A comparison of myocardial function after primary cardiac and primary asphyxial cardiac arrest
A comparison of myocardial function after primary cardiac and primary asphyxial cardiac arrest
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DOI：
10.1164/ajrccm.164.7.2007083
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发表时间：
2001-10-01
影响因子：
24.7
通讯作者：
Bisera, J
中科院分区：
文献类型：
--
作者：
Kamohara, T;Weil, MH;Bisera, J
虽然心室颤动（VF）复苏后的心肌功能障碍已被广泛研究，但对窒息性心脏骤停后心肌的功能知之甚少。本实验旨在比较窒息性心脏骤停与心律失常性心脏骤停复苏后左室功能的变化。研究了四组Sprague-Dawley大鼠，每组包括8只动物。在前两组中，心脏骤停后由神经肌肉阻滞引起的窒息伴或不伴气道阻塞。在第三组中，心脏骤停是由心室的电纤维性颤动引起的。第四组代表窒息性心脏骤停持续时间维持与VF组对应的时间间隔的动物。第四组接受的电击次数与第三组（VF）大致相同。所有动物均通过心前区按压和机械通气成功复苏。兴奋后测量，包括心输出量、左心室舒张末期压（LVEDP）、左心室压力40 mm Hg时的压力升高率（LV dP/dt（40））和负的LV dP/dt，均显示各组心肌功能降低。无论气道是否阻塞，在原发性呼吸骤停动物之间均未观察到心脏功能差异。然而，与窒息性心脏骤停的相同持续时间相比，VF导致的原发性心脏骤停后心肌功能不成比例且持续性更大的损害。我们的结论是，在这个健康的动物模型中，窒息性心脏骤停导致复苏后心肌功能的损害显着较轻时，与心脏骤停引起的VF。
Although myocardial dysfunction after resuscitation from ventricular fibrillation (VF) has been extensively investigated, less is known of the function of the myocardium after asphyxial cardiac arrest. The present experimental study was designed to compare postresuscitation left ventricular (LV) function after cardiac arrest caused by asphyxia with that of cardiac arrest induced by dysrhythmia. Four groups of Sprague-Dawley rats, which included eight animals in each group, were investigated. In the first two groups, cardiac arrest followed asphyxia produced by neuromuscular blockade with and without airway obstruction. In a third group, cardiac arrest was induced by electrical fibrillation of the ventricle. The fourth group represented animals in which the duration of asphyxial cardiac arrest was maintained for a time interval corresponding to that of the VF group. The fourth group received approximately the same number of electrical shocks as the third (VF) group. All animals were successfully resuscitated with precordial compression and mechanical ventilation. Postresuscitation measurements, including cardiac output, LV end-diastolic pressure (LVEDP), rate of pressure rise at LV pressure of 40 mm Hg (LV dP/dt(40)), and negative LV dP/dt, demonstrated decreased myocardial function in each group. No differences in cardiac function were observed between the animals with primary respiratory arrest whether or not the airway was obstructed. However, disproportionate and consistently greater impairment in myocardial function followed primary cardiac arrest due to VF when compared with equal duration of asphyxial cardiac arrest. We conclude that in this healthy animal model, asphyxial cardiac arrest resulted in significantly lesser impairment of postresuscitation myocardial function when compared with cardiac arrest caused by VF.