本文選題：心肺復(fù)蘇 + 腹部��； 參考：《南方醫(yī)科大學(xué)》2016年碩士論文

【摘要】：研究背景與目的心臟驟停(Cardiac Arrest,CA)是指各種原因引起的心肌細(xì)胞收縮及舒張運(yùn)動(dòng)的突然停止,繼而導(dǎo)致心臟喪失射血功能,從而引起人體的所有組織器官出現(xiàn)驟然的嚴(yán)重缺血、缺氧以及功能喪失。其主要臨床表現(xiàn)為患者突然意識(shí)喪失,不能觸及大動(dòng)脈搏動(dòng),以及聽(tīng)診心音消失,伴或者不伴有自主呼吸的停止,并導(dǎo)致全身所有臟器及組織因缺血、缺氧而發(fā)生衰竭并最終死亡。導(dǎo)致心臟驟停的原因很多,而較常見(jiàn)的根據(jù)病因分類(lèi)則可分為：1、心源性因素導(dǎo)致的心臟驟停：包括冠狀動(dòng)脈粥樣硬化性心臟病、各種類(lèi)型的心肌病、先天性心臟病及心肌炎等；2、肺源性因素導(dǎo)致的心臟驟停：包括各種原因?qū)е碌闹舷�、肺栓塞及過(guò)度應(yīng)用阿片類(lèi)藥物引起的呼吸抑制等；3、腦源性因素導(dǎo)致的心臟驟停：包括腦卒中、腦部創(chuàng)傷及各種原因引起的腦疝等；4、其他原因?qū)е碌男呐K驟停：如電解質(zhì)紊亂、中毒、低體溫及觸電等。在所有引起心臟驟停的病因中,心源性因素是最常見(jiàn)也是最重要的原因,約占心臟驟�；颊呖倲�(shù)的一半以上。心臟呼吸驟停具有較高的發(fā)生率,美國(guó)每年約有42萬(wàn)人、歐洲每年約有28萬(wàn)人發(fā)生心臟驟停,我國(guó)每年至少有50萬(wàn)人死于心臟驟停。而在復(fù)蘇結(jié)果上,盡管過(guò)去10-15年里,隨著醫(yī)院參與美國(guó)心臟病協(xié)會(huì)的遵循指南-復(fù)蘇項(xiàng)目,院內(nèi)心肺復(fù)蘇(Cardiopulmonary Resuscitation,CPR)的結(jié)果有了很大改善,但成人出院生存率也只從2000年的13.7%提高到2009年的22.3%,兒童出院生存率也僅從2000年1/1.3%提高到2009年的39.4%。在我國(guó),心肺復(fù)蘇的成功率大約為5-50%,平均復(fù)蘇成功率約為6%。隨著我國(guó)社會(huì)人口結(jié)構(gòu)逐漸加速進(jìn)入老齡化社會(huì),心腦血管發(fā)病率正呈現(xiàn)逐年上升趨勢(shì),心臟驟停及猝死患者的人數(shù)也會(huì)隨之增加。由于心臟驟停和心臟性猝死具有發(fā)病突然、進(jìn)展迅速及不易預(yù)測(cè)的特點(diǎn),因而一旦患者發(fā)生心臟驟停,第一目擊者采取正確的方式對(duì)患者實(shí)施有效的心肺復(fù)蘇,將有利于患者的預(yù)后。為了進(jìn)一步改善心肺復(fù)蘇效果,提高患者自主循環(huán)恢復(fù)率,自現(xiàn)代心肺復(fù)蘇技術(shù)及理論于上世紀(jì)60年代起應(yīng)用于臨床后,大量以提升心肺復(fù)蘇效率的有益研究被國(guó)內(nèi)外學(xué)者提出并進(jìn)行研究,以便能進(jìn)一步提升心臟驟停后患者自主循環(huán)恢復(fù)率,改善患者預(yù)后,挽救更多患者生命。依托于不斷產(chǎn)出的有關(guān)心肺復(fù)蘇方面的文獻(xiàn)以及資料,以大量循證醫(yī)學(xué)證據(jù)為依據(jù),美國(guó)心臟病協(xié)會(huì)心血管急救委員會(huì)每5年進(jìn)行一次心肺復(fù)蘇的指南更新,并于2015年發(fā)布新一版的指南,本次指南再一次強(qiáng)調(diào)了早期建立循環(huán)的重要性,并強(qiáng)調(diào)快速有力實(shí)施胸外按壓,盡量減少不必要的停頓與中斷,以免過(guò)多中斷按壓,導(dǎo)致冠狀動(dòng)脈和腦動(dòng)脈等重要器官出現(xiàn)血液供應(yīng)中斷,降低心肺復(fù)蘇成功率。同時(shí)還一如既往的強(qiáng)調(diào)及時(shí)有效的初級(jí)心肺復(fù)蘇,以便在等待專(zhuān)業(yè)急救隊(duì)伍抵達(dá)前為患者贏得更多搶救時(shí)間,并為實(shí)施高級(jí)心肺復(fù)蘇奠定基礎(chǔ)。但對(duì)比既往的指南,心肺復(fù)蘇的操作要求也更加苛刻,對(duì)有效的心肺復(fù)蘇給出了更加明確的界限,如按壓深度限定為5-6cm,按壓頻率控制在100-120次／分鐘,在缺少反饋裝置的前提下,對(duì)于專(zhuān)業(yè)急救人員實(shí)施如此精確的復(fù)蘇尚有難度,更何況非長(zhǎng)期從事急救復(fù)蘇的醫(yī)學(xué)從業(yè)人員,而向社區(qū)和普通群眾推廣該復(fù)蘇方式則更顯得有些繁瑣與困難。且胸外心臟按壓方式始終無(wú)法克服需要中斷按壓給予有效通氣的弊端,只能通過(guò)更嚴(yán)格的要求專(zhuān)業(yè)急救人員彌補(bǔ)并減少?gòu)?fù)蘇過(guò)程中的中斷對(duì)復(fù)蘇質(zhì)量造成的影響。為提高患者冠脈及大腦血流灌注,增加按壓深度是有效方法,但在增加了對(duì)患者胸廓的按壓深度后,導(dǎo)致患者胸骨骨折的風(fēng)險(xiǎn)也將隨之增加。過(guò)深程度的胸外心臟按壓將會(huì)引起患者胸骨、肋骨等發(fā)生骨折,從而使得胸廓的完整性受到破壞,并導(dǎo)致胸腔的泵機(jī)制失能,進(jìn)而嚴(yán)重影響心肺復(fù)蘇的效率。更甚者導(dǎo)致胸骨及肋骨的完全骨折,間接導(dǎo)致嚴(yán)重的肺部、肝臟和其他組織、器官的損傷,威脅患者生命。且胸廓本身缺陷或損傷的心臟驟�；颊邿o(wú)法實(shí)施胸外心臟按壓,這也是此類(lèi)患者救治的難題。鑒于此,依托于腹部的心肺復(fù)蘇技術(shù)在長(zhǎng)期的研究中得到了一定的應(yīng)用與發(fā)展,先后有Ralston在實(shí)驗(yàn)中發(fā)現(xiàn),采用插入式腹部心肺復(fù)蘇法(Interposed Abdominal Compression Cardiopulmonary Resuscitation,IAC-CPR)可以起到增加動(dòng)脈壓的效果,隨后Barranco及Berryman的研究也驗(yàn)證了腹部按壓法在升高動(dòng)脈壓上的作用,而Einagle等人的研究則發(fā)現(xiàn),腹部按壓技術(shù)在心肺復(fù)蘇時(shí)可以增加頸動(dòng)脈血流的效果,為腹部按壓技術(shù)改善腦灌注提供了支持依據(jù),之后Tang等人的研究發(fā)現(xiàn)腹部壓-松的方式可以起到增加心排出量的作用,Andrea等人根據(jù)其研究結(jié)果,更是認(rèn)為在心臟驟停時(shí),腹部是人體的第二心臟,但以上研究都是基于對(duì)腹部的按壓過(guò)程,卻忽視了對(duì)腹部提拉所能產(chǎn)生的效果。