<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

赵为禄  钱克检  马龙先  王联群  王年云  曹勇  郭光华

Cardiopulmonary resuscitation with active compression-decompression combined with high frequency jet ventilation in dogs.

ZHAO Weilu,QIAN Kejian,MA Longxcian, et al, Department of Anesthesiology, First Affiliated Hospital, Jiangxi Medical College, Nanchang 330006

【Abstract】Objective To evaluate the effect of active compression-decompression combined with high-frequeney 3et ventilation (ACD-H) on ventilative and hemodynamic efficacy during car-pulmonary resuscitation. Methods   During ACD-H, active compression or decompression was synchronized with expiration or inspiration respectively, while in the active compression-decompression combined with conventional ventilation (ACD-C), the active compression-decompression was performed for 5 successive times,followed by a break lasting 2 seconds {or the bag ventilation once. Nine dogs burnt by inhalation of 105'C steam for 4 seconds, served as the subjects. The respiratory parameters were compared following each of five ventilative patterns lasting 30 rain :high frequency jet ventilation (HFJV), active compression combined with HFJV without decompression (AC-H), tire compression alone with continuous oxygen-supply (AC),active compression-decompression with continuous oxygen-supply (ACD) and ACD-H. The hemodynamics of ACD-H was compared with that of ACD-C. Results  Before cardiac arrest, the peak values of inspiratory and expiratory velocities , tidal volume and minute ventilation volume increased significantly ,and PaCO2 decreased markedly in comparison with those following HFJV,AC-H,AC and ACD. (P<0. 05 or 0. 01). After electrical shock-induced cardiac arrest, the lowest arterial pressure was 0 versus 18.68 kPa,the mean arterial pressure 19. 07 versus 22.81 kPa during ACD-C or ACD-H ,with significant differences. The minimal cardiac output was 0 versus 0.81±0.45 L/min ,the mean cardiac output o. 65 ±0.1 4 L/rain versus 0. 922-0.33  /mir with dramatical difference. Conclusion  ACD-H may effectively applied to cardiopulmonary resuscitation, which is superior to other conventional methods.

【Key words】Resuscitation High-frequency jet ventilation Active compression-decompression.

 <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

为了提高心肺复苏（CPR）的效果，我们在胸外主动按压减压(ACD)以及高频喷射通气(HFJV)基础上，设计了一种心肺复苏新模式，称之为主动按压减压结合高频喷射通气(ACD－H)^[l-3]，其特点为胸外按压加提拉与高频喷射通气频率相等，按压与呼气同步，提拉与吸气同步。本研究旨评价其应用于心肺复苏的可行性。

材料与方法

一、心搏骤停前实验  选择健康杂种犬9条，体重(14.28±3.29)kg，静脉注射3％戊巴比妥钠(30mg／kg)麻醉，插气管导管，导管壁附两根直径2mm的细塑料管，一根尖端与气管导管尖端平齐，进行供氧和通气，另一根向气管内延伸5cm，测气道内压。此外从食管插一根带气囊的细管测食管内压。从左侧股静脉插入F5 Swan－Ganz漂浮导管，测心血管压力及心排血量，由股动脉插管检测血气。静注琥珀酰胆碱lmg／kg，使犬自主呼吸消失，迅速吸入105℃的热蒸气(流速为1L／s)，持续4秒，然后用高频喷射通气维持。l小时后，试验犬取右侧卧位，比较以下各通气方式：(1)高频喷射通气(HFJV)，使用南昌飞机公司生产程控双向喷射呼吸机，频率为100次／min，吸呼比l:l，驱动压力为0.6kg／cm²(0.06MPa)。(2)主动按压不减压结合HFJV(AC－H)，使用自制的“胸外按压与人工通气交替进行的心肺复苏器”(专利号为NP52360292)。该器械为程控气动装置，两个硅胶吸盘直径各为9cm，吸盘与胸(腹)壁之间有塑料薄膜相隔，两者无吸附关系。按压与呼气同步，按压深度为3cm，吸气时不提拉胸壁。(3)主动按压不减压也不通气(AC)，除连续供氧代替HFJV以外其它条件与AC－H相同。(4)主动按压及减压结合HFJV(ACD?H)，与AC－H比较，除去吸盘与胸(腹)壁之间的薄膜，使其密切吸附，按压条件同AC，吸气时提拉胸(腹)壁，提拉高度也是3cm。(5)主动按压减压不通气(ACD)，即以连续给氧代替HFJV，其余条件与ACD－H相同。

   上述五种通气方式，以HFJV为基础过渡，其它四种通气方式按随机顺序进行。每种通气方式持续30分，测定各呼吸参数，每条犬重复3次，取其平均值。呼吸指标测试的主要仪器有：呼吸流率压力测试仪(西安工业自动化仪表研究所生产，第四军医入学监制)，IL－1302型血气分析仪(美国)。

   二、心搏停止后实验上述实验完成后，取10cm长的细绝缘铜针，刺入胸壁接触心脏，接26V交流电电击，可见血压突然降低直到零位，心电图显示室颤波，立即注射肾上腺素0.03mg／kg，然后进行心肺复苏。复苏的方式，先取ACD-C方式，按二加提拉，连续5次停2次，进行一次通气(手挤压球囊)，测定血压和心排血量。而后改为ACD－H方式，条件与未致颤以前相同。每条犬每种复苏方式各重复3遍，取其平均值。循环指标测试主要仪器为LifeScope日本光电。