血流动力学导向心肺复苏在急诊中的应用价值  

Application value of hemodynamics-oriented cardiopulmonary resuscitation in emergency

作　　者：崔秀平 庄炯宇 付东明 张映坤 CUI Xiu-ping;ZHUANG Jiong-yu;FU Dong-ming(Department of Emergency,Zhongshan Boai Hospital Affiliated to Southern Medical University,Zhongshan 528400,China)

机构地区：[1]南方医科大学附属中山博爱医院急诊科,528400

出　　处：《中国实用医药》2018年第36期28-30,共3页China Practical Medicine

基　　金：中山市科技计划项目(项目编号:2017B1100)

摘　　要：目的探讨血流动力学导向心肺复苏(CPR)在急诊中的应用价值。方法选取2016年1～12月在急诊抢救室行心肺复苏的18例患者作为对照组,另选2017年1～12月在急诊抢救室行心肺复苏的20例患者作为治疗组。两组患者均按照《2015美国心脏协会心肺复苏及心血管急救指南》进行心肺复苏术,治疗组通过监测心肺复苏过程中无创心排血量(CO)、有创动脉压(IBP)及呼气末二氧化碳分压(P_(ET)CO_2)血流动力学指标来评估及优化胸外按压的质量、调整呼吸频率及呼吸末正压。比较两组患者自主循环恢复(ROSC)及24 h存活情况。将治疗组患者按是否恢复自主循环分为成功组和失败组,比较两组患者血流动力学指标水平。结果治疗组患者自主循环恢复率为80.00%,自主循环恢复时间为(18.52±3.68)min, 24 h存活率为70.00%优于对照组的44.44%、(33.25±4.56)min、33.33%,差异具有统计学意义(P<0.05)。治疗组患者按是否恢复自主循环分为成功组(16例)与失败组(4例),成功组IBP、P_(ET)CO_2、CO水平显著高于失败组,差异具有统计学意义(P<0.05)。失败组IBP<80/20 mm Hg(1 mm Hg=0.133 kPa), P_(ET)CO_2<10 mm Hg, CO<1.5 L/min。结论血流动力学导向心肺复苏,建立了个体化的复苏模式,从而提高了心肺复苏的成功率及24 h存活率。Objective To discuss the application value of hemodynamics-oriented cardiopulmonary resuscitation in emergency(CPR). Methods There were 18 cardiopulmonary resuscitation patients in our emergency resuscitation room in January 2016 to December 2016 as control group, and another 20 cardiopulmonary resuscitation patients in our emergency resuscitation room in January 2017 to December 2017 as treatment group. Cardiopulmonary resuscitation was performed in both groups according to 2015 American Heart Association Cardiopulmonary Resuscitation and Cardiovascular First Aid Guide. The treatment group assessed and optimized the quality of chest compression, adjusted the respiratory rate and positive end-breath pressure by monitoring non-invasive cardiac output(CO), invasive blood pressure(IBP) and end-tidal carbon dioxide partial pressure(PETCO2) hemodynamics during cardiopulmonary resuscitation. The return of spontaneous circulation(ROSC) and 24 h survival condition in the two groups was compared. The treatment group was divided into success group and failure group according to whether the autonomic circulation was restored or not, the hemodynamic indexes between the two groups were compared. Results The treatment group had better return rate of spontaneous circulation as 80.00%, return time of spontaneous circulation as(18.52±3.68) min and 24 h survival rate as 70.00% than 44.44%,(33.25±4.56) min and 33.33% in the control group, and the differences were statistically significant(P<0.05). Patients in the treatment group were divided into success group(16 cases) and failure group(4 cases) according to whether or not to resume spontaneous circulation. The success group had significantly higher IBP, PETCO2 and CO than the failure group, and the differences were statistically significant(P<0.05). The failure group had IBP <80/20 mm Hg(1 mm Hg=0.133 kPa), PETCO2<10 mm Hg and CO<1.5 L/min. Conclusion Hemodynamic oriented cardiopulmonary resuscitation establishes an individualized recovery pattern, thus improving the success ra

关 键 词：无创心排血量 有创动脉压 呼气末二氧化碳分压 血流动力学指标 心肺复苏术 

分 类 号：R459.7[医药卫生—急诊医学]