摘要
目的:探讨气管插管心肺复苏(CPR)、气囊面罩通气CPR对院前心搏骤停患者心功能、血气指标、神经功能以及预后的影响。方法:选择2018年6月—2019年12月期间我院急诊科收治的263例经急救人员院前现场判断CA患者,根据出诊顺序随机分派出诊小组,气囊组(131例患者)采用气囊面罩通气CPR,插管组(132例患者)采用气管插管CPR。CPR存活患者均评估心功能、血气指标、神经功能[格拉斯哥-匹兹堡脑功能表现分级(CPC)评分],追踪6个月生存情况。比较两组恢复自主循环时间、CPR成功率、脑复苏成功率、心功能、血气指标、神经功能以及生存率差异。结果:气囊组恢复自主循环时间短于插管组[(7.61±2.39) min vs.(9.13±3.25) min,P<0.05],CPR成功率、脑复苏成功率高于插管组[34.35%(45/131) vs.19.70%(26/132)、19.85%(26/131) vs. 10.61%(14/132),P<0.05]。两组入院即刻、CPR成功后1 h、3 h、6 h左心室射血分数(LVEF)、E/A比值、动脉氧分压(PaO2)、PaO2/氧体积分数(FiO2)逐渐增高(P<0.05),动脉二氧化碳分压(PaCO2)逐渐降低(P<0.05)。气囊组入院即刻、CPR成功后1 h、3 h、6 h LVEF、E/A比值高于插管组(P<0.05)。气囊组患者出院前CPC l^2级比例高于插管组(P<0.05),但两组6个月内存活率比较无统计学差异(P>0.05)。结论:气囊面罩通气CPR可缩短自主循环恢复时间,提高CPR成功率,降低对患者心脑功能的影响,但短期存活率与气管插管CPR无差异。
Objective: To investigate the effect of endotracheal intubation cardiopulmonary resuscitation(CPR) and airbag mask ventilation CPR on cardiac function, blood gas index, nerve function and prognosis of patients with prehospital cardiac arrest. Methods: A total of 263 CA patients judged by emergency personnel on the spot before hospitalization and admitted to the emergency department of our hospital from June 2018 to December 2019 were selected. The visiting groups were randomly assigned according to the order of their visits. The airbag group(131 patients) received CPR with airbag mask ventilation, and the intubation group(132 patients) received CPR with endotracheal intubation. CPR survived patients evaluated cardiac function, blood gas index, nerve function[cerebral performance category(CPC) score], tracked 6 months to live. The differences of recovery time, CPR success rate, brain resuscitation success rate, cardiac function, blood gas index, nerve function and survival rate were compared between the two groups. Results: The recovery time of the airbag group was shorter than that of the intubation group([7.61±2.39] min vs. [9.13±3.25] min, P<0.05), and the success rate of CPR[34.35%(45/131) vs. 19.70%(26/132) ]and brain resuscitation[19.85%(26/131) vs. 10.61%(14/132) ]was higher than that of the intubation group(P<0.05). Left ventricular ejection fraction(LVEF), E/A ratio, arterial oxygen partial pressure(PaO2) and PaO2/oxygen volume fraction(FiO2) at admitted to hospital immediately, 1 h, 3 h, 6 h after successful CPR in the two groups increased gradually(P<0.05), while arterial partial pressure of carbon dioxide(PaCO2) decreased gradually(P<0.05). The LVEF, E/A ratio in the airbag group at admitted to hospital immediately, 1 h, 3 h, 6 h after successful CPR were higher than that in the intubation group(P<0.05). Before discharge, the proportion of CPC l^2 in the airbag group was higher than that in the intubation group(P<0.05), but there was no significant difference in 6-month survival rate between the two groups(P>0.05). Conclusion: CPR with airbag mask ventilation can shorten the recovery time of spontaneous circulation, improve the success rate of CPR, and reduce the effect on cardiac and brain function of patients, but the short-term survival rate is not different from CPR with endotracheal intubation.
作者
曾涌
唐国强
赵金川
ZENG Yong;TANG Guoqiang;ZHAO Jinchuan(Department of Pre-hospital Emergency,Chongqing Emergency Medical Center,the Fourth Peoples Hospital of Chongqing,Chongqing,400010,China)
出处
《临床急诊杂志》
CAS
2020年第12期969-973,共5页
Journal of Clinical Emergency
关键词
心肺复苏术
院前急救
心搏骤停
心功能
血气指标
神经功能
生存率
cardiopulmonary resuscitation
pre-hospital first aid
cardiac arrest
cardiac function
blood gas index
neurological function
survival rate
