Application of thoraco-abdominal combined with cardiopulmonary resuscitation in treatment of patients with emergency cardiac arrest
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摘要: 目的:探讨Lucas与腹部提压仪联合复苏在急诊呼吸心跳骤停患者救治中的应用效果。方法:选取2019年2月—2021年2月期间广西中医药大学第一附属医院仙葫院区急诊科救治的180例心搏骤停患者,随机分为试验组和对照组各90例。对照组行胸外按压采用Lucas心肺复苏器,试验组在对照组基础上联合使用腹部提压心肺复苏仪,比较两组自主循环恢复(ROSC)率、平均动脉压(MAP)、呼吸末二氧化碳数值(PETCO2)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2)、乳酸(Lac)水平、ROSC时间及神经系统功能格拉斯哥(GCS)评分。结果:试验组复苏成功率及MAP均较对照组高(P<0.05)。ROSC后10 min、20 min及30 min,两组PaO2、SaO2及PETCO2均高于复苏前(P<0.05),PaCO2水平均低于复苏前(P<0.05),且试验组较对照组同一时间点改善明显(P<0.05)。试验组Lac在ROSC后30 min低于复苏前(P<0.05),较对照组同一时间点明显降低(P<0.05)。试验组复苏时间及住院天数较对照组短(P<0.05),而GCS评分高于对照组(P<0.05)。两组使用血管活性药物比较,试验组较对照组使用肾上腺素少,差异具有统计学意义(P<0.05);两组使用阿托品及胺碘酮比较,差异无统计学意义(P>0.05)。结论:与单纯应用Lucas行胸外心肺复苏相比,Lucas与腹部提压仪联合进行胸腹复苏在提高PETCO2、MAP、PaO2、SaO2及降低PaCO2、Lac方面优势明显,能缩短ROSC时间及提高ROSC率,使复苏成功后GCS评分较高。Abstract: Objective: To explore the application effect of Lucas and abdominal pressure lifting instrument combined with resuscitation in emergency treatment of patients with respiratory and cardiac arrest.Methods: From February 2019 to February 2021, 180 patients with cardiac arrest treated in the Emergency Department of the First Affiliated Hospital of Guangxi University of Chinese Medicine, were randomly divided into the experimental group and the control group with 90 cases in each group. The control group was treated with Lucas cardiopulmonary resuscitation device, and the experimental group was treated with abdominal pressure lifting cardiopulmonary resuscitation device on the basis of the control group. The ROSC rate, mean arterial pressure(MAP), end tidal carbon dioxide(PETCO2), arterial partial pressure of oxygen(PaO2), arterial partial pressure of carbon dioxide(PaCO2), arterial oxygen saturation(SaO2), lactic acid(Lac) levels and autonomic blood pressure were compared between the two groups. The recovery of circulation(ROSC) time and Glasgow neurological score(GCS) were measured.Results: The success rate of resuscitation and the MAP in the experimental group were higher than those in the control group(P<0.05). At 10 min, 20 min and 30 min after ROSC, PaO2, SaO2 and PETCO2 levels of the two groups were higher than those before resuscitation(P<0.05), and PaCO2 levels were lower than those before resuscitation(P<0.05), and the experimental group was significantly improved compared with the control group at the same time point(P<0.05). Lac in the experimental group was lower than that before resuscitation at 30 min after ROSC(P<0.05), and was significantly lower than that in the control group at the same time point(P<0.05). The recovery time and hospitalization days of the experimental group was shorter than those of the control group(P<0.05), and the GCS score was higher than that of the control group(P<0.05). Comparing the use of vasoactive drugs between the two groups, the experimental group used less epinephrine than the control group, and the difference was statistically significant(P<0.05); There was no significant difference in the use of atropine and amiodarone between the two groups(P>0.05).Conclusion: Compared with the use of Lucas alone for extra-thoracic cardiopulmonary resuscitation, the combination of Lucas and abdominal lift and pressure instrument for thoraco-abdominal resuscitation has obvious advantages in improving PETCO2, MAP, PaO2, SaO2, and decreasing PaCO2and Lac. It can shorten the ROSC time and increase ROSC rate, so that GCS score is higher after successful resuscitation.
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