摘要
目的 :明确院内心脏骤停的病人在行标准CPR的同时附加IAC能否提高复苏成功率并探讨IAC -CPR下冠脉灌注压的变化。方法 :5 1例院内发生的心脏骤停病人随机分为IAC -CPR组 (即实验组n =2 5 )和标准CPR组(即对照组n =2 6)。对照组按照ABC程序紧急行标准心肺复苏术 (S -CPR) ;实验组在进行S -CPR的同时 ,在胸部按压放松时行一次腹部按压 ,按压力度为 15 0mmHg～ 2 0 0mmHg(1Kpa =7.5mmHg) ,按压频率为 10 0次 /分～12 0次 /分 ,压胸与压腹交替进行。两组均监测有创动脉压及右房压。结果 :实验组自主循环恢复率为 84% ,对照组为 5 4% ,两组比较差异有显著性 ,P <0 .0 5 ;2 4h生存率分别为 68%、2 7% ,两组比较差异有显著性 ,P <0 .0 1;实验组冠脉最高灌注压为 3 1.4mmHg± 11.4mmHg对照组为 13 .0mmHg± 6.9mmHg ,两组比较差异有显著性 ,P <0 .0 1。结论 :IAC -CPR可明显地提高冠脉灌注压 ,增加自主循环恢复率和 2 4h生存率 。
Objective: To determine whether interposed abdominal compression (IAC) during standard cardiopulmonary resuscitation (CPR) improves outcome in patients experiencing in-hospital cardiac arrest, and explore the change of coronary perfusion pressure under IAC-CPR.Methods: 51 patients experiencing cardiac arrest in ICU and department of emergency were randomized into two groups: a IAC-CPR group (n=25) and the standard CPR group (n=26). The standard CPR group was urgent saved according to the ABC procedure. In IAC-CPR group during standard CPR , Abdominal compressions were performed at a pressure of 150～200mmHg(1Kpa=7.5mmHg)during the relaxation phase of chest compression, corresponding to CPR diastole, at a rate of 100/min to 120/min. Invasive arterial pressure and right atrium pressure were measured in both groups.Results: Return of spontaneous circulation (ROSC) was significantly greater in the group of IAC-CPR than in the S-CPR (84% vs 54%, P <0.05). Survival 24 hours after resuscitation was a significantly greater proportion of patients in IAC group than in the control group(68% vs 27%, P <0.01).The maximal coronary perfusion pressure(CPP) in IAC-CPR group was significantly greater than in the control group(31.4 11.4 mmHg vs 13.0 6.9 mmHg , P <0.01).Conclusion: IAC-CPR may significantly augment CPP, can improve meaningful ROSC and survival 24 hours, we found no complication directly related to the IAC-CPR procedure.
基金
开封市科技攻关项目 (2 0 0 1)
关键词
IAC-CPR
标准CPR
心脏骤停
应用
对比研究
心肺复苏术
插入式腹部按压
cardiac arrest cardiopulmonary resuscitation(CPR)
interposed abdominal compression CPR
standard CPR
coronary perfusion pressure
