腹部提压心肺复苏临床效果分析

Clinical effect of cardiopulmonary resuscitation with active abdominal compression-decompression

目的探讨腹部提压心肺复苏(AACD-CPR)对心搏骤停患者的复苏效果。方法选择2014年6月至2016年1月海南省人民医院急救中心收治的心搏骤停患者,纳入符合AACD-CPR适应证、无腹部提压禁忌证、体重40~150 kg、年龄>16岁者。所有患者均给予气管插管人工通气及常规药物抢救;同时,使用腹部提压心肺复苏仪进行AACD-CPR,腹部提压节律100次/min,按压与提拉时间比为1∶1,按压力度约50 kg,提拉力度约30 kg。记录患者复苏前后心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、血乳酸(Lac)等指标,并评价患者复苏及自主循环恢复(ROSC)情况。结果 41例心搏骤停患者中男性22例,女性19例;年龄15~89岁,平均(66.5±18.8)岁;心搏骤停原因包括:心源性10例、非心源性18例、原因不详13例。实施AACD-CPR患者的ROSC率为19.5%(8/41)。复苏过程中,所有患者的HR、MAP和SpO2均较复苏前明显改善〔HR(次/min):67.0(48.0,105.0)比0.0(0.0,11.5),MAP(mmHg,1 mmHg=0.133 kPa):23.0(16.0,37.0)比0.0(0.0,0.0),SpO2:0.79(0.45,0.90)比0.00(0.00,0.32),均P<0.01〕。对于ROSC患者,复苏过程中及ROSC后0.5 h各指标均较复苏前明显改善〔HR(次/min):88.5(53.8,105.0)、94.5(72.5,129.3)比0.0(0.0,17.3),MAP(mmHg):48.0(4.13,66.0)、54.0(42.0,72.5)比0.0(0.0,0.0),SpO2:0.74(0.64,0.80)、0.89(0.81,0.93)比0.00(0.00,0.42),均P<0.05〕;此外,复苏过程中及ROSC后0.5 h时Lac水平并未较复苏前升高(mmol/L:4.44±1.66、3.71±1.33比3.95±1.71,均P>0.05)。另外,心搏骤停发生于院前或急诊室的患者ROSC率〔11.1%(2/18)〕低于心搏骤停发生在急诊重症加强治疗病房(EICU)患者的ROSC率〔26.1%(6/23)〕;在标准胸外按压后出现胸肋骨骨折并发症后用AACD-CPR复苏者中,发生于院前或急诊室者ROSC率〔10.0%(1/10)〕也低于心搏骤停发生在EICU者〔20.0%(4/20)〕,但二组间ROSC率比较差异均无统计学意义(均P>0.05)。结论 AACD-CPR用于抢救存在单纯胸外按压禁忌证的心搏骤停患者效果肯定,弥补了常规胸部按压CPR的不足。

Objective To explore the resuscitation effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) on patients with cardiac arrest. Methods The patients with cardiac arrest admitted to emergency medical center of Hainan General Hospital from June 2014 to January 2016 were enrolled, who were satisfied with the indication of AACD-CPR and had no contraindication for AACD-CPR, and with 40-150 kg weight and over 16 years old. All of enrolled patients were given mechanical ventilation and conventional drug rescue. At the same time, AACD-CPR was performed with the active abdominal compression-decompression device, the rhythm of abdominal compression-decompression was 100 bmp and the ratio of compression time to lift time was 1∶1, the pressure intensity was approximately 50 kg and the lifting intensity was approximately 30 kg. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) and blood lactic acid (Lac) were recorded before and after CPR, and restoration of spontaneous circulation (ROSC) were calculated. Results Forty-one patients with cardiac arrest were enrolled, with 22 males and 19 females, and the age between 15 years old and 89 years old, with an average (66.5±18.8) years old. The etiologies of cardiac arrest were followed: cardiogenic for 10 cases, non-cardiogenic for 18 cases, and unknown causes for 13 cases. The rate of ROSC in patients with AACD-CPR was 19.5%(8/41). During the resuscitation, the HR, MAP and SpO2 of those patients were significantly improved compared with those index suffering the cardiac arrest [HR (bmp): 67.0 (48.0, 105.0) vs. 0.0 (0.0, 11.5), MAP (mmHg, 1 mmHg = 0.133 kPa): 23.0 (16.0, 37.0) vs. 0.0 (0.0, 0.0), SpO2: 0.79 (0.45, 0.90) vs. 0.00 (0.00, 0.32), all P < 0.01]. During the resuscitation and 0.5 hours after ROSC, the indexes of the ROSC patients were significantly improved compared with those suffering cardiac arrest [HR (bmp): 88.5 (53.8, 105.0), 94.5 (72.5, 129.3) vs. 0.0 (0.0, 17.3);MAP (mmHg): 48.0 (41.3, 66.0), 54.0 (42.0, 72.5) vs. 0.0 (0.0, 0.0);SpO2: 0.74 (0.64, 0.80), 0.89 (0.81, 0.93) vs. 0.00 (0.00, 0.42);all P < 0.05];in addition, the Lac of patients was not increased in the resuscitation and 0.5 hours after ROSC compared with the status before cardiopulmonary resuscitation (mmol/L: 4.44±1.66, 3.71±1.33 vs. 3.95±1.71, both P > 0.05).Besides, the ROSC rate of patients who suffered cardiac arrest before pre-hospital care or in emergency ward [11.1%(2/18)] were lower than those the patients who suffered cardiac arrest in emergency intensive care unit [EICU, 26.1%(6/23)];while the cardiac arrest patients who didn't experienced AACD-CPR until they got complications such as thoracic rib fracture after standard cardiopulmonary resuscitation (STD-CPR), the ROSC rate of those patients in pre-hospital care or in emergency ward [10.0%(1/10)] were lower than the ROSC rate of the patients who suffered cardiac arrest in EICU [20.0%(4/20)], but there was no significant difference between the two groups (both P > 0.05). Conclusion AACD-CPR is effective in the treatment of sudden cardiac arrest patients with contraindication of chest compression, and makes up for the deficiency of STD-CPR.