摘要目的：通过观察心肺复苏（CPR）时脉搏血氧波形的特征变化，探讨基于脉搏血氧技术的无创、简便、快速的自主循环恢复（ROSC）识别方法。方法描述性研究。建立小型猪心室纤颤（室颤）模型，室颤持续3 min后按照CPR指南进行胸外按压（按压深度为5 cm，频率为105次/min），同时连接呼吸机辅助呼吸，复苏2 min后给予100 J双向波电除颤，再次立即进行胸外按压。实时记录CPR过程中血流动力学参数、呼气末二氧化碳分压（PETCO2）及脉搏血氧波形，应用时域结合频域波形分析技术评价围CPR期脉搏血氧波形的变化特征。结果除1只动物死于麻醉诱导阶段外，其余6只均诱发室颤成功。①室颤后动物有创血压及脉搏血氧波形消失；胸外按压时PETCO2为（18.83±2.71）mmHg（1 mmHg＝0.133 kPa），动脉舒张压为（23.83±5.49）mmHg；除颤后1 min内PETCO2〔（51.83±9.35）mmHg〕和动脉舒张压〔（100.67±10.97）mmHg〕均较按压时明显增高（t1＝8.737、t2＝25.860，均P＝0.000），且出现动脉血压波形，提示ROSC。②成功入组动物均出现脉搏血氧波形特征性改变，其在诱发室颤—胸外按压—ROSC—停止按压各阶段的时域波形表现为：波形消失—规律按压波—波动融合波—稳定脉搏波；频域波形表现为：波形消失—单纯按压峰—双峰或融合峰—单纯脉搏峰。结论通过时域结合频域的方法分析脉搏血氧波形特征性变化，不仅能及时发现心脏停搏，还有助于快速识别CPR过程中的ROSC。

abstractsObjectiveTo investigate the feasibility of using pulse oximetry plethysmographic waveform (POP) to identify the restoration of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR).Methods An observational research was conducted. A porcine model of ventricular fibrillation (VF) arrest was reproduced. After 3 minutes of untreated VF, animals received CPR according to the latest CPR guidelines, providing chest compressions to a depth of 5 cm with a rate of 105 compressions per minute and instantaneous mechanical ventilation. After 2 minutes of CPR, animals were defibrillated with 100 J biphasic, followed by continuous chest compressions. Data of hemodynamic parameters, partial pressure of end-tidal carbon dioxide (PETCO2) and POP were collected. The change in POP was observed, and the characteristics of changes of the waves were recorded during the peri-CPR period using the time and frequency domain methods.Results VF was successfully induced in 6 pigs, except 1 death in anesthesia induction period.① After VF, invasive blood pressure waveform and POP of the animals disappeared. PETCO2 was (18.83±2.71) mmHg (1 mmHg=0.133 kPa), and diastolic arterial pressure was (23.83±5.49) mmHg in compression stage. Animals attained ROSC within 1 minute after defibrillation, with PETCO2 [(51.83±9.35) mmHg] and diastolic arterial pressure [(100.67±10.97) mmHg] elevated significantly compared with that of compression stage (t1 = 8.737,t2 = 25.860, bothP = 0.000), with appearance of arterial blood pressure waveform.② Characteristic changes in POP were found in all experimental animals. During the stages of induced VF, compression, ROSC, and compression termination, POP showed characteristic waveform changes. POP showed disappearance of waveform, regular compression wave, fluctuation hybrid and stable pulse wave in time domain method; while in the frequency domain method waveform disappearance, single peak of compression, double or fusion peak and single peak of pulse were observed.Conclusion Analysis of POP using time and frequency domain methods could not only quickly detect cardiac arrest, but also show a role as a feasible, non-invasive marker of ROSC during CPR.