心肺复苏中基础及进一步生命支持阶段优化实施的探讨

Basic and further life support during cardiopulmonary resuscitation

目的初步探讨2005年国际心肺复苏指南方案中基础及进一步生命支持阶段优化实施的疗效。方法选取2007年9月至2009年9月我院急诊科收治的心跳停搏患者386例,按随机数字表法分为2组。A组:196例,按2005年国际心肺复苏指南方案治疗;B组:190例,在2005年国际心肺复苏指南方案基础上优化实施治疗。具体方案为:(1)基础生命支持阶段的优化。判断神志→呼救→摆放体位→开放气道→人工循环→人工呼吸(人工循环∶人工呼吸为30∶2),由传统的ABC步骤调整为ACB。(2)进一步生命支持阶段的优化,①成立5人心肺复苏小组(2名医生,3名护士);②基于复苏指南中已肯定疗效的复苏药物,在目前应用的合理剂量及时间内建立复苏药物的统一应用流程,保证复苏药物应用的规范化;③在1min内完成电除颤;④在3min内完成气管插管;⑤"THUMPER"1007型心肺复苏仪适当延长心肺复苏时间至1h,保证有效按压。分别观察两组自主循环恢复率、自主呼吸恢复率、自主循环恢复时间、自主呼吸恢复时间、24h存活率和出院存活率。结果 A、B组自主循环恢复率分别为15.82%(31/196)和26.84%(51/190),A、B组自主呼吸恢复率分别为14.80%(29/196)和25.26%(48/190),B组自主循环恢复率为及自主呼吸恢复率明显高于A组(P<0.05);A、B组自主循环恢复时间分别为(12.38±3.96)min和(7.52±2.87)min,A、B组自主呼吸恢复时间分别为(152.70±10.80)min和(76.56±8.29)min,B组自主循环恢复时间及自主呼吸恢复时间明显短于A组(P<0.05);A、B组24h存活率分别为15.82%(31/196)和26.84%(51/190),A、B组出院存活率分别为13.27%(26/196)和21.58%(41/190),B组24h存活率及出院存活率显著高于A组(P<0.05)。结论 2005年国际心肺复苏指南优化实施方案较2005年国际心肺复苏指南方案可以明显提高自主循环恢复率、自主呼吸恢复率和24h存活率、出院存活率,缩短自主循环恢复时间及自主呼吸恢复时间。

Objective To study the therapy efficacy of basic and further life support recommended in the 2005 international cardiopulmonary resuscitation guide. Methods A total of 386 patients with cardiac arrest admitted to the emergency department of our hospital from September 2007 to September 2009 were randomly divided into control group （group A,n=196） and observation group （group B,n=190）. Patients in group A were treated following the 2005 international cardiopulmonary resuscitation guide. Patients in group B were treated following the improved 2005 international cardiopulmonary resuscitation guide. In brief,mentality→respiration→position→open airway→artificial circulation→artificial respiration （artificial circulation/artificial respiration=30/2）were assessed with the traditional ABC adjusted to ACB during basic life support. A cardiopulmonary resuscitation group including 2 physicians and 3 nurses was established to use resuscitation drugs following the improved 2005 international cardiopulmonary resuscitation guide,complete electric defibrilation within 1 min and endotracheal intubation within 3 min,etc. Autonomous circulation and respiration recovery rate and time,24 h survival rate and survival rate after discharge were recorded in patients of two groups. Results The autonomous circulation and respiration recovery rates were higher in group A than in group B （15.82% and 26.84% vs 14.80% and 25.26%,P0.05）. The autonomous circulation recovery time was 12.38±3.96 min and 7.52±2.87 min respectively in groups A and B. The autonomous respiration recovery time was longer in group A than in group B group （152.70±10.80 min vs 76.56±8.29 min）. The 24h survival rate and the survival rate after discharge were higher in group B than in group A（15.82% vs 26.84%,13.27% vs 21.58%,P0.05）. Conclusion The improved 2005 international cardiopulmonary resuscitation guide can significantly increase the autonomous circulation and respiration recovery rate,the 24 h survival rate and the survival rate after discharge,and shorten the autonomous circulation and respiration recovery time during cardiopulmonary resuscitation compared with the 2005 international cardiopulmonary resuscitation guide.