经胸超声心动图评估猪急性心肌梗死和心脏骤停后复苏后左心室功能障碍
Summary
经胸超声心动图是复苏后左心室功能障碍和猪心脏骤停模型中结构变化的一线诊断性检查。
Abstract
院外心脏骤停的主要原因之一是急性心肌梗死（AMI）。心脏骤停复苏成功后，约70%的患者在出院前因复苏后心肌和脑功能障碍而死亡。在实验模型中，心脏骤停后的心肌功能障碍（以左心室（LV）收缩和舒张功能受损为特征）已被描述为可逆的，但在与猪AMI相关的心脏骤停模型中可用的数据很少。经胸超声心动图是评估心肌功能障碍、结构改变和/或 AMI 扩展的一线诊断性检查。在这种缺血性心脏骤停的猪模型中，超声心动图在基线和复苏后2-4和96小时进行。在急性期，检查在麻醉，机械通气的猪（体重39.8±0.6kg）中进行，并连续记录心电图。获取单维和二维、多普勒和组织多普勒记录。测量主动脉和左心房直径、收缩末期和舒张末期左心室壁厚度、舒张末期和收缩末期直径以及缩短分数 （SF）。采集心尖 2 腔、3 腔、4 腔和 5 腔室视图，计算左心室体积和射血分数。进行节段室壁运动分析以检测定位并估计心肌梗死的程度。脉冲波多普勒超声心动图用于记录 4 腔室视图的经二尖瓣流速和 5 腔室视图的经主动脉流速，以计算左心室心输出量 （CO） 和每击输出量 （SV）。记录左心室外侧和间隔二尖瓣的组织多普勒成像（TDI）（TDI间隔和外侧s’，e’，a’速度）。所有记录和测量均根据美国和欧洲超声心动图学会指南的建议进行。
Introduction
心脏骤停经常发生在典型胸痛发作后几分钟，在某些情况下，这是冠状动脉疾病的首发表现1。事实上，48% 的院外心脏骤停幸存者在血管造影2 中出现冠状动脉闭塞。此外，对于心脏骤停后恢复自主循环（ROSC）的患者，心功能不全是发病率和死亡率的最重要决定因素之一3。
经胸超声心动图 （TTE） 是一种非侵入性诊断和预后工具，用于评估复苏后心肌功能障碍、结构变化和/或 AMI 扩展 ROSC 后和随后几天。在猪的实验性缺血性和非缺血性心脏骤停模型中，TTE 常用于无创连续评估心脏收缩功能、血流动力学和对治疗的反应。2008年，舒张功能障碍的变化表现为二尖瓣E速度和组织多普勒（TDI）e’速度比（E / e’）的增加以及复苏后不久二尖瓣E速度和A速度比（E / A）的降低4。
本研究描述了在缺血性猪心脏骤停模型中，TTE在不同时间点评估左心室（LV）结构以及左心室收缩和舒张功能所遵循的不同方法学步骤。
Protocol
Representative Results
Discussion
在猪 AMI 实验模型中进行完整的超声心动图检查、心脏骤停和复苏可能会提供有关左心室功能演变和左心室结构变化的不同信息，尽管文献中有一定数量的数据5，8。在实验性心脏骤停的“纯”模型中（仅限于诱导心室颤动），心肌功能损害在ROSC后的头几天逆转，但对AMI是心脏骤停的原因时会发生什么知之甚少。
这项针对猪的研究?…
Divulgations
The authors have nothing to disclose.
Acknowledgements
我们感谢Judith Bagott的语言编辑。
Materials
| Aquasonic | Parker | – | ultrasound gel |
| Adult foam ECG disposable monitoring and stress testing, wet gel, non-invasive patien | Philips | 40493E | ECG electrode |
| Bellavista 1000 | Bellavista | MB230000 | ventilator with infrared capnometer |
| ComPACS | Medimatic SRL | – | local database and software |
| CX50 | Philips | – | Echocardiographic machine |
| InTube Tracheal tube | Intersurgical Ltd | 8040080 | cuffed tracheal tube |
| LUCAS2 | Phisio-Control Inc | – | mechanical chest compressor |
| MRx defibrillator | Philips | – | defibrillator |
| S5-1 | Philips | – | Phased array probe |
| Swan-Ganz catheter 2 lumen 5fr | Edwards | 110F5 | for the coronary artery occlusion |
| Swan-Ganz catheter 2 lumen 7fr | Edwards | 111F7 | for mean arterial pressure measurement |
| Swan-Ganz catheter for thermodiluition 7fr | Edwards | 131F7 | to measure right atrial pressure, core temperature and cardiac output |
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