体外腹主动脉末端阻断辅助标准心肺复苏的影像解剖研究
Imaging anatomical study of abdominal aorta terminal blocking in vitro assisting in standard cardiopulmonary resuscitation
目的 为体外腹主动脉末端阻断辅助标准心肺复苏(CPR)提供影像解剖学基础。 方法 75名患者的CT影像解剖图中,以脐为标志点,主要观测:①脐中点水平面对应椎体的位置;②腹主动脉末端与脐中点的关系;③腹主动脉下段、下腔静脉下段与腰椎的相对位置关系。 结果 腹主动脉末端、腰椎与脐标志点基本重叠于人体正中线位置:①脐中点位于腰4椎体下缘以上40.31mm,以下32.82 mm范围内;②腹主动脉末端在脐上、下35 mm范围内;③腹主动脉末端所在的横切面上腹主动脉位于脊柱椎体前略偏左侧,下腔静脉在此平面位于椎体前偏右侧。 结论 可以脐为重要的标志点定位腹主动脉末端以进行体外腹主动脉远端阻断,辅助标准CPR改善血流动力学机制,保证心脑等重要器官血供,从而增高冠状动脉灌注压和CPR成功率。
Objective To supply imaging anatomical basis for abdominal aorta blocking assisting in standard cardiopulmonary resuscitation to improve coronary perfusion pressure. Methods CT images of 75 patients, 41 males and 34 females, were collected. The bellybutton was used as the landmark, and indexes as follows were measured:①The vertebral level of the bellybutton midpoint; ②The relationship between abdominal aorta termination and bellybutton midpoint;③The relationship among the vertical tracks of abdominal artery, lumbar vertebrae,and inferior vena cava. Results The markers for the end of abdominal artery,lumbar vertebrae and navel roughly overlapped at the human median line: ① The navel midpoint was located between 40.31 mm above and 32.82 mm below the inferior border of L4; ② The end of the abdominal artery was located between 35 mm above and 35 mm below the bellybutton midpoint; ③The end of abdominal artery was located slightly to the left of the lumbar spine, and inferior vena cava was located to right of the lumbar spine at the transverse section of the body at the level of the end of the abdominal artery. Conclusions According to the imaging study, navel can be adopted as the landmark for blocking in vitro the end of the abdominal aorta, assisting in the standard cardiopulmonary resuscitation. It could improve the hemodynamic indexes, ensure blood supply of the critical organs such as brain and heart, and improve coronary perfusion pressure with high success rate.
Abdominal aorta / Bellybutton / Lumbar vertebrae / Cardiopulmonary resuscitation / Imaging anatomy
[1] Halperin HR ,Lee K, Zviman M, et al. Outcomes from low versus high-flow cardiopulmonary resuscitation in a swine model of cardiac arrest[J].Am J Emerg Med,2010, 28(2):195-202.
[2] Guilbert JJ. The world health report 2002 - reducing risks, promoting healthy life[J]. Educ Health (Abingdon), 2003,16(2): 230.
[3] 张在其,骆福添,陈兵,等. 我国大中城市院前死亡患者流行病学调查分析-附12568例分析[J]. 新医学, 2010, 41(11):708-711.
[4] 张志标,李珂. 心肺复苏中血流动力学机制实验及应用研究进展[J]. 实用心脑肺血管病杂志, 2011, 19(2):170-172.
[5] 武钢, 桑显富, 鲍光欣, 等, 体外腹主动脉末端施压控制骨盆骨折大出血的应用解剖[J]. 中国临床解剖学杂志, 2010, 28(1): 20-22.
[6] 武钢, 肖利民, 杨庆永, 等. 犬体外腹主动脉末端阻断再灌注损伤指标的变化及意义[J]. 实用医学杂志, 2011, 27(9): 1545-1547.
[7] Zhou M, Ran Q, Liu Y, et al. Effects of sustained abdominal aorta compression on coronary perfusion pressures and restoration of spontaneous circulation during cardiopulmonary resuscitation in swine[J]. Resuscitation, 2011, 82(8):1087-1091.
[8] Park CH, Jeung KW, Min YI, et al. Sustained manual abdominal compression during cardiopulmonary resuscitation in a pig model: a preliminary investigation[J]. Emerg Med J, 2010, 27(1):8-12.
[9]艾寿坤,吴先国. 老年人腹主动脉的应用解剖学[J]. 中华老年医学杂志, 1990, 9(2):96-99.
[10]李连欣,周东生,王鲁博,等. 腹主动脉球囊阻断术治疗骨盆骨折大出血[J]. 中华骨科杂志, 2011, 31(5):487-490.
[11]李世德,李剑,韦玮. 低位腹主动脉外阻断的临床应用解剖学研究[J]. 中国脊柱脊髓杂志, 2010, 20(8):681-683.
广东省科技计划项目(2013B010401014;2014A0202 12192)
/
〈 |
|
〉 |