腹部提壓心肺復(fù)蘇急救儀就是根據(jù)“胸泵”、“腹泵”、“心泵”的機(jī)制,采用主動(dòng)按壓與提拉相結(jié)合的方法,通過(guò)對(duì)患者腹部加壓和提拉引起腹腔壓力變化啟動(dòng)“腹泵”,再利用膈肌在連接胸腔與腹腔的活塞作用,將腹腔壓力變化通過(guò)膈肌的位移傳導(dǎo)到胸腔,引起胸腔壓力變化,間接啟動(dòng)“胸泵”,隨后利用心臟與膈肌的解剖關(guān)系產(chǎn)生“心泵”的效果而進(jìn)行心肺復(fù)蘇的一種新技術(shù),該項(xiàng)技術(shù)動(dòng)物實(shí)驗(yàn)中已取得了明顯的應(yīng)用效果,所以我們采用腹部提壓心肺復(fù)蘇急救儀,選取有胸外按壓禁忌癥的心臟呼吸驟�；颊哌M(jìn)行腹部提壓法與傳統(tǒng)心肺復(fù)蘇術(shù)的對(duì)比研究,對(duì)所有接受復(fù)蘇患者自主循環(huán)恢復(fù)(Restoration of Spontaneous Circulation,ROSC)情況、血?dú)庾兓皟x器使用情況進(jìn)行觀察。研究方法1入組條件(1)美國(guó)心臟病協(xié)會(huì)指南標(biāo)準(zhǔn)：①神志喪失；②心音、頸動(dòng)脈、股動(dòng)脈搏動(dòng)消失；③嘆息樣呼吸；④瞳孔散大,對(duì)光反射減弱或消失。(2)體重40-150kg的成年人,性別不限；(3)患者近親屬及其法定代理人知情同意并簽署《知情同意書(shū)》；(4)有胸廓畸形、外傷等體征的患者。2病例排除標(biāo)準(zhǔn)如遇下列任何情況之一排除：(1)無(wú)復(fù)蘇的適應(yīng)癥；(2)腹部外傷、膈肌破裂、腹腔臟器出血、腹主動(dòng)脈瘤及腹腔巨大腫物等；(3)患者近親屬不同意使用腹部提壓心肺復(fù)蘇急救儀進(jìn)行救治；(4)患者有明顯的可能會(huì)影響到療效評(píng)價(jià)的其他疾病者(慢性消耗性疾病如惡性腫瘤、嚴(yán)重的結(jié)核性疾病等)。3臨床干預(yù)措施將符合條件的患者經(jīng)分組后分別采用腹部提壓心肺復(fù)蘇及標(biāo)準(zhǔn)胸外按壓心肺復(fù)蘇救治。所有患者均行經(jīng)口氣管插管(駝人醫(yī)療器械公司,中國(guó))、呼吸氣囊輔助呼吸(駝人醫(yī)療器械公司,中國(guó))、心電監(jiān)測(cè)(飛利浦,荷蘭)、0.9%氯化鈉注射液(石家莊四藥有限公司,中國(guó))建立兩路靜脈通路(0.9%氯化鈉注射液250ml×2快速靜滴),需要除顫者給予除顫(飛利浦,荷蘭)。4終止搶救標(biāo)準(zhǔn)：符合美國(guó)心臟病協(xié)會(huì)指南標(biāo)準(zhǔn)：(1)出現(xiàn)自主的大動(dòng)脈搏動(dòng)；(2)面色出現(xiàn)轉(zhuǎn)潤(rùn)；(3)出現(xiàn)自主呼吸；(4)瞳孔出現(xiàn)由大變小并有對(duì)光反射現(xiàn)象,出現(xiàn)眼球活動(dòng)或四肢抽動(dòng)；(5)經(jīng)持續(xù)規(guī)范搶救30min以上,患者仍未出現(xiàn)心搏和自主呼吸,在得到患者家屬充分知情并同意后終止搶救。5觀察指標(biāo)(1)主要評(píng)價(jià)指標(biāo)：自主循環(huán)恢復(fù)率(自主循環(huán)恢復(fù)率評(píng)價(jià)標(biāo)準(zhǔn)：恢復(fù)竇性或室上性心律,平均動(dòng)脈壓≥60mmHg,維持≥20分鐘)(2)次要評(píng)價(jià)標(biāo)準(zhǔn)：患者復(fù)蘇前、復(fù)蘇過(guò)程中和復(fù)蘇后不同時(shí)間段的血壓、心率、動(dòng)脈血?dú)?并依此計(jì)算平均動(dòng)脈壓。記錄自主循環(huán)恢復(fù)后30min及60min存活率。對(duì)儀器的安全性、便攜性及穩(wěn)定性作出評(píng)價(jià)。入院后的進(jìn)一步救治均按照美國(guó)心臟病協(xié)會(huì)指南執(zhí)行。結(jié)果本研究共入組101例病人,經(jīng)過(guò)進(jìn)一步篩選及對(duì)不符合要求病例的剔除,最后有83例納入分析,分別是腹部提壓心肺復(fù)蘇(Abdominal Lifting and Compression Cardiopulmonary Resuscitation,ALP-CPR)組40例,標(biāo)準(zhǔn)心肺復(fù)蘇(Standard Cardiopulmonary Resuscitation,STD-CPR)組43例。兩組患者的年齡、性別、心臟驟停時(shí)間、體重、身高及身體質(zhì)量指數(shù)(Body Mass Index,BMI)均無(wú)明顯統(tǒng)計(jì)學(xué)差異,患者出現(xiàn)心臟驟停后的平均動(dòng)脈壓(Mean Arterial Pressure,MAP)及血?dú)饨Y(jié)果均無(wú)明顯統(tǒng)計(jì)學(xué)差異。1 實(shí)施ALP-CPR及STD-CPR均可使患者獲得較基礎(chǔ)值明顯增高的平均動(dòng)脈壓,并維持在一定水平,但采用STD-CPR組的患者M(jìn)AP升高幅度較ALP-CPR高,兩者之間差異有統(tǒng)計(jì)學(xué)意義(P=0.001)。就血?dú)夥治鼋Y(jié)果而言,復(fù)蘇過(guò)程中ALP-CPR較STD-CPR組具有更高的PO2及乳酸(Lactic Acid,LAC)水平,但PH、PCO水平ALP-CPR則更低,差異均具有明顯統(tǒng)計(jì)學(xué)意義,而SPO2水平上兩種復(fù)蘇方法無(wú)明顯統(tǒng)計(jì)學(xué)差異；結(jié)合表4的結(jié)果可以發(fā)現(xiàn),ALP-CPR組SPO2、PO2水平上升,且PCO：水平下降,而STD-CPR組患者SPO：的水平雖較基礎(chǔ)值出現(xiàn)上升趨勢(shì),但該組患者PO：水平呈現(xiàn)下降趨勢(shì),而PCO：水平呈現(xiàn)上升趨勢(shì),LAC及PH則兩組患者均呈現(xiàn)下降的趨勢(shì),比較兩組患者SPO：較基礎(chǔ)值增加的水平也無(wú)明顯統(tǒng)計(jì)學(xué)差異。