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目的评估心肺复苏前室颤时的冠脉灌注压和室颤波形对自主循环恢复的预测价值。方法将20头家猪采用体外电击法制备动物室颤模型,室颤维持8min后依次给予2min心肺复苏和电除颤。将实验后的动物分为自主循环恢复组和自主循环未恢复组。记录室颤时的血流动力学以及室颤波的平均频率和振幅。结果自主循环恢复组的血流动力学、室颤波的平均频率和振幅明显高于自主循环未恢复组(P均<0.05);室颤时的冠脉灌注压和室颤波的平均频率和振幅对ROSC均有较高的预测价值(ROC曲线下面积:0.86,0.76,0.82)。室颤波的平均频率和振幅与冠脉灌注压呈正相关(r=0.67;r=0.71,P均<0.01)。结论心肺复苏前室颤时的冠脉灌注压和室颤波形可预测自主循环恢复。
Objective To evaluate the predictive value of coronary perfusion pressure and ventricular fibrillation waveform during cardiopulmonary bypass in patients with ventricular fibrillation. Methods 20 domestic pigs were prepared by in vitro electrokinetic shock ventricular fibrillation model, ventricular fibrillation maintained 8min followed by 2min cardiopulmonary resuscitation and defibrillation. The experimental animals were divided into spontaneous circulation recovery group and spontaneous circulation unrecovered group. The hemodynamics of VF as well as the average frequency and amplitude of VF were recorded. Results The hemodynamics and the frequency and amplitude of ventricular fibrillation in spontaneous circulation recovery group were significantly higher than those in spontaneous circulation recovery group (all P <0.05). The mean frequency and amplitude of coronary perfusion pressure and ventricular fibrillation in ventricular fibrillation ROSC have higher predictive value (area under the ROC curve: 0.86,0.76,0.82). The mean frequency and amplitude of ventricular fibrillation were positively correlated with coronary perfusion pressure (r = 0.67; r = 0.71, P <0.01). Conclusion Coronary artery perfusion pressure and ventricular fibrillation waveform before VF can predict spontaneous circulation recovery.