心肺复苏期间犬潮气末二氧化碳分压与冠状动脉灌注压的研究

目的以电击致犬心室颤动建立的心搏骤停动物模型为研究对象,研究在心肺复苏（CPR）模式下犬潮气末二氧化碳分压（PETCO2）和冠状动脉灌注压（CPP）的变化及相关性。方法选健康杂种犬36只随机分为三组：4 min胸外复苏组、4 min开胸复苏组、8 min开胸复苏组。每组12只犬,雌、雄各半,致颤前及复苏过程中对PETCO2及CPP进行监测。根据自主循环恢复（ROSC）情况,比较复苏成功和复苏失败犬的CPP和PETCO2。结果 4 min胸外心肺复苏（CCCPR）时CPP与PETCO2的Pearson相关系数为0.992,P〈0.05,CPP与PETCO2呈线性正相关。4 min开胸心肺复苏（OCCPR）时CPP与PETCO2的Pearson相关系数为0.937,P〈0.05,CPP与PETCO2呈线性正相关。8 min OCCPR时CPP与PETCO2的Pearson相关系数为0.952,P〈0.05,CPP与PETCO2呈线性正相关。4 min胸外复苏组ROSC 8只（66.7%）,4 min开胸复苏组ROSC 12只（100%）,8 min开胸复苏组ROSC 7只（58.3%）。在按压复苏1、2、5、10、15、20 min时,自主循环恢复组与失败组的CPP和PETCO2分别比较,两组之间差异均有统计学意义（P〈0.05）。结论心肺复苏期间CPP与PETCO2关系密切,呈线性正相关,因此可以用PETCO2参数评价心肺复苏的预后效果。     

呼气末二氧化碳分压监测在COPD中的应用

目的　了解在稳定期慢性阻塞性肺疾病 (COPD)患者中测定呼气末二氧化碳分压监测 (Pet CO2 )与 Pa-CO2 的相关性及其与肺功能之间的关系。方法　采用前瞻性、对照研究方法。 4 5例受试者中 COPD患者 2 5例 ,年龄 6 9± 7岁 ;正常成年人 2 0例 ,年龄 6 5± 5岁。在测定肺功能后同时测定 Pet CO2 和 Pa CO2 。结果　COPD患者 Pa-CO2 显著高于正常组 ,两组患者 Pet CO2 比较无显著性差异 ,但均与 Pa CO2 显著相关 (r=0 .716和 0 .5 80 ,p<0 .0 1和 p<0 .0 5 )。 COPD组 ADco2 与肺功能各参数如 FEV1 、MMEF、s RAW和 PV/TL C显著相关 (p<0 .0 1)。结论　Pet CO2 可用于判断 Pa CO2 变化 ,ADco2 则可反映气流阻塞程度的严重程度 ,Pet CO2 是一种有用的无创性指标     

危重患者呼气末二氧化碳与动脉血二氧化碳的相关性研究

目的:探讨成年患者在急危重状态下呼气末二氧化碳( ETCO2)与动脉血二氧化碳(PaCO2)的相关性.方法:100例ICU患者入院后使用碳酸波形图监测初始ETCO2值,监测完毕迅速抽血做血气分析监测PaCO2值.统计分析ETCO2和PaCO2之间的相关性与一致性,并比较主流法和旁流法监测对ETCO2的影响.结果:100例患者ETCO2平均值为31.32±7.81 mmHg,PaCO2平均值为35.44±8.57 mmHg,ETCO2和PaCO2呈中度相关(r=0.67).Bland-Altman绘图显示PaCO2与ETCO2差值的均值为4.12 mmHg,一致性范围为(-9,+17).主流法和旁流法监测对ETCO2值没有显著影响.结论:碳酸波形图监测的ETCO2不足以准确反映成年患者在急危重状态下PaCO2的变化.     

