| 郭 建,王世伟,陆晓晔,杨正飞,凌 钦,杨 倩,朱长清.呼气末二氧化碳分压在评估心脏骤停大鼠模型复苏结果中的作用[J].,2019,19(10):1818-1822 |
| 呼气末二氧化碳分压在评估心脏骤停大鼠模型复苏结果中的作用 |
| The Value of End Tidal Carbon Dioxide in Predicting the Cardiac Arrest Resuscitation Outcome in a SD Rat Model |
| 投稿时间：2018-10-23 修订日期：2018-11-18 |
| DOI：10.13241/j.cnki.pmb.2019.10.004 |
| 中文关键词: 室颤/窒息心脏骤停大鼠模型 心肺复苏结局 呼气末二氧化碳分压 |
| 英文关键词: Ventricular/asphyxial cardiac arrest SD rat model Cardiopulmonary resuscitation outcome Partial pressure of end tidal carbon dioxide (PETCO2) |
| 基金项目:国家自然科学基金面上项目（81671881） |
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| 中文摘要: |
| 摘要 目的：研究持续监测呼气末二氧化碳分压(Pressure of End Tidal Carbon Dioxide, PETCO2)在室颤法和窒息法所致的心跳骤停的大鼠模型中的差异，探究其在判断复苏结局中的意义。方法：分别用室颤法和窒息法建立心脏骤停-复苏的大鼠模型，持续监测大鼠复苏过程中复苏起点PC0 min（Precordial Compression, PC0），PC1 min，PC2 min，PC3 min，PC4 min，PC5 min，PC6 min呼气末二氧化碳分压,比较两组组间不同时间点PETCO2水平差异及两组组内自主循环恢复大鼠（Return Of Spontaneous Circulation，ROSC）和未能成功复苏(NOROSC)的大鼠PETCO2的差异，分别绘制PETCO2的受试者工作特征曲线。结果：窒息组大鼠ROSC 9只(9/12，75%) ，室颤组ROSC 8只（8/12，67%），组间无统计学差异（P=0.093）。窒息组平均复苏时间232±20 s，室颤组平均复苏时间360±30 s（P＜0.05）。心脏骤停后，室颤组大鼠PETCO2水平较基础值明显下降（p＜0.05），窒息组PETCO2先升高后降低。复苏开始即刻（PC0）窒息组大鼠明显高于室颤组45±4 vs 36±4 mmHg（p＜0.001），直到PC3 min，窒息组PETCO2水平仍高于室颤组。组内比较发现室颤组在PC5 min和PC6 min时ROSC大鼠PETCO2水平明显高于NOROSC组，PC5 34±3 vs 24±3 mmHg（P＜0.001），PETCO2曲线下面积为0.731，95%置信区间为（0.512, 0.764），根据约登指数计算，当截断点选择20 mmHg时，灵敏度66.6%，特异度63%。室颤组PC6时PETCO2 33±4 VS 23±2 mmHg（P＜0.001），ROC曲线下面积为0.875，95%置信区间为（0.662, 0.984），当截断点选择18 mmHg时，灵敏度87.4%，特异度71%。窒息组组内分析未见PETCO2水平在ROSC和NOROSC之间差异。结论： PETCO2水平在复苏早期可能有助于鉴别心脏骤停原因，窒息所致PETCO2水平可有升高。在室颤所致的心脏骤停，PETCO2水平可能有助于判断复苏结局。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the difference between ventricular and asphyxial cardiac arrest animal model in the pressure of end tidal carbon dioxide (PETCO2) and evaluate its potential role in predicting the resuscitation outcome. Methods: Cardiac arrest-resuscitation SD rat model was established by ventricular and asphyxial method respectively. Continuous measurements of PETCO2 was performed at different resuscitation time points, including precordial compression 0 min (PC0 min), PC1 min, PC2 min, PC3 min, PC 4 min, PC5 min and PC6 min in the two groups. The difference of PETCO2 was analyzed between the two groups as well as the ROSC rats and NOROSC rats within the individual group. In addition, a PETCO2 receiver operating characteristic curve (ROC curve) was also described in the two groups. Results: 9 out of 12 were successfully resuscitated in asphyxial group vs 8/12 in ventricular group, （P=0.093）. The average resuscitated time differs from 232±20S in asphyxial group to 360±30 s in ventricular group（P＜0.001）. PETCO2 declined dramatically in ventricular group compared with baseline（p＜0.001）while in asphyxial group the PETCO2 first rises then falls. From PC0 45±4 vs 36±4 mmHg to PC3, PETCO2 levels in asphyxial was much higher than that of ventricular group（p＜0.001）.Comparison within the group found that levels of PETCO2 in ROSC rats were higher than those of NOROSC in ventricular group at PC5&PC6 with a AUC (Area Under Curve) 0.713 [95%CI（0.512, 0.764）] and 0.875[95%CI（0.662, 0.984）] respectively. When 20 mmHg was selected as a threshhold according to Youden index, the sensitivity and specificity was 66.6% and 63% in PC5. In PC6 the threshhold was 18 mmHg with a sensitivity and specificity 87.4% and 71%. PETCO2 seems lower in NOROSC rats compared with ROSC ones in asphyxial group, but no difference was observed. Conclusion: PETCO2 may help to distinguish the cause of cardiac arrest in early resuscitation from ventricular or asphyxial. The level of PETCO2 may help to evaluate the resuscitation outcome in ventricular induced cardiac arrest. |
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