摘要目的 分析腹部提压心肺复苏(AACD-CPR)与标准心肺复苏(STD-CPR)对心搏骤停(CA)患者氧代谢和预后的影响,以评估AACD-CPR的救治效果.方法 选择2015年10月1日至2017年5月31日郑州人民医院收治的CA时间<30 min、无STD-CPR和AACD-CPR禁忌证的呼吸心搏骤停患者,并按随机数字表法分为STD-CPR组和AACD-CPR组.所有患者入院后均给予相同抢救措施,需要电除颤者给予除颤;STD-CPR组按照2015美国心脏协会(AHA)CPR指南进行操作;AACD-CPR组使用腹部提压心肺复苏仪进行复苏.记录两组患者复苏过程中氧代谢、血流动力学、动脉血气及预后指标.结果 共收入69例患者, STD-CPR组34例,AACD-CPR组35例.① 氧代谢:与STD-CPR组比较,AACD-CPR组复苏过程中动脉血氧含量(CaO2)、动-静脉血氧含量差(avDO2)、氧载量(DO2)、氧耗量(VO2)均显著升高〔CaO2(mL/L):156±15比142±19,avDO2(mL/L):83±14比73±13,DO2(mL/min):248±51比208±54,VO2(mL/min):134±29比118±32,均P<0.05〕,而心排血量(CO)、混合静脉血氧含量(CvO2)差异均无统计学意义.② 血流动力学和动脉血气: 两组心率(HR)、平均动脉压(MAP)、pH值、脉搏血氧饱和度(SpO2)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血乳酸(Lac)基础值差异均无统计学意义.复苏过程中,两组MAP、pH值、SpO2、PaO2均呈上升趋势,PaCO2、Lac呈下降趋势;除STD-CPR组MAP略高于AACD-CPR组外,AACD-CPR组各指标变化更为明显〔pH值差值:0.10±0.15比0.02±0.13,SpO2差值:0.311±0.255比0.159±0.232,PaO2差值(mmHg,1 mmHg=0.133 kPa):12.96±21.84比3.01±13.56,PaCO2差值(mmHg):-9.91±11.17比-3.52±13.87, Lac差值(mmol/L):-0.64±0.61比-0.31±0.58,均P<0.05〕.③ 预后:与STD-CPR组比较,AACD-CPR组自主循环恢复(ROSC)率略有升高(22.9%比8.8%,P>0.05),但ROSC时间明显缩短(min:9.59±2.67比11.83±3.05,P<0.01),1、2周神经功能缺损评分(NDS)明显下降(分:26.45±6.42比30.73±7.38,19.25±6.27比22.64±5.63,均P<0.05),2周生存率略有升高 (17.1%比5.9%,P>0.05).结论 AACD-CPR在改善CA患者血流动力学方面的作用与STD-CPR相当,但在组织器官血氧供应方面具有明显优势,且患者神经功能预后更佳.

abstractsObjective To analyze the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and standard cardiopulmonary resuscitation (STD-CPR) on oxygen metabolism and prognosis of patient with cardiac arrest (CA), and to evaluate the treatment effect of AACD-CPR. Methods Patients with CA, CA time less than 30 minutes, and without STD-CPR and AACD-CPR contraindications admitted to the Zhengzhou People's Hospital from October 1st 2015 to May 31st 2017 were enrolled. The patients were divided into STD-CPR group and AACD-CPR group according to random number table. All patients were given the same rescue measures, if required to give defibrillation; STD-CPR group was operated according to the 2015 American Heart Association (AHA) CPR guidelines; AACD-CPR group was recovered using abdominal lifting and compression cardiopulmonary resuscitation instrument. The oxygen metabolism, hemodynamic, arterial blood gas and prognostic indicators were recorded in the two groups during the resuscitation. Results A total of 69 cases, with STD-CPR group of 34 cases and AACD-CPR group of 35 cases were enrolled finally. ① The oxygen metabolism: during the recovery, compared with STD-CPR group, arterial blood oxygen content (CaO2), arterial-venous oxygen content difference (avDO2), the oxygen carrying capacity (DO2), oxygen consumption (VO2) in AACD-CPR group were significantly increased [CaO2(mL/L): 156±15 vs. 142±19, avDO2(mL/L): 83±14 vs. 73±13, DO2(mL/min): 248±51 vs. 208±54, VO2(mL/min): 134±29 vs. 118±32, all P < 0.05], but there were no significant differences in cardiac output (CO) and mixed venous oxygen content (CvO2). ② Hemodynamic and arterial blood gas: there were no significant differences in the base values of the heart rate (HR), mean arterial pressure (MAP), pH value, pulse oxygen saturation (SpO2), arterial oxygen pressure (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and blood lactate (Lac) between two groups. In the recovery process, MAP, pH value, SpO2, PaO2of two groups were increased, while PaCO2and Lac were decreased. Except MAP of STD-CPR group was slightly higher than AACD-CPR group, the change tendency of AACD-CPR group was more obvious in each index obviously [pH value difference: 0.10±0.15 vs. 0.02±0.13, SpO2difference: 0.311±0.255 vs. 0.159±0.232, PaO2 difference (mmHg, 1 mmHg = 0.133 kPa): 12.96±21.84 vs. 3.01±13.56, PaCO2difference (mmHg): -9.91±11.17 vs.-3.52±13.87, Lac value difference (mmol/L): -0.64±0.61 vs. -0.31±0.58, all P < 0.05]. ③ Prognosis: compared with STD-CPR group, the restoration of spontaneous circulation (ROSC) rate in AACD-CPR group was slightly increased (22.9% vs. 8.8%, P > 0.05), but the ROSC time in AACD-CPR group was significantly shortened (minutes: 9.59±2.67 vs. 11.83±3.05, P < 0.01), nerve function defect score (NDS) was significantly decreased at 1, 2 weeks (26.45±6.42 vs. 30.73±7.38, 19.25±6.27 vs. 22.64±5.63, both P < 0.05), and the 2-week survival was slightly increased (17.1% vs. 5.9%, P > 0.05). Conclusion AACD-CPR is similar to STD-CPR in improving hemodynamics of CA patients, but has advantage in the blood oxygen supply for tissues and organs, and the neurological function prognosis is better.