Glidoscope视频喉镜在心肺复苏患者的应用

目的观察Glidoscope视频喉镜气管插管和直接喉镜气管插管在心肺复苏中的应用及其对心肺复苏效果的影响。方法 48例心肺复苏患者按其就诊顺序分为视频喉镜组及直接喉镜组,记录每例患者插管所用时间、患者1次吃插管成功率、记录每例患者因配合气管插管胸外按压中断时间、插管成功2、5、10分钟呼气末二氧化碳分压数值及恢复自主循环例数并作统计学分析。结果两组患者使用视频喉镜组明显缩短平均插管时间、一次插管成功率明显提高、由插管所造成的按压中断明显减少、视频喉镜组插管成功2、5、10分钟呼气末二氧化碳分压平均数值明显高于直接喉镜组、恢复自主循环例数视频喉镜组明显多于直接喉镜组。结论视频喉镜在心肺复苏中有重要应用价值。     

中老年患者冠脉搭桥全麻手术中呼气末二氧化碳分压与心排量、血压、心率的相关性

目的研究中老年冠脉搭桥患者全麻手术中呼气末二氧化碳分压(PetCO_2)与心排量、血压(BP)、心率(HR)的相关性。方法入选行择期非体外循环冠脉搭桥术者40例,年龄57～69岁,病变冠脉2～3支,美国麻醉医师协会(ASA)分级Ⅱ～Ⅲ级。患者均采用全身麻醉、气管插管后行机械通气,麻醉诱导采用舒芬太尼(1～2μg/kg)、咪达唑仑(0.04～0.06 mg/kg)、依托咪酯(0.2～0.4 mg/kg)、罗库溴铵(0.6～1.0 mg/kg),麻醉维持采用异丙酚[3.0～6.0 mg/(kg·h)]、舒芬太尼[0.1～0.5μg/(kg·h)]、间断罗库溴铵20～40 mg静脉推注,七氟烷0.5%～2.0%吸入。根据麻醉过程中血压情况酌情给予硝酸甘油、多巴胺、去甲肾上腺素,盐酸肾上腺素等维持循环稳定。记录麻醉稳定后的基础水平(T1)、取桥血管时(T2)、吻合血管时T3(前降支为T3A、回旋支为T3B、右冠脉为T3C)、手术结束时(T4)的PetCO_2、心输出量(CO)、BP(采用平均动脉压)、HR等参数。结果吻合血管时,PetCO_2、CO、BP较基础水平明显下降(P0.05)。吻合回旋支时,PetCO_2、CO、BP较前降支及右冠脉明显下降;吻合右冠脉时,BP较吻合前降支、回旋支明显升高(P0.05),而PetCO_2、CO与前降支比较变化不大,差异无统计学意义(P0.05)。病变血管为3支时,PetCO_2、CO、BP较2支明显下降(P0.05)。△PetCO_2与△CO呈正相关(r=0.96,P0.05),与△BP呈正相关(r=0.74,P0.05)。结论中老年冠脉搭桥患者全麻手术中PetCO_2与心排量、BP变化呈明显正相关,可用于术中血流动力学监测及容量评价。     

旁流式呼气末二氧化碳分压监测在消化内镜麻醉中的应用

目的分析旁流式呼气末二氧化碳分压(PETCO₂)监测在消化内镜麻醉中应用的临床价值及意义。 方法选取山东省千佛山医院内镜诊疗科2020年3月至2020年5月期间行消化内镜麻醉患者200例,随机分为试验组(鼻导管吸氧＋PETCO₂监测,n＝100)和对照组(仅鼻导管吸氧,n＝100)。置镜前2 min,静脉注射地佐辛1～3 mg,丙泊酚1.5～3 mg/kg,待患者睫毛反射消失,托下颌无反应时,开始置镜,置镜成功后予丙泊酚3～5 mg/kg^-1·h^-1持续泵注输入直至检查结束。比较两组患者麻醉效果及并发症发生率。 结果两组患者年龄、性别、体质量指数、ASA分级、麻醉诱导时间、内镜检查时间均无差异(P>0.05);试验组患者低氧血症发生率、面罩加压给氧率、恶心呕吐率、丙泊酚用量、苏醒时间低于对照组,差异有统计学意义(P<0.05);试验组呼吸暂停发现次数、托下颌率、挤压胸廓辅助呼吸率高于对照组,差异有统计学意义(P<0.05)。 结论经鼻导管旁流式PETCO₂监测有利于及时观察肺通气状态,指导临床干预,降低并发症,缩短苏醒时间,提高消化内镜麻醉质量。     

