连续呼气末二氧化碳监测在心肺复苏患者中应用价值研究  

Application value of continuous end tidal CO2 in patients with cardiopulmonary resuscitation

作　　者：王飞 徐亮[2] 王斌[2] 王斐[2] 胡书群 WANG Fei;XU Liang;WANG Bin;WANG Fei;HU Shu-qun(Department of First Aid and Rescue Medicine,School of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州医科大学麻醉学院急救与救援医学系,江苏徐州221004 [2]徐州市肿瘤医院重症医学科,江苏徐州221005

出　　处：《创伤与急危重病医学》2020年第6期446-449,共4页Trauma and Critical Care Medicine

摘　　要：目的探讨连续呼气末二氧化碳(ETCO2)在心肺复苏患者中的应用价值。方法选取自2017年1月至2019年12月收治的97例成年非创伤院内心肺复苏患者为研究对象,记录心肺复苏30 min内患者ETCO2水平,根据复苏结果,将患者分为自主循环恢复(ROSC)组与非ROSC组,比较两组患者心肺复苏30 min内及总体ETCO2水平,绘制受试者工作曲线(ROC),计算ETCO2临界值。以不同时长ETCO2持续低于此临界值为标准,计算不同时长心肺复苏终止的敏感度、特异度、阳性预测值(PPV)及阴性预测值(NPV)等。结果ROSC组与非ROSC组患者心肺复苏30 min内每分钟ETCO2及总体ETCO2水平比较,差异均有统计学意义(P<0.05)。绘制ROC,当约登指数取最大值0.459时,ROSC最佳临界值为10.25 mmHg(1 mmHg=0.133 kPa),曲线下面积(AUC)为0.823,灵敏度为92.7%,特异度为53.2%。以持续10 min ETCO2≤10 mmHg的敏感度最低,特异性最高,其PPV达到100.0%,NPV为67.06%。结论连续ETCO2监测在指导成年非创伤性心跳骤停患者心肺复苏中的应用价值较高,连续10 min ETCO2≤10 mmHg有望成为心肺复苏终止操作的指标。Objective To investigate the value of continuous end tidal carbon dioxide(ETCO2)in patients with cardiopulmonary resuscitation(CPR).Methods A retrospective study was performed on adult patients with cardiopulmonary resuscitation(CPR)in non traumatic hospital from January 2017 to December 2019.The levels of ETCO2 were recorded within 30 minutes after cardiopulmonary resuscitation.According to the resuscitation results,the patients were divided into restoration of spontaneous circulation(ROSC)group and non ROSC group.The receiver operating curve(ROC)was drawn and the critical value of ETCO2 was calculated.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of cardiopulmonary resuscitation termination were calculated based on the standard of ETCO2 continuously lower than the critical value at different time.Results There were significant differences in ETCO2 per minute and total ETCO2 between ROSC group and non ROSC group within 30 minutes after cardiopulmonary resuscitation(P<0.05).When the maximum value of The Jorden index was 0.459,the optimal critical value of ROSC was 10.25 mmHg(1 mmHg=0.133 kPa),the area under the curve(AUC)was 0.823,the sensitivity was 92.7%,and the specificity was 53.2%.The sensitivity and specificity of ETCO2≤10 mmHg for 10 minutes were the lowest and the specificity was the highest,with PPV reaching 100.0%and NPV reaching 67.06%.Conclusion Continuous ETCO2 monitoring is of high value in guiding cardiopulmonary resuscitation in adult non-traumatic cardiac arrest patients,and ETCO2≤10 mmHg for 10 minutes is expected to be an indicator for the termination of cardiopulmonary resuscitation.

关 键 词：单个ETCO2 连续ETCO2 心肺复苏 

分 类 号：R459.7[医药卫生—急诊医学]