胸外按压器械AutoPulse在急诊科心搏骤停的应用及对血气和N末端B型钠尿肽的影响

目的 探讨胸外按压器械AutoPulse在急诊科心搏骤停患者心肺复苏(CPR)中的应用价值.方法 选择2008年9月至2009年8月首都医科大学附属北京朝阳医院急诊科发生心跳停止的病例,依据胸外按压方式分成徒手标准胸外按压组(42例)及器械胸外按压的AutoPulse复苏组(43例).两组患者均行气管插管接呼吸机,给予100%纯氧通气;其他抢救措施如开放静脉通道、心电监护、电击除颤等依据2005 CPR指南进行.剔除20 min内自主循环恢复的病例,复苏超过20 min者取股动脉血,检测复苏前及复苏20 min后血气及N末端B型钠尿肽(NT-proBNP),并观察两组全部患者2 h及24 h的复苏成功率.结果 复苏超过20 min者,AutoPulse复苏组(29例)复苏后pH值、动脉血氧分压(PaO2)高于标准胸外按压组28例,pH值:7.142±0.134比7.010±0.136,PaO2(mm Hg,1 mm Hg=0.133 kPa):71.92±9.59比65.61±7.66,均P＜0.01],动脉血二氧化碳分压(PaCO2)及NT-proBNP低于标准胸外按压组PaCO2(mmHg):39.43±14.09比51.07±16.31,NT-proBNP(ng/L):548.18±256.93比699.40±303.35,P＜0.01和P＜0.05].AutoPulse复苏组2 h复苏成功率明显高于标准胸外按压组74.4%(32/43)比52.4%(22/42),P＜0.05];24 h复苏成功率高于标准胸外按压组,但差异无统计学意义9.3%(4/43)比4.8%(2/42),P＞0.05].结论 AutoPulse装置改善了心搏骤停患者的组织灌注,短期内对病情有一定改善,但对患者预后无决定性意义.

The effect of the external chest compression appliance (AutoPulse) on cardiac arrest in the emergency department and influence on blood gas and N-terminal B-type natriuretic peptide

Objective To investigate the value of AutoPulse in the patients with cardiac arrest (CA)in emergency department.Methods Patients with CA seen in the Emergency Department of Chaoyang Hospital, Affiliated to Capital Medical University from September 2008 to August 2009 were divided into standard manual external chest compression group (n= 42) and mechanical chest compression group with AutoPulse (n = 43), based on the method of the external chest compression.Tracheal intubation was performed and mechanical ventilation instituted in all the patients.Other rescue measures, such as intravenous infusion of fluids, electrocardiogram, electric shock for defibrillation were performed following the cardiopulmonary guideline of 2005.The patients with restoration of spontaneous circulation in 20 minutes were excluded.Among patients with resuscitation over 20 minutes, there were 29 cases in AutoPulse group and 28 cases in standard manual external chest compression group.The blood gas and N-terminal B-type natriuretic peptide (NT-proBNP) from the blood samples obtained from the femoral artery 20 minutes after resuscitation were determined, and the survival rate at 2 hours and 24 hours in both groups was recorded.Results Twenty minutes after cardiopulmonary resuscitation, the Ph value and the arterial partial pressure of oxygen (PaO2) of the AutoPulse group (n= 29) were significantly higher than those of the standard manual external chest compression groupn = 28, Ph value: 7.142 ± 0.134 vs.7.010 ± 0.136, PaO2(mmHg, 1mmHg=0.133kPa): 71.92±9.59 vs.65.61±7.66, both P＜0.01], the arterial partial pressure of carbon dioxide (PaCO2) and NT-proBNP were significantly lower than those of the standard manual external chest compression groupPaCO2(mm Hg): 39.43±14.09 vs.51.07±16.31, NT-proBNP (ng/L): 548.18 ± 256.93 vs.699.40 ± 303.35, P＜0.01 and P＜0.05].The 2-hour survival rate in AutoPulse group was higher than that in the standard manual external chest compression group, the disparity of the two groups was statistically significant74.4% (32/43) vs.52.4% (22/42), P＜0.05].Though the 24-hour survival rate of AutoPulse group was higher than that of the standard manual external chest compression group, the difference was not statistically significant9.3% (4/43) vs.4.8% (2/42), P＞0.05].Conclusion The device of AutoPulse can improve the tissue perfusion in patients with CA.Though this device may give rise some benefit in resuscitation for a short time, there is no decisive improvement in term of outcome of the patient.