腹部提压心肺复苏创新技术理论与临床实践
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摘要
传统胸外按压心肺复苏方法存在缺陷:胸壁畸形、肋骨骨折及血气胸等情况影响了胸外按压的效果;不能很好地结合呼吸和循环,在一定程度上影响自主循环恢复率。据此,中国急救专家王立祥教授等经过多年的科学研究及临床实践,创建和发明了腹部心肺复苏学新理论和腹部提压心肺复苏新技术。本文通过对腹部提压与胸部按压CPR(STD-CPR)的产生缘由、作用机制、操作方法、环节应用等四个方面来相互对比分析,阐述胸部按压与腹部提压两种方法的精髓,为医务人员从事急诊急救工作提供重要参考。腹部提压CPR技术(AACDCPR)是对传统STD-CPR的补充和延伸,是推动全球CPR急救核心技术发展的直接思路和行动。科学合理地把握运用AACD CPR创新技术,展现中国智慧和方案,为世界急救水平提升和急救事业发展做出应有努力。
Chest compression can't be effectively applied under certain situations, such as chest wall deformity, rib fracture, or hemopneumothorax. In addition, it cannot involve well the respiration and circulation so as to be unhelpful to the recovery of spontaneous circulation. Considering the above, Professor Wang Lixiang, an expert in emergency medicine,invented an active abdominal compression-decompression cardiopulmonary resuscitation(AACD-CPR) that can achieve better resuscitation outcomes in certain cardiac arrest(CA) patients. In this article, we compared the invention cause,mechanism, operation methods and clinical application between standard single rescuer cardiopulmonary resuscitation(STD-CPR) and AACD-CPR. AACD-CPR is the improvement of STD-CPR. AACD-CPR is a direct wisdom of fueling the development of global CPR emergency core technology. We should scientifically and reasonably apply the innovative technology of AACD-CPR, not only for showing our China wisdom, but also for offering our efforts for improving world emergency treatment level and developing emergency medicine.
Chest compression can't be effectively applied under certain situations, such as chest wall deformity, rib fracture, or hemopneumothorax. In addition, it cannot involve well the respiration and circulation so as to be unhelpful to the recovery of spontaneous circulation. Considering the above, Professor Wang Lixiang, an expert in emergency medicine,invented an active abdominal compression-decompression cardiopulmonary resuscitation(AACD-CPR) that can achieve better resuscitation outcomes in certain cardiac arrest(CA) patients. In this article, we compared the invention cause,mechanism, operation methods and clinical application between standard single rescuer cardiopulmonary resuscitation(STD-CPR) and AACD-CPR. AACD-CPR is the improvement of STD-CPR. AACD-CPR is a direct wisdom of fueling the development of global CPR emergency core technology. We should scientifically and reasonably apply the innovative technology of AACD-CPR, not only for showing our China wisdom, but also for offering our efforts for improving world emergency treatment level and developing emergency medicine.
引文
[1]王一镗.必须大力提高现场救护的水准[J].中华急诊医学杂志, 2008, 17(4):341-342.
[2]王立祥.中国心肺复苏发展战略观[J].中华危重病急救医学, 2015(3):161-163.
[3]王立祥,王一镗.医务者向家庭成员传授CPR<1%的反思[J].中国急救医学, 2013, 33(11):986-987.
[4]Yannopoulos D, Aufderheide TP, Abella BS, et al. Quality of CPR:An important effect modifier in cardiac arrest clinical outcomes and intervention effectiveness trials[J].Resuscitation, 2015, 94:106-113.
[5]Morrison LJ, Gent LM, Lang E, et al. Part 2:evidence evaluationand management of conflicts of interest:2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency gardiovascular gare[J]. Circulation, 2015, 132(18 Suppl 2):S368-S382.
[6]余涛.高质量心肺复苏的实施——从指南到实践[J].中华急诊医学杂志, 2015, 24(1):17-21.
[7]Zhang SS, Liu Q, Han SP, et al. Standard versus abdominal lifting and compression CPR[J]. Evid Based Complement Alternat Med, 2016(1-2):1-8.
[8]陈晓松.古代心肺复苏术应用发展史略[J].中华医史杂志, 1997, 27(1):3-6.
[9]Wilder RJ, Jude JR, Kouwenhoven WB. Cardiopulmonary resuscitation by trained ambulance personnel-no fatal injuries were produced[J]. JAMA, 1964, 190(6):531-534.
[10]Kouwenhoven WB, Jude JR, Knickerbocker GG. Closedchest cardiac massage[J]. JAMA, 1960, 173(10):1064-1067.