血氧饱和度和呼气末二氧化碳分压监测阻塞性睡眠呼吸暂停综合征的对比研究

目的　监测阻塞性睡眠呼吸暂停综合征 (OSAS)患者的夜间血氧饱和度 (SaO2 )和呼气末二氧化碳分压 (PetCO2 ) ,以比较其临床价值。方法　对 2 5例OSAS患者同步进行多导睡眠图、SaO2 和PetCO2 监测 ,并对有关SaO2 和PetCO2 的指标进行对比。结果　伴有SaO2 下降的呼吸紊乱总频率 ( 75.2± 2 7.8) %较伴有PetCO2 上升的呼吸紊乱总频率 ( 2 7.2± 1 7.4) %明显高 (P <0 .0 0 1 )。平均SaO2 、最低SaO2 和伴氧饱和度下降≥ 4%的平均SaO2 与AI、AHI呈负相关 ;T 90 %与AI、AHI呈正相关。夜间平均PetCO2 和最高PetCO2 与AI、HI、AHI比较均无显著相关性。结论　夜间氧饱和度监测对OSAS筛选具有明确临床意义 ;PetCO2 监测对判断OSAS病情有价值 ;但PetCO2 不及SaO2 敏感 ,需大样本多中心进一步研究。     

不同呼气末二氧化碳分压对室间隔缺损婴儿麻醉诱导期间局部肠氧饱和度的影响

目的:比较不同呼气末二氧化碳分压(PETCO2)对室间隔缺损(VSD)婴儿麻醉诱导期间,局部肠氧饱和度(rSiO2)的影响.方法:本研究共纳入全麻下行心VSD修补术的婴儿65例.通过MostCare监测仪分析有创动脉压力波形,连续监测rSiO2、肾氧饱和度(rSkO2)和脑氧饱和度(rScO2).调整麻醉呼吸机通气参数...     

呼气末二氧化碳分压的变化对感染性休克机械通气患者容量反应性的预测价值

目的 探讨呼气末二氧化碳分压(PETCO2)在被动抬腿试验中的变化及对感染性休克机械通气患者容量反应性的预测价值.方法 选择行机械通气治疗的感染性休克患者42例.分别在被动抬腿试验、容量负荷试验后采用脉搏指示连续心输出量(PiCCO)监测患者血流动力学变化,呼气末二氧化碳监测装置监测患者PETCO2.以接受者操作特征曲线(ROC曲线)分析被动抬腿试验后PETCO2的变化对容量反应性的预测价值.结果 (1)42例患者中,24例有容量反应性(有反应组),18例无反应(无反应组).有反应组患者被动抬腿试验后心指数(CI)增加(21.4±12.9)％,PETCO2增加(9.6±4.7)％;无反应组CI[(3.2±1.1) L·min-1·m-1]和PETCO2[(33±4) mm Hg(1 mm Hg =0.133 kPa)]较基线值无变化[(3.0±1.0)L· min-1·m-1;(32±4) mm Hg;P值均＞0.05].有反应组患者被动抬腿试验后CI和PETCO2的变化均高于无反应组[(21.4±12.9)％比(6.4±3.5)％,(9.6±4.7)％比(3.0±2.6)％;P值均＜0.05].(2)相关分析:被动抬腿试验后CI的变化与PETCO2的变化呈正相关(r=0.64,P＜0.05).(3)被动抬腿试验后PETCO2的变化预测容量反应性的ROC曲线下面积为0.900±0.056(95％ CI0.775 ～1.000),以5％为临界值,敏感性为88.0％,特异性88.2％.结论 被动抬腿试验后PETCO2的变化可以作为预测感染性休克机械通气患者容量反应性的无创、简便的指标.     

