高级气道建立后不同种通气方式对心脏骤停患者通气频率和预后的影响  

The effect of different ventilation modes on the ventilation rate and prognosis in patients with cardiac arrest after advanced airway placement

作　　者：付阳阳 刘丹瑜 金魁 张丽利 余姗姗 王亚 尹路 徐军 朱华栋 于学忠 Fu Yangyang;Liu Danyu;Jin Kui;Zhang Lili;Yu Shanshan;Wang Ya;Yin Lu;Xu Jun;Zhu Huadong;Yu Xuezhong(Department of Emergency Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College & Peking Union Medical Hospital, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医学院/北京协和医院协和转化医学中心/中国医学科学院北京协和医院

出　　处：《中华急诊医学杂志》2019年第8期995-999,共5页Chinese Journal of Emergency Medicine

基　　金：中国医学科学院医学与健康科技创新工程项目(2017-12M-1-009);北京市科技计划课题(Z181100001918004).

摘　　要：目的评估高级气道建立后,不同种通气方式对心脏骤停患者通气频率和预后的影响。方法回顾性分析2013年12月至2018年06月,北京协和医院急诊科抢救室收治的CPR患者。纳入建立高级气道并采用呼气末二氧化碳(PetCO2)进行质量监测的心肺复苏(CPR)患者,同时要求PetCO2监测时间至少18 min。收集并记录入选CPR患者的流行病学资料、复苏参数及预后情况。根据通气方式,将CPR患者分为简易呼吸器组(BMG)和机械通气组(MVG);采用PetCO2计算CPR患者的通气频率,并将MVG分为低通气频率组(低于20次/min)和高通气频率组(高于20次/min)两个亚组。比较组间患者通气频率,ROSC成功率及24 h、7 d生存率。结果共纳入90例CPR患者,其中BMG 22例,MVG 68例。共采集通气数据1 620 min,中位通气频率为16.5(12.0, 26.0)次/min,通气频率合格率仅为30%,ROSC率约为35.6%,24 h生存率为1.1%,7 d生存率为0。与MVG相比,BMG通气频率明显更低(10次/min vs 21次/min),通气频率合格率更高(88.9% vs 11.5%)。但ROSC率、24 h生存率、7 d生存率两组均差异无统计学意义(P>0.05)。在MVG,可以看到通气频率>20次/min所占的比例为52.6%,超过40次/min的占5.6%,机械通气引起的通气频率过快很普遍。在MVG亚组分析中,低通气频率组与高通气频率组相比,在预后上差异无统计学意义。结论在CPR中,与使用机械通气相比,使用简易呼吸器通气频率明显更低,通气频率合格率更高,但在预后方面,两者并无差别。在机械通气亚组分析,低通气频率组与高通气频率组相比,在预后方面没有差别。Objective To investigate the effect of different ventilation modes on the ventilation rate and prognosis in patients with cardiac arrest after advanced airway placement. Methods Based on the national database of emergency cardiac arrest treatment, patients treated with advanced airway placement during cardiopulmonary resuscitation (CPR) were enrolled in PUMCH Emergency Department from December 2013 to June 2018. The physiological parameters, such as electrocardiograph waveform, pulse oximetry plethysmographic waveform and capnography, were recorded at least 18 minutes. The demographic data and resuscitation parameters were collected. Waveform capnography was used for calculating ventilation rate (VR) and the VR between 8 to 12 breaths/min was defined as the qualified ventilation rate (QVR). According to the ventilation modes, patients were divided into the bag-mask group (BMG) and mechanical ventilation group (MVG). According to the VR, patients in the mechanical ventilation group were divided into two subgroups, the high-frequency ventilation subgroup (HFV subgroup) with the VR more than 20 breaths/min and the low-frequency VR subgroup (LFV subgroup) with the VR less than 20 breaths/min. VR, the qualified ventilation rate ratio (QVRR), the return of spontaneous circulation (ROSC), and 24-h and 7-day survival were compared between the two groups and subgroups. Result A total of 90 patients were enrolled in the analysis with 22 patients in the bag-mask group and 68 patients in the mechanical ventilation group. The total rate of ROSC was 35.6%, 24-h survival was 1.1% and 7-day survival was 0. The first 18 minutes ventilation data were collected and added up to 1 620 min. The median VR was 16.5 (12.0, 26.0) breaths/min and the QVRR was 30%. Compared with the mechanical ventilation group, the VR in the bag-mask group were lower (10 breaths/min vs 21 breaths/min) and the QVRR was higher (88.9% vs 11.5%). The ROSC, 24-h survival and 7-day survival had no statistical differences between the two groups. In the mechanical

关 键 词：心脏骤停 心肺复苏 机械通气 通气频率 简易呼吸器 

分 类 号：R541.78[医药卫生—心血管疾病]