Postresuscitation myocardial diastolic dysfunction following prolonged ventricular fibrillation and cardiopulmonary resuscitation
Postresuscitation myocardial diastolic dysfunction following prolonged ventricular fibrillation and cardiopulmonary resuscitation
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DOI：
10.1097/01.ccm.0000295595.72955.7c
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发表时间：
2008-01-01
影响因子：
8.8
通讯作者：
Weil, Max Harry
中科院分区：
文献类型：
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作者：
Xu, Tingyan;Tang, Wanchun;Weil, Max Harry
目的：复苏后心肌功能障碍是猝死复苏成功后早期死亡的主要原因之一。然而，复苏后心肌功能障碍的舒张期特征尚不清楚。因此，我们研究了长时间心脏骤停和随后的心肺复苏后复苏后左室舒张功能。设计：前瞻性观察性动物研究。单位：大学附属研究和教育机构的医学研究实验室。7只麻醉猪(40+/-4 kg)在未经处理的阻塞性室颤诱导心脏骤停前和7分钟后进行了研究。分别于术前、复苏后60、120、180、240分钟、复苏后72小时测量射血分数、二尖瓣血流早期和心房峰值血流速度、二尖瓣早期血流减速时间、心肌功能指数、多普勒组织成像二尖瓣环血流E-max和A(Max)峰值、舒张期早期左心室血流传播速度。五只动物被成功复苏。左心室射血。分数、E-m/A(M)比值、传播速度较术前显著降低，心肌功能指数较术前显著升高。复苏72小时后，左心室舒缩功能恢复到基线水平。结论：心脏骤停和心肺复苏后，左心室收缩功能明显受损。这与严重的左室舒张功能障碍有关。然而，在这种室性纤颤心脏骤停的实验模型中，复苏后的左心室收缩和舒张期心肌功能障碍在72小时后是可逆的。
Objective: Postresuscitation myocardial dysfunction is one of the leading causes of early death after successful resuscitation from sudden death. However, the diastolic characteristics of postresuscitatiori myocardial dysfunction are not well defined. We therefore investigated the postresuscitation left ventricular diastolic function following prolonged cardiac arrest and subsequent cardiopulmonary resuscitation.Design: Prospective, observational animal study.Setting: Medical research laboratory in a university-affiliated research and educational institute.Subjects: Domestic pigs.Interventions. Seven anesthetized pigs (40 +/- 4 kg) were studied before and after 7 mins of untreated occlusive ventricular fibrillation induced cardiac arrest. Ejection fraction, early and atrial peak transmitral flow velocities, deceleration time of early transmitral flow velocity, myocardial performance index, peak E-max and A(max) mitral annulus velocities by Doppler tissue imaging, and early diastolic left ventricular flow propagation velocity were measured at baseline; 60, 120, 180, and 240 mins; and 72 hrs after resuscitation.Measurements and Main Results. Five animals were successfully resuscitated. Left ventricular ejection. fraction, E-m/A(m) ratio, and propagation velocity were significantly decreased, and myocardial performance index was significantly increased compared with baseline measurements. Left ventricular diastolic and systolic function returned to baseline level at 72 hrs postresuscitation.Conclusions: Left Ventricular systolic dysfunction was significantly impaired after cardiac arrest and cardiopulmonary resuscitation, as previously demonstrated. This was associated with a profound left ventricular diastolic dysfunction. However, this postresuscitation left ventricular systolic and diastolic myocardial dysfunction was reversible after 72 hrs in this experimental model of ventricular,fibrillation cardiac arrest.