插入式腹部提压复苏法对心跳呼吸骤停患者血流动力学的影响  

Effects of interposed abdominal pulling-pressing cardiopulmonary resuscitation on the hemodynamic parameters of 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,连云港222000 [2]中国人民武装警察部队总医院急救医学中心

出　　处：《中国急救复苏与灾害医学杂志》2015年第11期1043-1046,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：全军医学科研“十二五”课题计划（BWS11J077）

摘　　要：目的观察插入式腹部提压复苏法（interposed abdominal pulling-pressing cardiopulmonary resuscitation）和常规胸外心脏按压法（standard cardiopulmonary resuscitation, S-CPR）对心跳骤停（cardiac arrest，CA）患者CA至自主循环恢复（return of spontaneous circulation, ROSC）时间、血流动力学、ROSC率、24hE存率的影响，探讨插入式腹部提压复苏法的复苏机制，为发生的CA选择更合适的复苏方法提供参考。方法20例CA患者随机分为：插入式腹部提压复苏组、常规胸外心脏按压组，每组10例，所有患者都监测有创血压和中心静脉压，发生心跳呼吸骤停后采用插入式腹部提压复苏法或常规胸外心脏按压法进行心肺复苏，观察二种复苏方法的复苏效果，对比二组患者CA至ROSC的时间、血流动力学变化、ROSC率及24h生存率的不同。结果①CA至ROSC时间：插入式腹部提压复苏法组显著低于常规胸外心脏按压；②CPR15min内冠脉灌注压（coronary perfusion pressure，CPP）、平均动脉压（mean arterial pressure，MAP）变化：插入式腹部提压复苏法组组cPP、MAP明显高于常规胸外心脏按压（P〈0．05）。③ROSC后SBP、DBP变化：插入式腹部提压复苏组明显高于常规胸外心脏按压（P〈0．05）。④ROSC率：插入式腹部提压复苏组组的ROSC率高于S—CPR组80％vs50％（P〉0．05）。⑤24h存活率：插入式腹部提压复苏组组24h存活率明显高于常规胸外心脏按压组70％vs30％（P〈0．05）。结论①插入式腹部提压复苏组较常规胸外心脏按压产生更好的血流动力学效果，显著提高CPP、MAP，提高ROSC率及24h生存率；②插入式腹部提压复苏组有较高的ROSC率及24hE存率可能与其缩短CA至ROSC的时间有关。Objective To observe the effects of interposed abdominal pulling-pressing cardiopulmonary resuscitation （IAPP-CPR） and standard cardiopulmonary resuscitation （S-CPR） on the duration from cardiac arrest （CA） to return of spontaneous circulation （ROSC）, hemodynamic changes, ROSC rate and 24 h survival rate in CA patients, in order to discuss the mechanism of IAPP-CPR for better selection of a proper resuscitation method for CA patients. Methods A total of 20 patients were randomly divided into an S-CPR group and an IAPP-CPR group （n=10 in each）. Invasive blood pressure and venous pressure in the heart were measured for all patients. After CA, they underwent IAPP-CPR or S-CPR and their recovery was monitored. The two groups were compared for the duration from CA to ROSC, hemodynamic changes, ROSC rate and 24 h survival rate. Results IAPP-CPR resulted in remarkably shorter duration from CA to ROSC than S-CPR. Patients receiving IAPP-CPR presented substantially higher coronary perfusion pressure （CPP） and mean arterial pressure （MAP） within 25 min of CPR than those after S-CPR （P 〈0.05）. After ROSC, changes of SBP and DBP were markedly higher in the IAPP-CPR group than in the S-CPR group （P 〈0.05）. The IAPP-CPR group showed a significantly higher rate of ROSC and 24 h survival rate than the S-CPR group （P 〈 0.05）. Conclusion Compared with S-CPR, IAPP-CPR results in better hemodynamic effects, remarkably improved CPP, MAP, 24 h survival rate, and ROSC rate, which may be associated with shortened duration of CA to ROSC.

关 键 词：插入式腹部提压法 心跳骤停 血流动力学 心肺复苏 

分 类 号：R605.974[医药卫生—急诊医学]