中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2010年
11期
660-662
,共3页
AutoPulse%心肺复苏%血气分析%N末端B型钠尿肽
AutoPulse%心肺複囌%血氣分析%N末耑B型鈉尿肽
AutoPulse%심폐복소%혈기분석%N말단B형납뇨태
AutoPulse%Cardiopulmonary resuscitation%Blood gas analysis%N-terminal B-type natriuretic peptide
目的 探讨胸外按压器械AutoPulse在急诊科心搏骤停患者心肺复苏(CPR)中的应用价值.方法 选择2008年9月至2009年8月首都医科大学附属北京朝阳医院急诊科发生心跳停止的病例,依据胸外按压方式分成徒手标准胸外按压组(42例)及器械胸外按压的AutoPulse复苏组(43例).两组患者均行气管插管接呼吸机,给予100%纯氧通气;其他抢救措施如开放静脉通道、心电监护、电击除颤等依据2005 CPR指南进行.剔除20 min内自主循环恢复的病例,复苏超过20 min者取股动脉血,检测复苏前及复苏20 min后血气及N末端B型钠尿肽(NT-proBNP),并观察两组全部患者2 h及24 h的复苏成功率.结果 复苏超过20 min者,AutoPulse复苏组(29例)复苏后pH值、动脉血氧分压(PaO2)高于标准胸外按压组[28例,pH值:7.142±0.134比7.010±0.136,PaO2(mm Hg,1 mm Hg=0.133 kPa):71.92±9.59比65.61±7.66,均P＜0.01],动脉血二氧化碳分压(PaCO2)及NT-proBNP低于标准胸外按压组[PaCO2(mmHg):39.43±14.09比51.07±16.31,NT-proBNP(ng/L):548.18±256.93比699.40±303.35,P＜0.01和P＜0.05].AutoPulse复苏组2 h复苏成功率明显高于标准胸外按压组[74.4%(32/43)比52.4%(22/42),P＜0.05];24 h复苏成功率高于标准胸外按压组,但差异无统计学意义[9.3%(4/43)比4.8%(2/42),P＞0.05].结论 AutoPulse装置改善了心搏骤停患者的组织灌注,短期内对病情有一定改善,但对患者预后无决定性意义.
目的 探討胸外按壓器械AutoPulse在急診科心搏驟停患者心肺複囌(CPR)中的應用價值.方法 選擇2008年9月至2009年8月首都醫科大學附屬北京朝暘醫院急診科髮生心跳停止的病例,依據胸外按壓方式分成徒手標準胸外按壓組(42例)及器械胸外按壓的AutoPulse複囌組(43例).兩組患者均行氣管插管接呼吸機,給予100%純氧通氣;其他搶救措施如開放靜脈通道、心電鑑護、電擊除顫等依據2005 CPR指南進行.剔除20 min內自主循環恢複的病例,複囌超過20 min者取股動脈血,檢測複囌前及複囌20 min後血氣及N末耑B型鈉尿肽(NT-proBNP),併觀察兩組全部患者2 h及24 h的複囌成功率.結果 複囌超過20 min者,AutoPulse複囌組(29例)複囌後pH值、動脈血氧分壓(PaO2)高于標準胸外按壓組[28例,pH值:7.142±0.134比7.010±0.136,PaO2(mm Hg,1 mm Hg=0.133 kPa):71.92±9.59比65.61±7.66,均P＜0.01],動脈血二氧化碳分壓(PaCO2)及NT-proBNP低于標準胸外按壓組[PaCO2(mmHg):39.43±14.09比51.07±16.31,NT-proBNP(ng/L):548.18±256.93比699.40±303.35,P＜0.01和P＜0.05].AutoPulse複囌組2 h複囌成功率明顯高于標準胸外按壓組[74.4%(32/43)比52.4%(22/42),P＜0.05];24 h複囌成功率高于標準胸外按壓組,但差異無統計學意義[9.3%(4/43)比4.8%(2/42),P＞0.05].結論 AutoPulse裝置改善瞭心搏驟停患者的組織灌註,短期內對病情有一定改善,但對患者預後無決定性意義.
