呼气末二氧化碳在心肺复苏中的临床价值  

Continuous monitoring of end-tidal carbon dioxide in cardiopulmonary resuscitation

作　　者：张春艳[1] 池菲[1] 梁建琴[2] 安慧茹[2] 孟宇 李香兰[1] Zhang Chunyan;Chi Fei;Liang Jianqin;An Huiru;Meng Yu;Li Xianglan(Department of Emergency,Hebei Chest Hospital,Hebei Shijiazhuang 050041,China;The Eighth Medical Center,Chinese PLA General Hospital,Beijing 100091,China;Shijiazhuang Emergency Center,Hebei Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院急诊科,河北石家庄050041 [2]解放军总医院第八医学中心,北京100091 [3]石家庄市急救中心,河北石家庄050041

出　　处：《中国医刊》2021年第11期1207-1210,共4页Chinese Journal of Medicine

基　　金：河北省医学科学研究重点课题项目计划(20191017)。

摘　　要：目的探讨呼气末二氧化碳(end-tidal carbon dioxide,ETCO_(2))在心肺复苏中的临床价值。方法选择2018年1月至2020年12月河北省胸科医院急诊科收治的院内心脏停搏后行心肺复苏的92例患者作为研究对象。收集患者的临床资料,包括性别、年龄、首次监测心律、心脏停搏的原因及ETCO_(2)连续监测数据等。根据是否出现持续自主循环恢复(return of spontaneous circulation,ROSC)分为ROSC组与非ROSC组。分析两组患者的一般资料及ETCO_(2)在不同时间点的数值变化。绘制ROC曲线,根据约登指数得出最佳临界值。根据ETCO_(2)对不同复苏时长的心肺复苏结局的比较,判断患者复苏失败的时间界点。结果ROSC组与非ROSC组性别、年龄、首次监测心律及心脏停搏的原因等临床资料比较差异均无显著性(P>0.05)。ROSC组ETCO_(2)高于非ROSC组(P<0.001)。ETCO_(2)预测ROSC的最佳临界值为12.5mmHg,约登指数为0.418。ETCO_(2)≤12.5mmHg持续时间超过20min,则复苏失败率为100%。结论连续ETCO_(2)监测在指导成人心脏停搏心肺复苏中的应用价值较高,ETCO_(2)≤12.5mmHg持续时间超过20min可作为心肺复苏失败的预测指标。Objective To explore the value and significance of ETCO_(2)in cardiopulmonary resuscitation.Method 92 patients who underwent cardiopulmonary resuscitation after respiratory cardiac arrest in the emergency department of Hebei Chest Hospital from January 2018 to December 2020 were selected as the research objects.Patient data were collected,including gender,age,initial monitoring of cardiac rhythm,etiology of cardiac arrest,and ETCO_(2).According to the occurrence of persistent ROSC,they were divided into ROSC group and non-ROSC group.The general data of the two groups and the changes of ETCO_(2)at different time points were analyzed.ROC curve was plot and the optimal critical value was obtained according to the Youden index.According to the comparison of cardiopulmonary resuscitation outcomes of different resuscitation duration with ETCO_(2),the time point of resuscitation failure was determined.Result There were no significant differences between the ROSC group and the non-ROSC group in age,sex,cause of cardiac arrest and initial monitoring of cardiac rhythm(P>0.05).The ETCO_(2)level of ROSC group was higher than that of non-ROSC group(P<0.001).The optimal critical value of ROSC was 12.5mmHg and the Youden index was 0.418.When ETCO_(2)≤12.5mmHg lasted for more than 20 minutes,the resuscitation failure rate was 100%.Conclusion Continuous ETCO_(2)monitoring has a high application value in guiding cardiopulmonary resuscitation in adult patients with cardiac arrest,and ETCO_(2)≤12.5mmHg for more than 20 minutes can be an indicator of cardiopulmonary resuscitation failure.

关 键 词：呼气末二氧化碳 心肺复苏 自主循环恢复 

分 类 号：R605.97[医药卫生—急诊医学]