2兩種復(fù)蘇方式按照性別進(jìn)行二次分組并做統(tǒng)計(jì)學(xué)分析,按照性別劃分后的四組間MAP、PO2、PCO以及LAC水平均具有明顯的統(tǒng)計(jì)學(xué)差異(P0.05),而PH、SPO。的變化情況則均無(wú)明顯統(tǒng)計(jì)學(xué)差異。將具有統(tǒng)計(jì)學(xué)差異的結(jié)果分別進(jìn)行多重比較后可以發(fā)現(xiàn),對(duì)于同一組內(nèi)不同性別間比較,除STD-CPR組在P02和PCO2存在組內(nèi)不同性別間差異外,其余指標(biāo)均不存在不同性別間的差異。而在不同組之間,在MAP、PO2及PCO：分壓三項(xiàng)指標(biāo)上,ALP-CPR組的女性與STD-CPR組的男性之間存在統(tǒng)計(jì)學(xué)差異。而在LAC的結(jié)果中,ALP-CPR組中女性與STD-CPR組中女性以及男性均具有統(tǒng)計(jì)學(xué)差異,而ALP-CPR組中男性與STD-CPR組中女性以及男性比較,則均未出現(xiàn)明顯統(tǒng)計(jì)學(xué)差異。3兩種復(fù)蘇方式按照年齡進(jìn)行二次分組并進(jìn)行統(tǒng)計(jì)學(xué)分析,按照年齡劃分后的四組間MAP、SPO2及LAC均具有明顯的統(tǒng)計(jì)學(xué)差異(P0.05),而PH、P0：及PC02均無(wú)明顯統(tǒng)計(jì)學(xué)差異。將具有統(tǒng)計(jì)學(xué)差異的指標(biāo)進(jìn)行多重比較可以發(fā)現(xiàn)(見(jiàn)表8),對(duì)于同一組內(nèi)不同年齡間比較,除STD-CPR組在MAP和SPO2以及65y的兩組復(fù)蘇方式的MAP存在差異外,其余指標(biāo)均無(wú)明顯統(tǒng)計(jì)學(xué)意義。4 兩組的ROSC率、ROSC后30min和60min均無(wú)明顯統(tǒng)計(jì)學(xué)差異,但ALP-CPR組的ROSC率及ROSC后30min和60min的存活率均高于STD-CPR組,且ALP-CPR組ROSC后及ROSC后30min和60min較STD-CPR組優(yōu)勢(shì)比越來(lái)越明顯。5 在復(fù)蘇過(guò)程中,腹部提壓復(fù)蘇儀的穩(wěn)定性、安全性及便攜性均得到所有參與人員的充分肯定,試驗(yàn)過(guò)程中均未出現(xiàn)明顯不良反應(yīng)。結(jié)論腹部提壓心肺復(fù)蘇急救儀在除胸部外的區(qū)域提供了復(fù)蘇手段,并能兼顧心臟驟�；颊叩牟婚g斷循環(huán)及有效的通氣,為心肺復(fù)蘇開(kāi)辟了新的途徑,為合并心臟按壓相對(duì)禁忌癥患者的急救提供了一種安全有效的手段。
[Abstract]:Background and objective Cardiac Arrest (CA) refers to the sudden stop of cardiac contractile and diastolic movement caused by various causes, which leads to the loss of blood function of the heart, which causes sudden severe ischemia in all tissues and organs of the human body, and the loss of oxygen and function. The main clinical manifestation is the sudden consciousness of the patients. Loss, failure to touch the pulsation of the large artery, and the disappearance of the sound of the auscultation, with or without the stop of spontaneous breathing, and leading to the failure of all organs and tissues of the body due to ischemia and hypoxia and eventually death. The causes of cardiac arrest are many, and the more common classification according to the cause of the disease can be divided into 1, cardiogenic factors leading to the heart. Sudden stop: including coronary atherosclerotic heart disease, various types of cardiomyopathy, congenital heart disease, and myocarditis; 2, cardiac arrest caused by pulmonary factors: asphyxia caused by various causes, pulmonary embolism, and excessive use of opioid induced inhibition of respiration; 3, cardiac arrest caused by brain origin factors: package Cerebral apoplexy, brain trauma, and various causes of cerebral hernia; 4, other causes of cardiac arrest, such as electrolyte disturbance, poisoning, hypothermia, and electrical shock. Cardiogenic factors are the most common and most important cause of all causes of cardiac arrest, accounting for more than half of the total cardiac arrest. The sudden stop has a high incidence of about 420 thousand people in the United States each year, and about 280 