无创性呼气末二氧化碳分压监测在呼吸衰竭的应用

无创的血氧饱和度监测等技术已广泛应用于临床,方便了临床医疗工作的同时减轻了患者的创伤和痛苦;同样作为呼吸衰竭重要监测指标的二氧化碳在某些疾病的治疗中有着更为重要的意义。呼气末二氧化碳分压（end—tidal CO2 pressure,PETCO2）在正常健康人和无呼吸衰竭的慢性阻塞性肺疾病（COPD）者,测定PETCO2基本可代替测定动脉血二氧化碳分压（PaCO2）;作为重要的无创呼吸监护指标亦已在临床中广泛应用。我院自2005年11月～2007年8月来,对机械通气病人应用无创PETCO2技术;现总结如下。     

Application of extracorporeal cardiopulmonary resuscitation in adult patients with refractory cardiac arrest

BackgroundThe aim of this study was to summarize the clinical experience of extracorporeal cardiopulmonary resuscitation (ECPR) in the treatment of adult patients with refractory cardiac arrest.MethodsThe clinical data of 12 cases of adult patients with cardiac arrest hospitalized between June 2015 and September 2019 who were unable to achieve return of spontaneous circulation effectively with conventional cardiopulmonary resuscitation (CCPR) and were treated with ECPR technology were retrospectively analyzed. The group included six males and six females aged between 18 and 69 years. All the patients underwent veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support with the adoption of femoral artery and vein catheterization.ResultsThe duration of cardiopulmonary resuscitation (CPR) for the 12 patients was 32–125 min, and the ECMO duration was 2–190 h. Four patients were successfully weaned from ECMO and survived until hospital discharge. The other eight patients died in hospital; hemodynamic collapse (four patients) in the early stage of ECMO and severe neurological complications (three patients) were the main causes of death.ConclusionsSingle-center data showed that ECPR provided a new rescue alternative for some patients with reversible refractory cardiac arrest. We have demonstrated that the success rate of treatment could be improved by selecting suitable patients and reducing the CPR duration as much as possible.     

心脏骤停患者心肺复苏程序的探讨

目的 探讨心脏骤停患者的心肺复苏的程序,以便为心肺复苏提供更多的复苏途径.方法 选择近年来心肺复苏成功的39例心脏骤停患者,根据不同情况采取相应的五种不同复苏程序:ABCD、D、C、CD、CABD.结果13例呼吸完全停止的患者采用传统ABCD复苏程序;26例呼吸尚存的患者,7例现场直接给予电除颤(D),其余19例现场不具备立即除颤的,立即给予胸外心脏按压,其中3例通过心脏按压直接复苏(C),9例心脏按压再电除颤后复苏(CD),7例心脏按压时间较长,呼吸逐渐停止,给予人工通气、复苏药物及电除颤最终复苏(CABD).结论对原发性心跳骤停的患者应视不同情况采取不同的复苏程序.     

老年人心肺复苏的特点及临床分析

目的了解6年来我院老年人心肺复苏（CPR）现状,分析其临床特点,研究防治对策。方法对本院2002年6月至2008年6月发生的335例心跳骤停（CA）的患者资料进行分析,按年龄分为老年组（年龄≥60岁）和非老年组（年龄〈60岁）,比较2组自主循环恢复（ROSC）成功率、脑复苏成功率; 分析2组CPR开始时间、人工气道开始建立时间、CPR持续时间、除颤次数、肾上腺素用量,组间进行比较。结果非老年组ROSC成功率为32.42%,脑复苏率为3.85%,老年组ROSC成功率为20.92%,脑复苏成功率为0.65%。2组之间CPR开始时间、人工气道开始建立时间方面无显著性差异（P〉0.05）,肾上腺素用量上有显著性差异（P〈0.05）。结论老年人CA患者CPR成功率相当低,重视老年人基础疾病的救治,完善急救医疗体系建设,是提高老年人CPR成功率的关键措施。     

Good estimation of arterial carbon dioxide by end-tidal carbon dioxide monitoring in the neonatal intensive care unit

End-tidal carbon dioxide pressure (PetCO(2)) was measured in the neonatal intensive care unit (NICU) to assess its reliability and accuracy in predicting arterial partial pressure of carbon dioxide (PaCO(2)). Arterial blood was drawn for gas analysis and compared with exhaled CO(2) measured by mainstream capnography. In total, 130 PetCO(2)/PaCO(2) comparisons were obtained from 61 patients (20 term and 41 preterm infants). PetCO(2) was significantly different from PaCO(2) (PetCO(2) = 42.3 +/- 10.5 mmHg vs. PaCO(2) = 45.8 +/- 12.3 mmHg, P < 0.001, mean +/- SD). The overall PetCO(2) bias (mean +/- SD) was 3.5 +/- 7.1 mmHg. There was a positive correlation between PetCO(2) and PaCO(2) (n = 130, r = 0.818, P < 0.001) in both term (n = 44, r = 0.779, P < 0.001) and preterm infants (n = 86, r = 0.849, P < 0.001). The PetCO(2) biases (95% CI) were 3.5 +/- 9.0 mmHg (0.8-6.2) in the term group and 3.4 +/- 6.0 mmHg (2.2-4.7) in the preterm group. Therefore, PetCO(2) was a valid and reliable method for monitoring PaCO(2) in neonates, especially preterm infants. This method decreases blood loss and prevents complications associated with arterial catheters. In conclusion, we recommend using mainstream capnography to monitor PetCO(2) instead of measuring PaCO(2) in the NICU.     

