腹部提压心肺复苏技术在急诊急救中的临床应用

Clinical application of cardiopulmonary resuscitation with abdominal lifting and compression in emergency treatment

目的观察腹部提压心肺复苏（CPR）在严重胸部外伤致呼吸、心搏骤停患者救治中的临床应用效果。方法选择2011年10月至2016年10月靖远煤业集团公司总医院救治的66例严重胸部外伤致呼吸、心搏骤停患者，按随机数字表法分为腹部提压组（32例）和徒手腹部按压组（34例）。两组均给予畅通气道、辅助呼吸、除颤、建立静脉通道、应用血管活性药物等常规治疗。腹部提压组在常规治疗基础上，应用腹部提压装置以100次／min的频率连续交替向下按压与向上提拉腹部，按压和提拉幅度均为腹部原始状态以下或以上的3—5cm；徒手腹部按压组采用徒手腹部按压法进行CPR，按压频率、腹部下陷深度等与腹部提压组相同。比较两组患者CPR后30min心率（HR）、动脉血气及复苏成功率；动态观察腹部提压CPR后自主循环恢复（ROSC）患者CPR前及CPR后30min和60min HR、平均动脉压（MAP）．脉搏血氧饱和度（SpO2）的变化。结果与徒手腹部按压组比较，腹部提压组CPR后30min HR（次／min：136．13±6．14比148．45±5．16）、动脉血二氧化碳分压[PaCO2（mmHg，1mmHg=0．133kPa）：48．51±2．60比62．51±2．50]均明显降低，动脉血氧分压[PaO2（mmHg）：88．07±3．92比74．12±2．12]明显升高（均尸〈0．05）；腹部提压组ROSC患者4例，徒手腹部按压组2例，腹部提压组复苏成功率明显高于徒手腹部按压组（12．50％比5．82％，P〈0．05）04例经腹部提压CPR后ROSC患者随CPR时间延长，HR呈降低趋势，MAP、SpO2呈升高趋势。结论腹部提压CPR救治效果明显优于徒手腹部按压CPR，可用于抢救严重胸部外伤致呼吸、心搏骤停患者。

Objective To investigate the clinical value of cardiopulmonary resuscitation （CPR） with abdominal lifting and compression on patients with breathing and cardiac arrest induced by severe chest trauma. Methods Sixty-six breathing and cardiac arrest patients induced by severe chest trauma admitted to the General Hospital of Jingyuan Coal Industry Group Company from October 2011 to October 2016 were enrolled, and they were divided into abdominal lifting and compression group （n = 32） and unarmed abdominal compression group （n = 34） by random number table. The patients in both two groups were given the airway open, respiration support, defibrillation treatment, venous access establishment, vasoactive drugs application and other conventional treatments. On the basis of the routine treatment, the patients in abdominal lifting and compression group were given application of abdominal lifting and compression device with 100 times/min frequency and continuously alternating press down to lift the abdomen, the amplitude of pressing and pulling were 3-5 cm below or above the original level of the abdomen. Those in unarmed abdominal compression group were given abdominal CPR pressing method by hand, the frequency of pressing and depth of subsidence was the same as abdominal lifting and compression group. Heart rate （HR） and arterial blood gas at 30 minutes after CPR as well as the success rate of resuscitation were compared between the two groups. The changes in HR, mean arterial pressure （MAP） and pulse oxygen saturation （SpO2） before and 30 minutes and 60 minutes after CPR were dynamically observed in patients with restoration of spontaneous circulation （ROSC） after abdominal lifting and compression CPR treatment. Results Compared with the unarmed abdominal compression group, HR （bmp： 136.13 ±6.14 vs. 148.45 ±5.16） and arterial partial pressure of carbon dioxide [PaCO2 （mmHg, 1 mmHg = 0.133 kPa）： 48.51±2.60 vs. 62.51±2.50] at 30 minutes after CPR in abdominal lifting and compression group were significantly lowered, and arterial partial pressure of oxygen （PaO2） was significantly increased （mmHg： 88.07 ± 3.92 vs. 74.12± 2.12, all P 〈 0.05）. Four patients with ROSC were found in abdominal lifting and compression group, and 2 in unarmed abdominal compression group. The success rate of resuscitation in abdominal lifting and compression group was significantly higher than that of unarmed abdominal compression group （12.50% vs. 5.82%, P 〈 0.05）. In 4 patients with ROSC after abdominal lifting and compression CPR showed a downward trend in HR and an upward trend in MAP and SpO2 with CPR time prolongation. Conclusions The effect of abdominal lifting and compression CPR is better than that of unarmed abdominal compression CPR, which is of great value for the life saving of patients with breathing and cardiac arrest induced by severe chest trauma.