thousand people in Europe have cardiac arrest every year. At least 500 thousand people die from cardiac arrest every year in our country. In the recovery results, although the hospital has been involved in the guidelines of the American Heart Association for the past 10-15 years, hospital heart resuscitation (Cardiopulmonary The results of Resuscitation, CPR) have been greatly improved, but the survival rate of adult discharge has increased only from 13.7% in 2000 to 22.3% in 2009. The survival rate of children's discharge is also increased from 1/1.3% in 2000 to 39.4%. in 2009 in China. The success rate of cardiopulmonary resuscitation is about 5-50%, and the average recovery success rate is about 6%. with the social population structure of our country. The incidence of cardiovascular and cerebrovascular diseases is on the rise year by year, and the number of patients with sudden cardiac arrest and sudden death will increase. Sudden cardiac arrest and sudden cardiac death have the characteristics of sudden onset, rapid progress and unpredictable. The effective cardiopulmonary resuscitation will be beneficial to the patient's prognosis. In order to further improve the effect of cardiopulmonary resuscitation and improve the recovery rate of patients' autonomic circulation, a lot of beneficial studies on improving the efficiency of cardiopulmonary resuscitation have been studied by scholars both at home and abroad after the application of modern cardiopulmonary resuscitation Technology and theory in 60s. In order to further improve the recovery rate of autonomic circulation after cardiac arrest, improve the prognosis and save more of the patient's life. Relying on the continuous production of literature and data concerned with pulmonary resuscitation, based on a large number of evidence-based medical evidence, the cardiovascular emergency committee of the American Heart Association for heart disease carries out one heart every 5 years. The guidelines for pulmonary resuscitation were updated and a new edition of the guide was issued in 2015. This guide once again emphasizes the importance of early cycle building, and emphasizes the rapid and effective implementation of external pressure, minimized unwanted pause and interruption, so as to avoid overpressure and lead to blood supply interruptions in important organs such as the coronary and cerebral arteries. Reduce the success rate of cardiopulmonary resuscitation. It also emphasizes timely and effective primary cardiopulmonary resuscitation so as to win more rescue time for patients before waiting for the professional first aid team to arrive and lay the foundation for the implementation of advanced cardiopulmonary resuscitation. The recovery gives more clear boundaries, such as the pressure depth of 5-6cm, frequency control at 100-120 / minute, and the difficulty of such precise recovery for professional first-aid workers without feedback devices, not