俯卧位心肺复苏(反式CPR)实施技术要点及成功率的影响因素分析  

Technical key points of prone position cardiopulmonary resuscitation(reverse CPR)and analysis of influencing factors of success rate

作　　者：许越媛 王智勇[1] 孟稳利[1] 牛子珍 边丹凤 Xu Yueyuan;Wang Zhiyong;Meng Wenli;Niu Zizhen;Bian Danfeng(Intensive Care Medicine Department,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院重症医学科,石家庄050051

出　　处：《保健医学研究与实践》2023年第S02期72-76,共5页Health Medicine Research and Practice

基　　金：河北省重点研发计划项目(19277740D)。

摘　　要：目的总结俯卧位心肺复苏操作技术要点,分析与俯卧位心肺复苏成功有关的因素,为临床实践提供参考。方法通过检索国内外文献数据库,对符合纳入与排除标准的文献进行收集,对病例基本信息、主要诊断、主要治疗/手术部位(类型)、心脏骤停发生前及发生时情况(包括引起心脏骤停的始动原因和直接原因)、抢救经过(包括技术关键点)及是否成功(即自主循环是否恢复)等信息进行提取分析,并根据复苏是否成功进行分组,尝试寻找与复苏成功有关的因素。结果最终纳入39篇文献,共50个病例用于数据资料的提取与分析。俯卧位心肺复苏实施中,如背部正中具备按压条件,则主要按压部位为胸椎中段(T4~T8),如不具备按压条件(如存在手术切口),则可考虑按压左右肩胛区,同时也有在患者胸骨体中下段与俯卧平面之间放置对抗物的报道。室颤患者可采用俯卧位体外电除颤,除颤电极板的安放位置应根据是否存在背部手术切口,可将电极板A放置于左侧第五肋间腋中线处或略向前,电极板S放置于尽量靠近心脏右上,即靠近心底的位置。全部50例病例,复苏成功35例,复苏失败15例,成功率为70%。在心脏骤停的直接原因方面,快速型室性心律失常病例(均为室颤)的复苏成功率为100%,而其他病例的复苏成功率仅为53.13%,差异有统计学意义(P<0.05)。进一步分析心脏骤停的始动原因与复苏成功率的关系,发现急性呼吸道梗阻所致心脏骤停更容易复苏成功,而空气栓塞所致者成功率较低(P<0.05)。结论在不允许患者迅速翻转为仰卧的情况下,俯卧位心肺复苏应该果断实施,而各种相关经验都需要在临床实践与基础研究中进一步积累。Objective To summarize the technical key points of prone position cardiopulmonary resuscitation and analyze the factors affecting the success of prone position cardiopulmonary resuscitation,providing evidence for clinical practice.Methods By searching literature databases in China and globally,relevant literature that met the inclusion and exclusion criteria was collected.The basic information of the cases,main diagnosis,main treatment/surgical site(type),situation before and during cardiac arrest(including the initiating and direct causes of cardiac arrest),rescue process(including technical key points),and success of resuscitation(i.e.,restoration of spontaneous circulation)were extracted and analyzed.The cases were grouped based on the success of resuscitation,and attempts were made to identify influencing factors of successful resuscitation.Results A total of 39 articles and 50 cases were included for data extraction and analysis.During prone position cardiopulmonary resuscitation,if the midline of the back is suitable for compression,the main compression site is the middle thoracic vertebrae(T4-T8).If compression conditions are not met(e.g.,presence of surgical incision),compression on the left and right scapular areas can be considered.There are also reports of placing counterweights between the lower sternum and the prone surface.External defibrillation in a prone position can be used for ventricular fibrillation patients,and the placement of defibrillation electrode pads should be based on the presence of a surgical incision on the back.Electrode pad A can be placed at the midaxillary line of the left fifth intercostal space or slightly forward,and electrode pad S should be placed as close to the upper right side of the heart,near the cardiac apex,as possible.Among the 50 cases,35 cases were successfully resuscitated and 15 cases failed,resulting in a success rate of 70%.Regarding the direct causes of cardiac arrest,the success rate of resuscitation for rapid ventricular arrhythmia cases(all ventricular f

关 键 词：俯卧位心肺复苏 反式CPR 电除颤 

分 类 号：R605.974[医药卫生—急诊医学]