插入式腹部提压复苏法对心跳呼吸骤停患者复苏效果的影响  

Effect of interposed abdominal pulling-pressing cardiopulmonary resuscitation for patients with cardiac arrest

作　　者：顾彩虹[1] 石远峰[1] 王立祥[2] 刘克喜[1] 王言理[1] 

机构地区：[1]连云港市第一人民医院ICU,222000 [2]武警总医院急救医学中心,北京100039

出　　处：《中华灾害救援医学》2015年第11期611-614,共4页Chinese Journal of Disaster Medicine

摘　　要：目的探讨插入式腹部提压复苏法(interposed abdominal pulling-pressing cardiopulmonary resuscitation,IAPP-CPR)和常规胸外心脏按压法(standard cardiopulmonary resuscitation,S-CPR)对心脏骤停(cardiac arrest,CA)患者冠脉灌注压(coronary perfusion pressure,CPP)、平均动脉压(mean arterial pressure,MAP)、呼气末二氧化碳分压(partial pressure of carbon dioxide in endexpiratory gas,Pet CO2)的影响,以及两组自主循环恢复(restoration of spontaneous circulation,ROSC)率的差异。方法 20例CA患者随机分为IAPP-CPR组和S-CPR组,每组10例,监测其有创血压和中心静脉压,发生心跳呼吸骤停后采用IAPP-CPR或S-CPR进行心肺复苏(cardiopulmonary resuscitation,CPR),对比分析两组患者CPP、MAP、Pet CO2、ROSC率等指标的不同。结果 (1)随着CPR时间的推移,两组CPP、MAP、Pet CO2总体都升高,且抢救方法与时间存在交互作用(P<0.05);(2)IAPPCPR组的CPP与MAP从复苏2 min或3 min开始升高,Pet CO2从复苏5 min开始升高;S-CPR组的CPP与MAP在复苏期间变化不大,但Pet CO2也是从复苏5 min开始升高;(3)从复苏1 min到结束,IAPP-CPR组的CPP、MAP、Pet CO2均高于S-CPR组,且两组之间的差异均有统计学意义(P<0.05);(4)IAPP-CPR组的ROSC率为80%,高于S-CPR组的50%,但两组ROSC率的差异无统计学意义(P=0.3498)。结论两种方法复苏均能使CPP、MAP、Pet CO2总体上升高,且IAPP-CPR方法较S-CPR方法能更快升高CPP、MAP、Pet CO2;但两种方法的ROSC率无差异,这可能与本研究复苏人数较少有关。Objective To observe the effect of interposed abdominal pulling-pressing cardiopulmonary resuscitation （IAPP- CPR） for patients with cardiac arrest as compared with standard cardiopulmonary resuscitation （S-CPR）. Methods 20 Patients with cardiac arrest were divided into two groups randomly; each group with 10 patients and was treated with IAPIS-CPR or S-CPR after cardiac arrest. All patients were monitored with invasive blood pressure and central venous pressure, and indexes such as coronary perfusion pressure （CPP）, mean arterial pressure （MAP）, partial pressure of carbon dioxide in endexpiratory gas （PetCO2）, restoration of spontaneous circulation （ROSC） rates of two groups were compared. Results （1） Over the time Of CPR, the mean levels of CPP, MAP, PetCO2 had risen on the whole, and there was interaction between therapeutic method and time（P〈O.05）. （2） Mean levels of CPP and MAP in IAPP-CPR group had increased since 2 or 3 min after CPR, and mean levels of PetCO2 had increased since 5 min after CPR; the mean levels of CPP and MAP in S-CPR group changed little, however, mean levels of PetCO2 had increased from 5 min as well. （3） From 1 minute to the end of CPR, the mean levels of CPP, MAP and PetCO2 in IAPP-CPR group were all higher than that of S-CPR group, and the difference all had statistical significance （P〈O.05）. （4） ROSC rate of IAPP-CPR group was 80%, and it was higher than that of S-CPR group （50%）, but without a statistical significance （P=0.3498）. Conclusions Both types of CPR method can increase the mean levels of CPP, MAP and PetCO2, and IAPP-CPR method increased those values faster than S-CPR method. The insignificance of ROSC rate may relate to the small number of patients that included in this study.

关 键 词：插入式腹部提压法 心跳骤停 心肺复苏 

分 类 号：R459.7[医药卫生—急诊医学]