to mention the non long-term medical workers engaged in first aid recovery, and to the community and the ordinary people. The resuscitation approach is more complicated and difficult. And the external cardiac compression method has always been unable to overcome the drawbacks of the need to interrupt effective ventilation, only through more stringent requirements for professional emergency workers to make up for and reduce the effect of interruption on the resuscitation quality in the recovery process. It is an effective method to increase the compression depth, but the risk of the fracture of the sternum will increase after the compression depth of the chest, which will cause the fracture of the patient's sternum, rib and so on. There is a serious impact on the efficiency of cardiopulmonary resuscitation. More serious fractures of the sternum and ribs are caused, which indirectly lead to severe lung, liver and other tissue, organ damage, and threat to the patient's life. The chest pressure is not possible for patients with cardiac arrest or injury of the chest itself. This is also a difficult problem for such patients. Cardiopulmonary resuscitation (CPR) based on the abdomen has been applied and developed in a long period of study. It has been found in the experiment that the insertion of abdominal cardiopulmonary resuscitation (Interposed Abdominal Compression Cardiopulmonary Resuscitation, IAC-CPR) can increase the effect of arterial pressure, followed by Barranco and Berryman. The study also demonstrated the effect of abdominal compression on increasing arterial pressure, and Einagle et al.'s study found that abdominal compression could increase the effect of the carotid artery blood flow during cardiopulmonary resuscitation, providing a support basis for the abdominal compression technique to improve cerebral perfusion, and then Tang et al. The effect of cardiac output, Andrea et al. According to the results of the study, is that the abdomen is the second heart of the human body during cardiac arrest, but the above research is based on the pressing process of the abdomen, but neglects the effect on the abdominal pulling. The mechanism of pump "is to use the combined method of active pressing and pulling to start" abdominal pump "through the change of abdominal pressure and abdominal pressure, and then use the diaphragm to connect the piston of the thoracic cavity with the abdominal cavity. The change of abdominal pressure changes through the diaphragm of the diaphragm to the thoracic cavity, causing the change of the thoracic pressure and indirectly starting the" chest ". "Pump", a new technique for cardiopulmonary resuscitation with the effect of the heart pump on the heart and the diaphragm, which has been used in the animal experiment, so we use the abdominal pressure cardiopulmonary resuscitation apparatus and select the patients with cardiac respiratory arrest with pressure contraindication