[11]Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update:a report from the American Heart Association[J]. Circulation, 2015, 131(4):434-441.
[12]Shao F, Li CS, Liang LR, et al. Outcome of out-of-hospital cardiac arrests in Beijing, China[J]. Resuscitation, 2014,85(11):1411-1417.
[13]王国涛,张思森,刘青,等.腹部提压心肺复苏临床应用研究:附40例报告[J].中华急诊医学杂志, 2015,24(11):1264-1267.
[14]Kralj E, Podbregar M, Kej?ar N, et al. Frequency and number of resuscitation related rib and sternum fractures are higher than generally considered[J]. Resuscitation, 2015,93:136-141.
[15]王立祥.心肺复苏共识的再认识[J].中华急诊医学杂志,2010,19(1):108-110.
[16]谢钢.单纯胸外心脏按压—心肺复苏共识的再认识[J].医学综述, 2014, 20(2):286-288.
[17]王立祥,郑静晨.单纯腹部提压:一种心肺复苏的新方法[J].中国危重病急救医学, 2009, 21(6):323-324.
[18]Kouwenhoven WB, Langworthy OR. Cardiopulmonary resuscitation. An account of forty-five years of research[J].Johns Hopkins Med J, 1973, 132(3):186-193.
[19]Babbs CF. New versus old theories of blood flow during CPR[J]. Crit Care Med, 1980, 8(3):191-195.
[20]Rudikoff MT, Maughan WL, Effron M, et al. Mechanisms of blood flow during cardiopulmonary resuscitation[J].Circulation, 1980, 61(2):345-352.
[21]中国腹部心肺复苏协作组.经膈肌下抬挤心肺复苏共识[J].中华急诊医学杂志, 2014, 23(4):369-370.
[22]Babbs CF. Interposed abdominal compression CPR:a comprehensive evidence based review[J]. Resuscitation,2003, 59(1):71-82.
[23]王立祥.开创腹部提压心肺复苏“腹泵”机制研究之路[J].解放军医学杂志, 2014, 39(10):767-770.
[24]GeddesLA,RundellA,LottesA,etal.Anew cardiopulmonary resuscitation method using only rhythmic abdominal compression:a preliminary report[J]. Am J Emerg Med, 2007, 25(7):786-790.
[25]Berg RA, Hemphill R, Abella BS, et al. Part 5:adult basic life support:2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2010, 122(18 Suppl3):S685-S705.
[26]Neumar RW, Shuster M, Callaway CW, et al. Part 1:executive summary:2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2015,132(18Suppl 2):S315-S367.
[27]中国腹部提压心肺复苏协作组.腹部提压心肺复苏专家共识[J].中华急诊医学杂志, 2013, 22(9):957-959.
[28]王立祥.标准心肺复苏面临的窘境及对策[J].中华灾害救援医学, 2014, 2(1):1-5.
[29]Sha X, Zhang SS, Wang HW, et al. Effect of active abdominal compression-decompression cardiopulmonary resuscitation on oxygen metabolism and prognosis in patients with cardiac arrest[J]. ARC J Anesthesiol, 2017, 2(4):24-31.
[30]戚文涛,彭丹洋,张思森,等.腹部提压心肺复苏法救治心搏骤停临床疗效观察:附57例病例报告[J].中华危重病急救医学, 2016, 28(7):654-656.
[31]王立祥,宋维,张思森,等.腹部提压心肺复苏多中心临床实验报告[J].中华急诊医学杂志, 2017, 26(3):333-336.
[32]刘青,张思森,彭丹洋,等.腹部提压法急救复苏效果临床观察[J].中华危重病急救医学, 2015, 27(12):1011-1012.
[33]王立祥.腹部心肺复苏学[M].北京:人民军医出版社,2014:7-8.
[2]王立祥.中国心肺复苏发展战略观[J].中华危重病急救医学, 2015(3):161-163.
[3]王立祥,王一镗.医务者向家庭成员传授CPR<1%的反思[J].中国急救医学, 2013, 33(11):986-987.
[4]Yannopoulos D, Aufderheide TP, Abella BS, et al. Quality of CPR:An important effect modifier in cardiac arrest clinical outcomes and intervention effectiveness trials[J].Resuscitation, 2015, 94:106-113.
[5]Morrison LJ, Gent LM, Lang E, et al. Part 2:evidence evaluationand management of conflicts of interest:2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency gardiovascular gare[J]. Circulation, 2015, 132(18 Suppl 2):S368-S382.
