兩組復(fù)蘇初期冠狀動脈灌注壓(CPP)等血流動力學(xué)指標(biāo),記錄自主循環(huán)恢復(fù)(ROSC)時間、ROSC率及72h存活率;TUNEL法檢測的ROSC72h心肌細(xì)胞凋亡情況;ELISA法測定ROSC6h內(nèi)cTnI血清學(xué)指標(biāo)的變化;采用腦功能評分(CPC)評估ROSC后24hCA豬腦功能情況。(2)CT影像下,以腹主動脈分叉為基點,觀測108例患者臍、髂嵴頂點與腹主動脈分叉的垂直距離和上下位置關(guān)系。研究結(jié)果(1)復(fù)蘇初期,除CVP之外兩組血流動力學(xué)指標(biāo)均呈逐漸升高趨勢,其中C-CPR 組 30s、60s、120s SBP 均顯著低于 DAAO-CPR 組(P0.05),而 90s、150s、180s兩組SBP差異無統(tǒng)計學(xué)意義(P0.05);C-CPR組各個時間點DBP均顯著低于 DAAO-CPR 組(P0.05);除 90s 外,C-CPR 組 30s、60s、120s、150s、180s MAP顯著低于DAAO-CPR組(P0.05);兩組各個時間點CVP差異無統(tǒng)計學(xué)意義(P0.05);除 30s 外,C-CPR 組 60s、90s、120s、150s、180s CPP 顯著低于 DAAO-CPR 組(P0.05);與 C-CPR 組比較,DAAO-CPR 組 ROSC所需時間更短(P0.05);兩組ROSC率和72h存活率差異比較均無統(tǒng)計學(xué)意義(P0.05),DAAO-CPR組數(shù)值較 C-CPR組高(75.4%VS71.4%);ROSC 后72hDAAO-CPR組心肌細(xì)胞凋亡率低于C-CPR組(P0.05);ROSC后3h、6h DAAO-CPR組血清 cTnI 水平顯著低于 C-CPR組(P0.05);ROSC 后 24hDAAO-CPR 組 CPC 評分低于 C-CPR 組(P0.05)。(2)臍(62.0%)多投影于腹主動脈分叉以上,髂嵴頂點(65.7%)則多在腹主動脈分叉以下,兩者與腹主動脈的位置關(guān)系差異比較有統(tǒng)計學(xué)意義(P0.01)。在腹主動脈分叉以上,臍至腹主動脈分叉的垂直距離(BU)大于髂嵴頂點至腹主動脈分叉的垂直距離(BC)(P0.05);腹主動脈分叉以下,BU和BC差異比較無統(tǒng)計學(xué)意義(P0.05)。研究結(jié)論(1)在CA豬復(fù)蘇初期,采用DAAO-CPR方法可以優(yōu)化CPP等血流動力學(xué)指標(biāo),縮短ROSC所需時間,減輕心肌細(xì)胞損傷和凋亡,利于腦功能損傷恢復(fù)。(2)臍多投影于腹主動脈分叉上方,以臍為體表標(biāo)志點,更易完全阻斷血流,且可選擇阻斷的范圍更為廣泛,是進(jìn)行體外腹主動脈“末端”阻斷的重要體表解剖標(biāo)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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.78

【參考文獻(xiàn)】

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本文編號：1475846