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目的探讨肾上腺素(Epi)和血管加压素(Vas)在心肺复苏(CPR)过程中对冠状动脉灌注压(CPP)的影响。方法将实验犬随机分为Epi组、Vas组和对照组,通过电击致颤制作心跳骤停模型,在CPR第3、8、13min时分别静脉应用Epi、Vas和0.9%氯化钠溶液,并于每次给药后1.5、5min时分别记录主动脉压及中心静脉压,并计算平均动脉压和CPP。于实施CPR18min后行电除颤1~3次(能量依次为3、4、6J/kg),CPR成功于第5、15、30min重复给药并记录心率及动脉压的变化情况。结果21只实验犬中有8只(38.1%)出现了自主循环恢复,其中Vas组6只(85.7%),Epi组2只(28.6%),对照组实验犬则全部死亡。与Epi组比较,第1、2次给药后的1.5min及5min,第3次给药的5min,Vas组CPP明显升高;但第3次给药的1.5minEpi组CPP骤然增加。Epi及Vas组的CPP均明显高于对照组。结论CPR过程中,Vas和Epi均可显著地增加CPP,而Vas对CPP的升高作用明显优于Vas,且作用持续时间较长,压力波动的幅度较小。
Objective To investigate the effects of epinephrine (Epi) and vasopressin (Vas) on coronary perfusion pressure (CPP) during cardiopulmonary resuscitation (CPR). Methods The experimental dogs were randomly divided into Epi group, Vas group and control group. The model of cardiac arrest was established by electroshock-induced shock. Epi, Vas and 0.9% sodium chloride solution were intravenously administered at 3, 8 and 13 minutes of CPR respectively. Aortic pressure and central venous pressure were recorded at 1.5 and 5 minutes after each administration, and mean arterial pressure and CPP were calculated. After CPR18min, defibrillation was performed 1 ~ 3 times (energy was 3,4,6J / kg). CPR was repeated on the 5th, 15th and 30th minutes and the changes of heart rate and arterial pressure were recorded. RESULTS: Eight of the 21 experimental dogs (38.1%) developed spontaneous circulation recovery. Among them, 6 (85.7%) in Vas group and 2 (28.6%) in Epi group all died in the control group. Compared with Epi group, the CPP in Vas group increased significantly at 1.5min and 5min after the first and second administrations and 5mins after the third administration. However, the CPP in 1.5minEpi group increased suddenly in the third administration. The CPP in Epi and Vas groups were significantly higher than those in control group. Conclusion During CPR, both Vas and Epi can significantly increase CPP. However, the effect of Vas on CPP is obviously better than that of Vas, and the duration of action is longer and the pressure fluctuation is smaller.