插入式腹部提压CPR患者颈动脉血流的超声监测  

Ultrasonic monitoring of carotid blood flow in interposed abdominal pulling-pressing cardiopulmonaryresuscitation

作　　者：张楠 张红 倪诤 尚少红 陈刚 张丽英 李湘 朱京炜 曹正 马素霞 Zhang Nan;Zhang Hong;Ni Zheng;Shang Shaohong;Chen Gang;Zhang Liying;Li Xiang;Zhu Jingwei;Cao Zheng;Ma Suxia(Department of Emergency,Shijingshan Teaching Hospital of Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学石景山教学医院急诊科,北京100043

出　　处：《中华危重病急救医学》2018年第7期691-694,共4页Chinese Critical Care Medicine

摘　　要：目的探讨插入式腹部提压心肺复苏（IAPP-CPR）与传统标准胸外按压心肺复苏（STD-CPR）在颈动脉血流超声监测、复苏效果和预后方面的差异。 方法选择2015年6月至2017年12月首都医科大学石景山教学医院急诊科收治的75例院内呼吸心跳停止患者作为研究对象，按照接诊顺序并结合患者家属意愿分为STD-CPR组和IAPP-CPR组。所有患者均给予持续胸外按压、开放气道、气管插管、机械通气，发生心室纤颤（室颤）时给予电除颤，按常规给予抢救药物。STD-CPR组按照2015年美国心脏协会（AHA）CPR指南操作；IAPP-CPR组在常规CPR基础上，待患者胸部按压松弛时，使用腹部提压心肺复苏仪在患者中上腹部进行连续交替垂直向下按压与向上提拉（频率100次/min，提压时间比1：1，按压力度约50 kg，提拉力度约30 kg）。记录两组患者性别、年龄、心脏停搏（CA）原因；在CPR过程中进行生命体征及颈总动脉超声监测；观察患者自主循环恢复（ROSC）率和48 h存活率。采用Logistic回归分析筛选ROSC的影响因素。结果75例CA患者均纳入最终分析，其中STD-CPR组38例，IAPP-CPR组37例。两组患者的性别、年龄、CA原因比较差异无统计学意义。与STD-CPR组相比，IAPP-CPR组颈总动脉血流峰流速明显加快（cm/s：107.16±13.75比78.99±14.77，P〈0.01），颈总动脉血流量明显增加（mL/min：989.06±115.88比751.62±118.92，P〈0.01），而颈总动脉内径差异无统计学意义（mm：4.55±0.25比4.61±0.21，P〉0.05）。在CPR过程中，IAPP-CPR组平均动脉压（MAP）和经皮血氧饱和度（SpO2）均明显高于STD-CPR组，而两组心率比较差异无统计学意义。STD-CPR组4例患者恢复自主循环，但其中有1例患者因大面积心肌梗死再发室颤，抢救无效死亡，48 h后存活3例；IAPP-CPR组有6例患者实现ROSC，且48 h后仍存活。两组ROSC率和48 h存活率差异无统计学�ObjectiveTo explore the difference in ultrasonic monitoring in carotid blood flow, resuscitation effects and prognosis between interposed abdominal pulling-pressing cardiopulmonary resuscitation （IAPP-CPR） and standard cardiopulmonary resuscitation （STD-CPR）.MethodsSeventy-five cardiac arrest （CA） patients admitted to emergency department of Shijingshan Teaching Hospital of Capital Medical University from June 2015 to December 2017 were enrolled. The patients were divided into STD-CPR group and IAPP-CPR group according to the treatment orders of them and the desire of relatives. All patients were given persistent external compression, airway open, tube intubation, and mechanical ventilation, vasoactive drugs application, defibrillation if required. STD-CPR group was operated according to the 2015 American Heart Association （AHA） CPR guidelines. On the basis of the standard CPR, IAPP-CPR group was recovered using abdominal lifting and compressing CPR instrument to press down to lift the upper abdomen continuously, when the chest compressing relaxed （frequency 100 times/min, down and lift time ratio 1：1, compressing strength 50 kg, lifting strength 30 kg）. The patients＇ gender, age and CA etiology were recorded in the two groups. The vital signs and blood flow of carotid artery were monitored with ultrasonic Doppler during the CPR. The return of spontaneous circulation （ROSC） rate and 48-hour survival rate were observed in patients. The influence factors of ROSC were screened by Logistic regression analysis.ResultsThe data of 75 patients with CA were enrolled finally, with STD-CPR group of 38 patients and IAPP-CPR group of 37 patients. There were no significant differences in patients＇ gender, age or CA etiology between the two groups. Comparing with STD-CPR group, the peak blood flow velocity of carotid artery in IAPP-CPR group was speeded up significantly （cm/s： 107.16±13.75 vs. 78.99±14.77, P 〈 0.01）, the overall blood flow volume of carotid artery was increased significan

关 键 词：插入式腹部提压心肺复苏 心肺复苏 超声多普勒技术 颈总动脉血流 

分 类 号：R459.7[医药卫生—急诊医学]