[6]余涛.高质量心肺复苏的实施——从指南到实践[J].中华急诊医学杂志, 2015, 24(1):17-21.
[7]Zhang SS, Liu Q, Han SP, et al. Standard versus abdominal lifting and compression CPR[J]. Evid Based Complement Alternat Med, 2016(1-2):1-8.
[8]陈晓松.古代心肺复苏术应用发展史略[J].中华医史杂志, 1997, 27(1):3-6.
[9]Wilder RJ, Jude JR, Kouwenhoven WB. Cardiopulmonary resuscitation by trained ambulance personnel-no fatal injuries were produced[J]. JAMA, 1964, 190(6):531-534.
[10]Kouwenhoven WB, Jude JR, Knickerbocker GG. Closedchest cardiac massage[J]. JAMA, 1960, 173(10):1064-1067.
[11]Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update:a report from the American Heart Association[J]. Circulation, 2015, 131(4):434-441.
[12]Shao F, Li CS, Liang LR, et al. Outcome of out-of-hospital cardiac arrests in Beijing, China[J]. Resuscitation, 2014,85(11):1411-1417.
[13]王国涛,张思森,刘青,等.腹部提压心肺复苏临床应用研究:附40例报告[J].中华急诊医学杂志, 2015,24(11):1264-1267.
[14]Kralj E, Podbregar M, Kej?ar N, et al. Frequency and number of resuscitation related rib and sternum fractures are higher than generally considered[J]. Resuscitation, 2015,93:136-141.
[15]王立祥.心肺复苏共识的再认识[J].中华急诊医学杂志,2010,19(1):108-110.
[16]谢钢.单纯胸外心脏按压—心肺复苏共识的再认识[J].医学综述, 2014, 20(2):286-288.
[17]王立祥,郑静晨.单纯腹部提压:一种心肺复苏的新方法[J].中国危重病急救医学, 2009, 21(6):323-324.
[18]Kouwenhoven WB, Langworthy OR. Cardiopulmonary resuscitation. An account of forty-five years of research[J].Johns Hopkins Med J, 1973, 132(3):186-193.
[19]Babbs CF. New versus old theories of blood flow during CPR[J]. Crit Care Med, 1980, 8(3):191-195.
[20]Rudikoff MT, Maughan WL, Effron M, et al. Mechanisms of blood flow during cardiopulmonary resuscitation[J].Circulation, 1980, 61(2):345-352.
[21]中国腹部心肺复苏协作组.经膈肌下抬挤心肺复苏共识[J].中华急诊医学杂志, 2014, 23(4):369-370.
[22]Babbs CF. Interposed abdominal compression CPR:a comprehensive evidence based review[J]. Resuscitation,2003, 59(1):71-82.
[23]王立祥.开创腹部提压心肺复苏“腹泵”机制研究之路[J].解放军医学杂志, 2014, 39(10):767-770.
[24]GeddesLA,RundellA,LottesA,etal.Anew cardiopulmonary resuscitation method using only rhythmic abdominal compression:a preliminary report[J]. Am J Emerg Med, 2007, 25(7):786-790.
[25]Berg RA, Hemphill R, Abella BS, et al. Part 5:adult basic life support:2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2010, 122(18 Suppl3):S685-S705.
[26]Neumar RW, Shuster M, Callaway CW, et al. Part 1:executive summary:2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2015,132(18Suppl 2):S315-S367.
[27]中国腹部提压心肺复苏协作组.腹部提压心肺复苏专家共识[J].中华急诊医学杂志, 2013, 22(9):957-959.
[28]王立祥.标准心肺复苏面临的窘境及对策[J].中华灾害救援医学, 2014, 2(1):1-5.
[29]Sha X, Zhang SS, Wang HW, et al. Effect of active abdominal compression-decompression cardiopulmonary resuscitation on oxygen metabolism and prognosis in patients with cardiac arrest[J]. ARC J Anesthesiol, 2017, 2(4):24-31.
[30]戚文涛,彭丹洋,张思森,等.腹部提压心肺复苏法救治心搏骤停临床疗效观察:附57例病例报告[J].中华危重病急救医学, 2016, 28(7):654-656.
[31]王立祥,宋维,张思森,等.腹部提压心肺复苏多中心临床实验报告[J].中华急诊医学杂志, 2017, 26(3):333-336.
[32]刘青,张思森,彭丹洋,等.腹部提压法急救复苏效果临床观察[J].中华危重病急救医学, 2015, 27(12):1011-1012.
[33]王立祥.腹部心肺复苏学[M].北京:人民军医出版社,2014:7-8.
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