목적 탐토흉외안압기계AutoPulse재급진과심박취정환자심폐복소(CPR)중적응용개치.방법 선택2008년9월지2009년8월수도의과대학부속북경조양의원급진과발생심도정지적병례,의거흉외안압방식분성도수표준흉외안압조(42례)급기계흉외안압적AutoPulse복소조(43례).량조환자균행기관삽관접호흡궤,급여100%순양통기;기타창구조시여개방정맥통도、심전감호、전격제전등의거2005 CPR지남진행.척제20 min내자주순배회복적병례,복소초과20 min자취고동맥혈,검측복소전급복소20 min후혈기급N말단B형납뇨태(NT-proBNP),병관찰량조전부환자2 h급24 h적복소성공솔.결과 복소초과20 min자,AutoPulse복소조(29례)복소후pH치、동맥혈양분압(PaO2)고우표준흉외안압조[28례,pH치:7.142±0.134비7.010±0.136,PaO2(mm Hg,1 mm Hg=0.133 kPa):71.92±9.59비65.61±7.66,균P＜0.01],동맥혈이양화탄분압(PaCO2)급NT-proBNP저우표준흉외안압조[PaCO2(mmHg):39.43±14.09비51.07±16.31,NT-proBNP(ng/L):548.18±256.93비699.40±303.35,P＜0.01화P＜0.05].AutoPulse복소조2 h복소성공솔명현고우표준흉외안압조[74.4%(32/43)비52.4%(22/42),P＜0.05];24 h복소성공솔고우표준흉외안압조,단차이무통계학의의[9.3%(4/43)비4.8%(2/42),P＞0.05].결론 AutoPulse장치개선료심박취정환자적조직관주,단기내대병정유일정개선,단대환자예후무결정성의의.
Objective To investigate the value of AutoPulse in the patients with cardiac arrest (CA)in emergency department.Methods Patients with CA seen in the Emergency Department of Chaoyang Hospital, Affiliated to Capital Medical University from September 2008 to August 2009 were divided into standard manual external chest compression group (n= 42) and mechanical chest compression group with AutoPulse (n = 43), based on the method of the external chest compression.Tracheal intubation was performed and mechanical ventilation instituted in all the patients.Other rescue measures, such as intravenous infusion of fluids, electrocardiogram, electric shock for defibrillation were performed following the cardiopulmonary guideline of 2005.The patients with restoration of spontaneous circulation in 20 minutes were excluded.Among patients with resuscitation over 20 minutes, there were 29 cases in AutoPulse group and 28 cases in standard manual external chest compression group.The blood gas and N-terminal B-type natriuretic peptide (NT-proBNP) from the blood samples obtained from the femoral artery 20 minutes after resuscitation were determined, and the survival rate at 2 hours and 24 hours in both groups was recorded.Results Twenty minutes after cardiopulmonary resuscitation, the Ph value and the arterial partial pressure of oxygen (PaO2) of the AutoPulse group (n= 29) were significantly higher than those of the standard manual external chest compression group[n = 28, Ph value: 7.142 ± 0.134 vs.7.010 ± 0.136, PaO2(mmHg, 1mmHg=0.133kPa): 71.92±9.59 vs.65.61±7.66, both P＜0.01], the arterial partial pressure of carbon dioxide (PaCO2) and NT-proBNP were significantly lower than those of the standard
manual external chest compression group[PaCO2(mm Hg): 39.43±14.09 vs.51.07±16.31, NT-proBNP (ng/L): 548.18 ± 256.93 vs.699.40 ± 303.35, P＜0.01 and P＜0.05].The 2-hour survival rate in AutoPulse group was higher than that in the standard manual external chest compression group, the disparity of the two groups was statistically significant[74.4% (32/43) vs.52.4% (22/42), P＜0.05].Though the 24-hour survival rate of AutoPulse group was higher than that of the standard manual external chest compression group, the difference was not statistically significant[9.3% (4/43) vs.4.8% (2/42), P＞0.05].Conclusion The device of AutoPulse can improve the tissue perfusion in patients with CA.Though this device may give rise some benefit in resuscitation for a short time, there is no decisive improvement in term of outcome of the patient.
