手掌腋下平移法定位胸外按压部位在心肺复苏中的应用研究

Application of Chest Compression Site Positioning by Palm Armpit Translation Method in Cardiopulmonary Resuscitation

目的探讨一种心肺复苏胸外按压的定位方法——手掌腋下平移法的实用性和可行性。方法采用随机数字表法选取2014年10月10—19日在三峡大学人民医院急诊心电图室行心电图检查的患者30例为模拟心肺复苏被抢救者(模拟者)。同期选取急诊科医生或护士50例为心肺复苏抢救者(抢救者)。抢救者分别采用手掌腋下平移法和传统方法对同一模拟者进行定位。手掌腋下平移法为五指自然并拢,拇指朝向患者头侧并紧贴腋窝顶部,立即平移手掌,相当于沿两侧腋窝顶部连线移动使掌跟停在胸部正中线上。传统方法参照《2010年美国心脏协会心肺复苏及心血管急救指南》及《2015年美国心脏协会心肺复苏及心血管急救指南》定位。收集模拟者的年龄、身高、体质量、整个胸骨长度(SL)、两侧腋窝顶部连线与前正中线交点到胸骨下切迹的距离(AY)、两侧乳头连线(INL)与前正中线交点到胸骨下切迹的距离(DX-INL),收集抢救者的性别、年龄、身高、体质量、右手五指自然并拢时手掌的宽度(HW)以及抢救者采用手掌腋下平移法和传统方法准确找到定位点所需要的时间及定位点距胸骨下切迹的距离与SL的比值,即(AY-1/2HW)/SL、DX-INL/SL。结果 30例模拟者年龄(45.7±14.0)岁,体质指数(BMI)(22.6±2.3)kg/m^2,SL(21.8±1.9)cm,AY(12.6±0.8)cm,DX-INL(8.0±0.9)cm。50例抢救者中,男17例、女33例,年龄(32.6±7.9)岁,BMI(21.7±2.6)kg/m^2,HW(8.4±1.0)cm。女性抢救者HW为(8.1±1.0)cm,男性抢救者HW为(9.1±0.4)cm,差异有统计学意义(t'=5.24,P<0.001)。手掌腋下平移法准确找到定位点所需要的时间为(2.5±0.3)s,传统方法准确找到定位点所需要的时间为(21.2±2.6)s,差异有统计学意义(t=-282.40,P<0.001)。(AY-1/2HW)/SL为(0.38±0.03),DX-INL/SL为(0.37±0.01),差异无统计学意义(t=-1.61,P=0.11)。结论手掌腋下平移法定位胸外按压部位是一种简单、方便、可行、快捷、准确的定位方法,能为尽早心肺复苏赢得更多时间。

Objective To explore the feasibility and practicability of a method positioning CPR chest compression site which is palm armpit translation method. Methods By random number table method, we enrolled 30 patients who received electrocardiographic examination at the Emergency Center of Three Gorges University People＇ s Hospital from October 10 to 19,2014 as simulated CPR patients to be rescued. In the same period,we enrolled 50 doctors and nurses of the Emergency Center to conduct CPR rescue. The rescue workers used both palm armpit translation method and traditional method to position chest compression site on each patient. Palm armpit translation method is folding five fingers naturally with the thumb heading toward head and clinging to the armpit,and then moving palm from armpit to mid- chest. The traditional method refers to 2010 American Heart Association Guidelines for CPR and ECC and 2015 American Heart Association Guidelines for CPR and ECC. Data of stimulated patients were collected,including age,height,BMI,sternum length（ SL）,the distance from the intersection point of two armpits line and anterior median line to sternum incised trace（ AY）, the distance from the intersection point of two nipples line and anterior median line to sternum incised trace（ DX-INL）. Data of rescue workers were also collected,including gender,age,height,BMI,the breadth of the right palm when fingers naturally folding（ HW） and time needed to position compression site and the ratio of the distance from the site positioned and sternum incised trace to SL by the two methods. Results The age,BMI,SL,AY and DX-INL were（ 45. 7 ± 14. 0） years old,（ 22. 6 ± 2. 3） kg / m^2,（ 21. 8 ± 1. 9） cm,（ 12. 6± 0. 8） cm and（ 8. 0 ± 0. 9） cm respectively. Among the 50 rescue workers,there were 17 males and 33 females,and their age,BMI and HW were（ 32. 6 ± 7. 9） years old,（ 21. 7 ± 2. 6） kg / m^2 and（ 8. 4 ± 1. 0） cm respectively. HW was（ 8. 1± 1. 0） cm for female rescue workers and（ 9. 1 ± 0. 4） cm for male rescue workers,with significant differences between them（ t＇ = 5. 24,P〈0. 001）. The time needed to position compression site by palm armpit translation method and traditional method was（ 2. 5 ± 0. 3） s and（ 21. 2 ± 2. 6） s respectively,with significant differences between them（ t =- 282. 40,P〈0. 001）.（ AY- 1 /2HW） /SL was（ 0. 38 ± 0. 03）,and DX-NIL/SL was（ 0. 37 ± 0. 01）; they have no significant difference（ t=- 1. 61,P = 0. 11）. Conclusion Chest compression site positioning by palm armpit translation method is simple,convenient,feasible,fast and accurate,saving more time for cardiopulmonary resuscitation.