to the abdomen. The comparative study of pressure method and traditional cardiopulmonary resuscitation (CPR) was used to observe all recovery patients' self circulation recovery (Restoration of Spontaneous Circulation, ROSC), blood gas changes and instrument use. Study methods 1 entry conditions (1) guidelines for the American Heart Association: (1) loss of mind; (2) heart sound, carotid artery, and femoral head The arterial pulsation disappeared; (3) the sigh like respiration; (4) the pupil was large and the light reflex was weakened or disappeared. (2) the adult of the body weight 40-150kg was not limited to sex; (3) the close relatives and their legal agents informed consent and signed the "informed consent"; (4) the exclusion criteria for the patients with thoracic deformity and trauma were in any case in the following cases One of the exclusions: (1) no resuscitation indications; (2) abdominal trauma, diaphragmatic rupture, abdominal viscera hemorrhage, abdominal aortic aneurysm and abdominal massive swelling, and (3) the close relatives of the patients did not agree to use abdominal pressure cardiopulmonary resuscitation apparatus for treatment; (4) patients with other diseases (chronic attrition) that could significantly affect the evaluation of the disease (chronic attrition) .3 clinical interventions, such as malignant tumors, serious tuberculous diseases, etc., were treated by abdominal pressure cardiopulmonary resuscitation and standard external pressure cardiopulmonary resuscitation. All patients were treated by oral tracheal intubation (humpman medical device company, China), respiratory airbag auxiliary breathing (hump medical device male) Division, China), ECG monitoring (PHILPS, Holland), 0.9% Sodium Chloride Injection (Shijiazhuang four drugs limited, China) to establish two channels (0.9% Sodium Chloride Injection 250ml x 2 fast drops), defibrillators to defibrillation (PHILPS, Holland).4 termination of rescue standards: compliance with the American Heart Association guidelines: (1) autonomous Great artery pulsation; (2) the appearance of the facial color, (3) the emergence of spontaneous breathing; (4) the pupil appeared from large to light reflection, the occurrence of eye movement or extremities movement; (5) the continuous standardized rescue of 30min, the patients still have no heart beat and spontaneous breathing, after the patient's family is fully informed and agreed to terminate.5 observation after the consent to terminate the observation finger. Standard (1) main evaluation indicators: self circulation recovery rate (independent circulation recovery rate evaluation criteria: restoring sinus or supraventricular rhythm, mean arterial pressure more than 60mmHg, maintaining over 20 minutes) (2) secondary evaluation criteria: the blood pressure, heart rate, arterial blood gas before resuscitation, the recovery process and the resuscitation, and the calculation of the