目的：比较心肺复苏（ CPR）同时即刻降温与常规复苏和复苏后降温治疗对复苏成功率、存活率、神经系统功能等的影响。方法24只健康雄性新西兰家兔采用4 min室颤模型，随机分为三组，每组8只。常温复苏（ normothermia theat， NT）组：常规致颤复苏，不行降温干预。复苏中降温（ intra－arrest therapeutic hypothermia， IATH）组：于CPR同时启动颈部快速降温，目标脑温为34℃，以后维持目标脑温至自主循环恢复（ ROSC ）后4 h。复苏后1 h降温（ post －arrest therapeutic hypothermia， PATH ）组：于CPR后1 h 启动颈部快速降温，目标脑温为34℃，余同IATH组。观察复苏成功率，4 h内脑温、肛温、血流动力学及呼吸功能的变化，24 h神经功能缺损评分（ NDS）评分。结果 IATH组有7只、NT组和PATH组分别有4只和5只复苏成功；在诱发室颤4 min后，各组肛温、脑温比较差异无统计学意义；经过4 min CPR，IATH组、NT组、PATH组脑温分别为（37．4±0．7）℃、（38．2±0．3）℃、（38．1±0．5）℃，IATH组与另外两组比较差异有统计学意义（P＜0．05）；各组肛温比较差异无统计学意义。在CPR 4 min内，IATH 组舒张压从5．2 mm Hg升至32．0 mm Hg，而NT组从5．7 mm Hg增高至22．0 mm Hg，PATH组从5．4 mm Hg增高至21．0 mm Hg（P＜0．05）；复苏期间各组收缩压比较差异无统计学意义。 IATH组48 h存活率明显高于NT组（P＜0．05）。复苏后24 h NDS评分各组均较差，各组比较差异无统计学意义，但颈部降温组的评分还是好于NT组。结论在CPR同时早期选择颈部降温不仅能降低脑温还能提高复苏时舒张压，进而提升复苏时的冠状动脉灌注压，提高CPR成功率和48 h生存率。%Objective This study aims to investigate a new hypothermia treatment method of brain cooling at the begining of cardiopulmonary resuscitation ( CPR) recovery.and to determine whether this method has a better success rate of recovery, survival rate and nervous system function compared with the method which brain cooling is after CPR or method without brain cooling.Methods Twenty-four healthy male New Zealand rabbits, exposed to 4 minutes of ventricular fibrillation, were randomly divided into three groups with 8 rabbits in each group. A normal temperature recovery group (normothermia theat NT group): regular quiver recovery, no cooling intervention.A cooling during recovery group ( intra -arrest therapeutic hypothermia group IATH): at the begining of CPR, rapid cooling was run and the target brain temperature was 34 ℃, then maintain the target brain temperature unthil 4 hours after ROSC. Start cooling 1 hour after recovery group ( post -arrest therapeutic hypothermia group PATH):start rapid neck cooling 1 hour after CPR, target brain temperature is 34℃, other parameters are the same as group.The method was to observe the success rate of recovery and monitor the brain temperature, anus temperature, change of hemodynamics and respiratory function in 4 hours, NDS score 24 hours a day.Results There were 7 rabbits successfully recovered in the IATH group and only 4 in NT group and 5 in PATH group.There was no significant difference in anus temperature and brain temperature among all the groups, 4 mins after inducing ventricular fibrillation. After four minutes of CPR, the animal's brain temperature of IATH group, NT group, the PATH were (37.4 ±0.7)℃, (38.2 ±0.3)℃ and (38.1 ±0.5)℃, respectively, though the IATH group was statistically more significant compare to the other two groups (P<0.05).No obvious difference in anal temperature between the groups.4 minutes after CPR, the diastolic pressure of IATH group increased from 5.2 mm Hg to 32.0 mm Hg, NT group only increased from 5.7 mm Hg to 22.0 mm Hg and PATH group only increased from 5.4 mm Hg to 21.0 mm Hg (P<0.05).There was no significant difference in systolic blood pressure among the groups during recovery.48 hours survival rate of IATH group was obviously higher than that of NT group, and there was statistically significant between them (P<0.05). The recovery after 24 hours NDS rating of each group were all poor wtithout any significant differences among the groups, though the rating for neck cooling group was better than regular recovery group. Conclusion The neck cooling in the early CPR stage can lower brain temperature at early as possible and improve recovery diastolic blood pressure, followed by improved coronary perfusion pressure during recovery, improved the successful rate of CPR and 48-hour survival rate.
展开▼