Outcomes of cardiopulmonary resuscitation efforts in a Greek tertiary hospital

Abstract

Introduction: In-hospital cardiac arrest is a leading cause of death and despite recent advances in cardiopulmonary resuscitation, the survival to hospital discharge is poor. The aim of our study was to evaluate the success of resuscitation efforts in a tertiary hospital.

Patients and Methods: We retrospectively collected and analysed data on all patients in whom cardiopulmonary resuscitation was attempted after in-hospital cardiac arrest in one-year period.

Results: 96 cardiac arrest victims were studied. Sustained return of spontaneous circulation was achieved in 15 (15.6%) patients, while all of them survived for 24 h. Training in cardiopulmonary resuscitation, initiation of resuscitation efforts in less than 5 min, and intubation time < 1 min after team arrival were predictive factors associated with restoration of spontaneous circulation. Non-certified residents resuscitated 87 (90.6%) patients with 6 (6.8%) of them achieving return of spontaneous circulation and surviving for 24 h. On the contrary, certified ward residents resuscitated nine (9.3%) patients with 100% immediate and 24-h survival.

Conclusion: In our hospital, certified providers had remarkably higher successful resuscitation rates for in-hospital cardiac arrest than non-certified providers. This finding suggests that training in cardiopulmonary resuscitation, continuing medical education, and implementation of the existing legislation will result in increased survival.     

Factors modifying the effect of bystander cardiopulmonary resuscitation on survival in out-of-hospital cardiac arrest patients in Sweden.

AIM: To describe possible factors modifying the effect of bystander cardiopulmonary resuscitation on survival among patients suffering an out-of-hospital cardiac arrest. PATIENTS: A national survey in Sweden among patients suffering out-of-hospital cardiac arrest and in whom resuscitative efforts were attempted. Sixty per cent of ambulance organizations were included. DESIGN: Prospective evaluation. Survival was defined as survival 1 month after cardiac arrest. RESULTS: In all, 14065 reports were included in the evaluation. Of these, resuscitation efforts were attempted in 10966 cases, of which 1089 were witnessed by ambulance crews. The report deals with the remaining 9877 patients, of whom bystander cardiopulmonary resuscitation was attempted in 36%. Survival to 1 month was 8.2% among patients who received bystander cardiopulmonary resuscitation vs 2.5% among patients who did not receive it (odds ratio 3.5, 95% confidence interval 2.9-4.3). The effect of bystander cardiopulmonary resuscitation on survival was related to: (1) the interval between collapse and the start of bystander cardiopulmonary resuscitation (effect more marked in patients who experienced a short delay); (2) the quality of bystander cardiopulmonary resuscitation (effect more marked if both chest compressions and ventilation were performed than if either of them was performed alone); (3) the category of bystander (effect more marked if bystander cardiopulmonary resuscitation was performed by a non-layperson); (4) interval between collapse and arrival of the ambulance (effect more marked if this interval was prolonged); (5) age (effect more marked in bystander cardiopulmonary resuscitation among the elderly); and (6) the location of the arrest (effect more marked if the arrest took place outside the home). CONCLUSION: The effect of bystander cardiopulmonary resuscitation on survival after an out-of-hospital cardiac arrest can be modified by various factors. Factors that were associated with the effect of bystander cardiopulmonary resuscitation were the interval between the collapse and the start of bystander cardiopulmonary resuscitation, the quality of bystander cardiopulmonary resuscitation, whether or not the bystander was a layperson, the interval between collapse and the arrival of the ambulance, age and the place of arrest.