本文選題：心肺復(fù)蘇 + 面罩通氣��； 參考：《浙江大學(xué)》2014年博士論文

【摘要】：目的： 因?yàn)榉菍I(yè)人員實(shí)施成人心肺復(fù)蘇(CPR)時口對口人工呼吸(MMB)的作用被質(zhì)疑,并且非專業(yè)人員被建議放棄MMB而進(jìn)行單純胸外按壓CPR。我們懷疑有其它的呼吸方式比MMB效果更好。我們假設(shè)成人CPR,口對鼻人工呼吸(MNB)比MMB能更好的維持氣道開放和通氣。我們以成人非肌松狀態(tài)的全身麻醉模擬需要CPR患者的昏迷和無自主呼吸狀態(tài),分別比較經(jīng)鼻面罩和經(jīng)口面罩通氣效果及直接MNB和MMB的通氣效果來驗(yàn)證我們的假設(shè)。 方法： 一共48例成年患者加入本實(shí)驗(yàn)。實(shí)驗(yàn)分為兩部分：第一部分有28例患者在頭中立位隨機(jī)進(jìn)行經(jīng)鼻面罩通氣和經(jīng)口面罩通氣；第二部分另外20例患者在頭中立位和后仰位隨機(jī)進(jìn)行直接的MNB和MMB。本實(shí)驗(yàn)采用自身交叉對照,分別比較面罩通氣和人工呼吸的有效通氣率和呼吸參數(shù)(潮氣量、吸氣峰壓和二氧化碳呼出量等),評價經(jīng)鼻路徑和經(jīng)口路徑的通氣效果。 結(jié)果： 所有數(shù)據(jù)用均數(shù)±標(biāo)準(zhǔn)差或中位數(shù)(25%-75%位數(shù))表示。實(shí)驗(yàn)第一部分：經(jīng)鼻面罩通氣的有效通氣率100%(100%-100%)明顯高于經(jīng)口面罩0%(0-100%)00.001)。經(jīng)鼻面罩的吸氣峰壓(15.3±2.9cmH2O)低于經(jīng)口面罩的吸氣峰壓(27.3±7.7cmH2O)(p0.001).經(jīng)鼻面罩的通氣效率(呼出二氧化碳量/吸氣峰壓)0.3ml/cm H2O(0.2-0.6ml/cm H2O)高于經(jīng)口面罩0.0ml/cm H2O(0.0-0.3ml/cm H2O)(p=0.01).第二部分：結(jié)合頭中立位和頭后仰位的所有數(shù)據(jù),MNB的有效通氣率91.1%(42.4-100%)明顯高于MMB的43.1%(42.5-100%)(p0.001), MNB吸入潮氣量320ml(141-533.5ml)和呼出潮氣量324.5ml (140.8-509ml)分別高于MMB的136ml (43.5-355.5ml)和130.5ml (44.0-372.8ml)(p＜0.001).頭中立位時,MNB的有效通氣率和潮氣量都高于MMB。頭后仰位時,兩種呼吸方式MMB和MNB無明顯差別。結(jié)論： 在未使用肌松劑的全身麻醉成人患者中,經(jīng)鼻路徑(鼻面罩和MNB)比經(jīng)口路徑(口面罩和MMB)的有效通氣率更高、通氣效果更好。MNB是否能改善心肺復(fù)蘇患者的生存率還有待進(jìn)一步研究。
[Abstract]:Objective: The role of non-professionals in the implementation of adult cardiopulmonary resuscitation (CPR) was questioned, and non-professionals were advised to give up MMB and simply press it out of the chest. We suspect there are other breathing patterns that work better than MMB. We hypothesized that adult CPR, oral to nasal artificial respiration (MNB) could maintain airway opening and ventilation better than MMB. We tested our hypothesis by comparing the ventilation effect of nasal mask and oral mask and the ventilation effect of direct MNB and MMB in patients with CPR by simulating general anesthesia in adult non-muscular relaxation state. Methods: A total of 48 adult patients were enrolled in this study. The experiment was divided into two parts: in the first part, 28 patients were randomly ventilated by nasal mask and oral mask in the head neutral position, and in the second part, the other 20 patients were randomly given direct MNB and MMB in the head neutral position and backward position. The effective ventilation rate and respiratory parameters (tidal volume, inspiratory peak pressure and carbon dioxide exhalation volume) of mask ventilation and artificial respiration were compared to evaluate the ventilation effect of nasal and oral pathways. Results: All data are represented by mean 鹵standard deviation or median of 25-75%). The first part of the experiment: the effective ventilation rate through nasal mask was 100%-100%) significantly higher than that of 0 0-100% through mouth mask. The inspiratory peak pressure of the nasal mask was 15.3 鹵2.9 cmH2O, which was lower than that of the nasal mask (27.3 鹵7.7 cmH2O). The ventilation efficiency (exhalation carbon dioxide / inspiratory peak pressure of 0.3 ml / cm H2O(0.2-0.6ml/cm H 2O) of nasal mask was higher than that of 0.0ml/cm H2O(0.0-0.3ml/cm H 2O via nasal mask. Part two: the effective ventilation rate of MNB was 91.1and 42.4-100 (combined with head neutral position and head backward position), which was significantly higher than that of MMB (43.1-100ml) and 42.5-100ml (P 0.001C). The volume of tidal volume of MNB was 320ml ~ 141-533.5ml (324.5ml 140.8-509ml) higher than that of MMB (43.5-355.5ml) and 130.5ml 44.0-372.8ml (p < 0.001), respectively. The effective ventilation rate and tidal volume of MNB in head neutral position were higher than those of MMB. There was no significant difference in MMB and MNB between the two breathing modes. Conclusion: In general anesthetized adults without muscle relaxants, transnasal pathways (nasal masks and MNBs) had higher effective ventilation rates than oral pathways (face masks and MMBs). Whether the ventilation effect is better. MNB can improve the survival rate of patients with cardiopulmonary resuscitation (CPR) remains to be further studied.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R614

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相關(guān)期刊論文 前1條

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本文編號：1775254