急救人员院前指导目击者心肺复苏成功救治院外心脏骤停1例并文献复习  

A case of out-of-hospital cardiac arrest successfully treated by emergency personnel guiding eyewitness cardiopulmonary resuscitation before hospitalization and literature review

作　　者：邓坤龙 李文浩 谢永惠 DENG Kunlong;LI Wenhao;XIE Yonghui(Airport Emergency Center,the Affiliated Guangdong Second Provincial General Hospital of Jinan University,Guangdong,Guangzhou 518025,China;Department of Emergency Medicine,Pazhou Campus,the Affiliated Guangdong Second Provincial General Hospital of Jinan University,Guangdong,Guangzhou 510317,China)

机构地区：[1]暨南大学附属广东省第二人民医院机场急救中心,广东广州518025 [2]暨南大学附属广东省第二人民医院琶洲院区急诊医学科,广东广州510317

出　　处：《中国医药科学》2025年第6期176-180,共5页China Medicine And Pharmacy

基　　金：“十四五”广东省临床重点专科建设项目(粤卫办医函[2024]10号)。

摘　　要：急救人员指导现场第一目击者实施心肺复苏(CPR)并使用除颤器成功救治1例院外心脏骤停患者。患者男,55岁,于广州白云国际机场内突然倒地,意识丧失,现场目击者立即拨打120急救电话。机场急救中心接到指令后,第一时间电话联系现场工作人员,指导其对患者实施高质量CPR,包括胸外心脏按压频率在100~120次/min,按压深度保持5~6 cm,按压占复苏时间80%以上,按压有力,按压时保持胸廓充分回弹,每2分钟换人按压,减少换人中断时间,在10 s内完成;保持充分的气道开放,高质量的人工呼吸和30∶2的按压与人工呼吸比例等。同时确定现场位置后,就近派出两组救援小组携带除颤器等抢救设备迅速到达现场,并在早期给予电除颤,静脉推注肾上腺素等抢救措施,持续CPR约15 min后患者恢复自主循环(ROSC),心电图提示急性下壁心肌梗死。急救人员在救护车上为患者做好各项术前检查,医院专科团队为患者开通绿色通道,直接绕行急诊医学科、心脏重症科直达导管室,患者经冠状动脉造影检查确诊为右侧冠状动脉闭塞,急诊置入冠状动脉支架1枚,10 d后患者痊愈出院。ROSC患者救治的关键在于急救人员指导现场第一目击者进行高质量CPR,并尽早除颤及使用肾上腺素。The first responder to perform cardiopulmonary resuscitation(CPR)was guided by emergency personnel and a patient with out-of-hospital cardiac arrest was successfully treated using a defibrillator.The patient,a 55-year-old male,suddenly collapsed at Guangzhou Baiyun International Airport and lost consciousness.The on-site witness called the emergency number 120.Upon receiving the instruction,the Airport Emergency Center immediately contacted the on-site staff and instructed them to perform high-quality CPR on the patient,including chest compressions at a frequency of 100-120 times/minute,with a compression depth of 5-6 centimeters,and compressions accounting for more than 80%of the resuscitation time.The compressions should be strong,and the chest should fully rebound during compression.Compressions should be performed by different personnel every 2 minutes to minimize interruption time,and should be completed within 10 seconds.The airway should be kept fully open,with high-quality artificial respiration and a compression-to-respiration ratio of 30∶2.After determining the location of the scene,two rescue teams equipped with defibrillators and other rescue equipment were dispatched to the scene quickly.Early defibrillation and intravenous epinephrine administration were performed,and CPR was continued for about 15 minutes until the patient’s return of spontaneous circulation(ROSC).The electrocardiogram indicated acute inferior myocardial infarction.The emergency personnel performed various preoperative examinations on the patient in the ambulance,and the hospital’s specialized team opened a green channel for the patient,bypassing the emergency department and cardiac intensive care unit directly to the catheterization laboratory.The patient was diagnosed with right coronary artery occlusion by coronary angiography,and an emergency coronary stent was placed.Ten days later,the patient recovered and was discharged.The key to the treatment of ROSC patients lies in the emergency personnel guiding the first responde

关 键 词：院外心脏骤停 第一目击者 心肺复苏 除颤器 尽早除颤 肾上腺素 

分 类 号：R459.7[医药卫生—急诊医学]