average artery. The safety, portability and stability of the instrument were evaluated after the recovery of 30min and 60min. The further treatment after admission was carried out in accordance with the American Heart Association guidelines. Results 101 patients were enrolled in the study. After further screening and rejection of the incompatible cases, 83 were finally included in the study. Analysis, 40 cases of Abdominal Lifting and Compression Cardiopulmonary Resuscitation, ALP-CPR group, 43 cases of standard cardiopulmonary resuscitation (Standard Cardiopulmonary Resuscitation, STD-CPR) group. Age, sex, cardiac arrest time, weight, height and body mass index (Body) in the two groups. There was no significant difference in statistical difference. There was no significant difference in the average arterial pressure (Mean Arterial Pressure, MAP) and blood gas results after cardiac arrest..1 implementation ALP-CPR and STD-CPR can make the patients gain a higher average arterial pressure than the basic value, and maintain a certain level, but the MAP elevation of the patients in the STD-CPR group is used. The difference between the two was higher than that of ALP-CPR (P=0.001). As for the results of blood gas analysis, ALP-CPR had higher PO2 and lactic acid (Lactic Acid, LAC) than that of the STD-CPR group during the recovery process, but PH, PCO ALP-CPR was lower, and the difference had obvious sense of integration, while the two resuscitation methods on the SPO2 level were not statistically significant. Difference; with the results of Table 4, it was found that the level of SPO2 and PO2 increased in group ALP-CPR, and PCO: the level decreased, while the level of SPO in group STD-CPR was higher than the basic value, but the level of PO in this group was declining, while PCO: the level of SPO was on the rise, and both LAC and PH were decreased in the two groups, compared to two. Group SPO: there was no significant difference in the level of the base value..2 two resuscitation methods were divided into two groups according to sex and made statistical analysis. The levels of MAP, PO2, PCO and LAC after sex division were statistically significant (P0.05), but there was no significant difference in the change of PH and SPO.. After multiple comparison of the results with statistical differences, we can find that in the same group, the difference between the same sex differences between the STD-CPR group and the group of P02 and PCO2 in the same group does not exist in the other indexes, but there are three indexes in the MAP, PO2 and PCO: ALP-CPR group among the different groups. There was a statistically significant difference between the women in the group STD-CPR and those in the group LAC, while in the ALP-CPR group, the women in the ALP-CPR group and the women in the group were male.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R459.7

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