急进高原青年人胸外按压时的生理反应和质量变化及心肺复苏反馈技术的干预效果  

The physiological responses of healthy youth to doing chest compression as a feedback of the quality and intervention effects of CPR after their rapid ascent to high altitude

作　　者：陈坤[1] 管军[1] 林兆奋[1] 

机构地区：[1]上海长征医院急救科,上海200003

出　　处：《中华急诊医学杂志》2016年第5期633-637,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨急进高原青年人生理反应和胸外按压质量的变化及心肺复苏反馈技术的干预效果。方法本研究采用前瞻性单样本前后对照研究。纳入15例世居平原的健康青年人作为受试者，事先均接受过心肺复苏术培训。在重庆（海拔259m），受试者先后实施4min经验按压和4min反馈按压，每轮按压均通过AEDPLUS记录按压深度、频率等按压质量参数。经验按压指受试者根据感觉经验进行胸外按压，反馈按压指受试者根据AEDPLUS测量并实时反馈的按压质量数据调整按压深度和频率等。每轮按压前后均测量受试者的血压、脉率和经皮氧饱和度。所有受试者飞机进入拉萨（海拔3658m）1周后重复上述测试。受试者监测参数干预前后的变化采用配对￡检验或Wilcoxon符号秩检验。结果受试者在拉萨比在重庆基线生理指标显著异常，收缩压（125．9±9．5）mmHg vs．（112．7±13．4）mmHg（1mmHg=0．133kPa），舒张压（75．3±7．7）mmHg vs．（64．2±7．3）mmHg，心率（86．3±13．0）次／min vs．（72．7±11．6）次／min，氧饱和度（90．4±1．7）％vs．（97．8±0．9）％，均P〈0．01。在拉萨，经验按压仅造成心率增快（91．1±14．9）次／min vs．（86．3±13．0）次／min，P〈0．01；反馈按压则造成心率增快（87．9±17．5）次／min vs．（80．9±11．7）次／min，P〈0．05，收缩压升高（130．9±11．7）mmHg vs．（120．1±11．9）mmHg，P〈0．05，和氧饱和度下降（88．3±3．4）％ vs．（90．6±1．9）％，P〈0．01。在拉萨，反馈按压比经验按压更接近指南要求，综合合标率中位数（四分位间距）43．6％（55．9％） vs 0．6％（5．3％），P〈0．01。结论高原环境使急进高原青年人心肺复苏术质量下降。心肺复苏反馈技术可有效引导施救者改善胸外按压质量，可能是以刺激施救者消耗更多体能为代价的。Objective To investigate the physiological responses of healthy youth to doing chest compression as a feedback of quality of CPR after their rapid ascent to high altitude and to evaluate the feedback in the intervention effects of CPR. Methods Prospective, single sample, before-after comparison method was used in this study. Fifteen young adults from plains natives were enrolled as trial subjects in this study. All of them received basic life support training course in advance. In Chongqing （259 m above sea level）, subjects performed empiric chest compressions on the model body for4 minutes followed by feedback compressions for 4 minutes after at least 30 minutes rest. Compression depth, rate and other compression quality parameters were measured and recorded at each turn of compressions with an AED PLUS device. Subjects performed empiric compressions based on their knowledge and experiences, and practiced feedback compressions according to the audiovisual guidance of AED PLUS device. Blood pressure, heart rate and SpO2 were taken before and after each turn of compressions. One week after arrival to Lhasa （3 658 m above sea level） by flight, all subjects were asked to do the same procedure as did in Chongqing to see their physiological response to. Paired t tests or Wilcoxon matched pair rank test were used for comparisons of measurements before and after trials. Results Systolic pressures, diastolic pressures, heart rates at baseline in Lhasa were significant different from those in Chongqing, including systolic pressure （125.9 ±9.5） mmHgvs. （112.7 ±13.4） mmHg, diastolic pressure （75.3 ±7.7） mmHg vs. （64.2 ±7.3） mmHg, heartrate （86.3±13.0） beat/minvs. （72.7±11.6） beat/min, SpO2 （90.4±1.7）% vs. （97.8 ±0. 9）%, all P 〈 0.01. In Lhasa, empiric compressions only caused an increase in heart rate （91.1± 14.9） beat/rain vs. （86.3 ± 13.0） beat/rain, P 〈0.01. However, feedback compressions resulted in a significant decrease in SpO2 [ （88.3 ± 3.4） % vs. （

关 键 词：心肺复苏质量 心肺复苏反馈 高原 生理反应 青年人 

分 类 号：R459.7[医药卫生—急诊医学]