现场复苏不加口对口单独胸外按压CPR指南的推荐方案  

Recemmend a program of guidelines for CPR by chest compression alone without mouth-to-mouth ventilation.

作　　者：张天平[1] 张涛[2] 葛再吉 梁延成 冯淑华[1] 丁新[1] 王丽娟[1] 莫玉玲[1] 张振宇[1] 

机构地区：[1]松原市中心医院心内科,138001 [2]松原市中心医院耳鼻喉科,138001

出　　处：《中国实用医药》2013年第6期10-13,共4页China Practical Medicine

摘　　要：目的揭示1982年举世首创成功单独胸外心(肺)按压不加口对口通气CPR-ECPC的研创史。推荐方案建议修订《CPR指南》。方法回顾ECPC的研创历史。1982年张天平教授应用ECPC急救首例心性猝死成功。本法以全手掌(指)按压胸骨中下段,压幅深(4～6cm),频率慢80(60～80)次/min,每次压胸起到了人工循环兼有效的人工通气的双重作用,潮气量达350ml,它是举世首创成功的不加口对口徒手单独胸外按压CPR,也是人类第一次把徒手高频人工通气法应用于CPR成功的创举。1990年首先公布于世报道于《吉林医学》。1991年应用ECPC急救复苏一例冠心病心脏骤停,连续单独压胸49min而复活,向世人揭示了ECPC胸外按压本身兼有良好的肺通气作用。本法若无有效的肺通气,长达49min的单独按压,血氧从何而来!1990～1992年张氏实验观测4例亡尸行ECPC,收集每压胸呼出气体测得潮气量为350ml(275～400ml),则ECPC每分肺泡通气量Mv=(350ml-无效腔150ml)×压频60/min=12L。大于正常人静息分通气量4.2L的2倍,从实验角度证实了ECPC单独胸外按压的本身可实现有效的肺通气,不必另加口对口通气。95-99年观测4例心性猝死行有效的单独胸外按压,使血氧饱和度上升达90%～98%。说明ECPC同时具有良好的人工循环效果。结果我院1982～2007年应用ECPC急救心性猝死115例,33例存活(28.7%)近10年65例配合电除颤,27例存活(41.5%)。ECPC经国内查新属首创1999年获吉林省科技进步4等奖及松原市科技进步奖。结论不加口对口张氏ECPC的问世为现场复苏开拓一条新途径,为降低人类心性猝死的病死率贡献卓著。它必永载世界医史。张氏指出超快的胸外按压压频大于100次/min反不利于推动血流,大于80次/min减少了肺通气,故他建议应尽快修改《国际CPR指南》现场复苏不加口对口采用全手掌,深幅(4-6cm)按压胸骨中下段,兼顾通气与血流,压频以80次/min为宜。Objective To research means of the effectual barehanded artificial ventilation and circulation.To uncover the history of study creator the External Cardiopulmonary Compression Resuscitation（ECPC） by chest compression alone don＇t plus mouth-to-mouth ventilation.It is first of all reported in the world and 1982 has proved successful.Methods In retrospective history to study created of ECPC.Zhang Tianping first created a new CPR of chest compression alone do not plus mouth-to-mouth.that is External cardiopulmonary compression resuscitation（ECPC） in 1982 first aid has been succeeded.This means using a whole palm compression on the middle-lower segment of sternum.compressed depth was increased（4-6 cm）.compression rate was reduced 80（60-80）/min.EEPC the each a time compression produce a double action of artificial circulation and ventilation,tidal volume（Tv）350 ml（275～400 ml）don＇t plus mouth-to-mouth.It is first creating barehanded artificial high frequency ventilation（AHFV） was applied in CPR.1990 reported to 《JILIN MEDICAL JOURNAL》.1991 one case of sudden cardiac death（SCD） ECPC was applited the cardiopulmonary compression for 49 minutes at a stretch the heart rebeats and lifesave.This Case was compressed by Zhang＇s itself 30 minutes.Reveal lung ventilation action of ECPC is good.This is long time the chest compression,If there was not effective lung ventilation for the compression itself,which was obtained for blood oxygen of body ？! 1990～1992 Zhang＇s has experimented observation to measured of the ECPC the tidal Volume（TV）.for dead body of 4 patients were performed cardiopulmonary compression one time expiration of air approaching 350 ml（275～400 ml）.So minute volume of ECPC =（tidal volume 350 ml-noneffective cavity 150 ml）×rate 60/min=12L.It is over twice larger than motionless Mv of normal data.It has been proved the ECPC＇s compression itself may reaches effectual Lung Ventilation.1990 this a research first reported to the world.Results 1982-2007 I

关 键 词：肺心同步按压 胸外(心肺)按压 “口对口” 心性猝死 高频人工通气 肺通气 

分 类 号：R459.7[医药卫生—急诊医学]