颈动脉搏动实时超声检测对胸外按压CPR效果评价的可行性研究

Feasible study of carotid artery Doppler ultrasound blood flow measurement during chest compression cardiopulmonary resuscitation

目的探讨超声实时监测颈动脉血流对胸外按压心肺复苏(CPR)效果评价的可行性,提出一种实时、无创的血流动力学评估方法。方法采用前瞻性研究方法,选择2016年5月至2018年11月在郑州人民医院急诊科及重症加强治疗病房(ICU)进行CPR的患者。在开始胸外按压的同时应用床旁超声测量患者的颈动脉血流,记录CPR开始1 min和结束前1 min的颈动脉收缩期血流速度峰值(PSV)和舒张期末流速(EDV);记录整个复苏周期内按压频率均值;通过超声评价按压达标率(按压频率100~120次/min为达标);根据CPR过程中记录的超声图像资料回顾计算按压中断时间。结果研究期间共完成CPR过程中超声监测39例,其中抢救成功21例,成功率为53.8%;自主循环恢复(ROSC)时间(10.9±5.3)min。从开始CPR到获得满意超声图像的时间为1.1~4.9 min,平均(2.5±1.2)min。28例患者在胸外按压全程获取到了满意的超声图像,获取率为71.8%(28/39)。在按压过程中如出现按压频率<100次/min或颈动脉流速下降(PSV<30 cm/s)则及时提醒实施胸外按压者予以纠正。28例获取到满意超声图像的患者CPR开始1 min PSV为(62.9±18.5)cm/s、EDV为(13.9±3.5)cm/s,CPR结束前1 min PSV为(55.4±18.4)cm/s、EDV为(12.9±3.7)cm/s,两个时间点间比较差异均无统计学意义(均P>0.05),提示CPR全程均获得了满意的复苏效果。28例患者按压频率100~149次/min,平均(117±47)次/min;按压达标率为85.7%(24/28);按压中断总时间占所有按压时间的4.4%(25.9 min/587.2 min)。结论应用床旁急诊超声监测颈动脉血流具有实时、无创的特点,可作为一种反馈胸外按压CPR效果的可行性方法。

Objective To determine the feasibility of ultrasound to measure blood flow on patients with chest compression cardiopulmonary resuscitation (CPR), and to find out a real-time, noninvasive hemodynamic evaluation method. Methods A prospective study was conducted. All adult patients undergoing CPR admitted to Department of Emergency and intensive care unit (ICU) of Zhengzhou People's Hospital from May 2016 to November 2018 were enrolled. The blood flow over the right carotid arteries during chest compressions was recorded with a bedside ultrasound machine. The peak systolic flow velocity (PSV) and end diastolic flow velocity (EDV) of carotid artery were recorded at 1 minute after the start of CPR and 1 minute before the end of CPR. The mean compression frequency during the whole recovery period was recorded, the rate of compression reaching the standard was evaluated by ultrasound (the rate of compression 100-120 times/min was defined as up to standard), and the interruption time of compression was calculated retrospectively according to the ultrasound image data recorded during CPR. Results Thirty-nine patients were enrolled, and 21 patients were successfully rescued, with a successful rate of 53.8%, the time of restoration of spontaneous circulation (ROSC) was (10.9±5.3) minutes. The time from CPR to retrieve an ultrasound image was 1.1-4.9 minutes, with an average of (2.5±1.2) minutes. Satisfactory ultra-sonographic images were obtained in 28 patients during the whole course of chest compression. The acquisition rate was 71.8%(28/39). In the process of compression, if the frequency of compression was less than 100 times/min or the velocity of carotid artery dropped (PSV < 30 cm/s), the chest compressors should be reminded and corrected in time. The PSV at 1 minute after CPR start of 28 patients with satisfactory ultrasound images was (62.9±18.5) cm/s, and the EDV was (13.9±3.5) cm/s, the PSV at 1 minute before the end of CPR was (55.4±18.4) cm/s, and the EDV was (12.9±3.7) cm/s. There was no significant difference in above parameters between the two time points (both P > 0.05), suggesting that satisfactory resuscitation effect was achieved in the whole process of CPR. The compression frequency of 28 patients was 100-149 times/min with an average of (117±47) times/min. The rate of compression with standard was 85.7%(24/28), and the total interruption time of compression accounted for 4.4% of all compression time (25.9 minutes/587.2 minutes). Conclusion Ultrasound measurement of common carotid artery blood flow during CPR has the advantage of real-time and non-invasive, and it is feasible in clinical work.