Thierbach A R, Wolcke B B, Krummenauer F, Kunde M, Jänig C, Dick W F
Clinic of Anaesthesiology, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131 Mainz, Germany.
Resuscitation. 2003 Jun;57(3):269-77. doi: 10.1016/s0300-9572(03)00042-x.
The 'Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - International Consensus on Science' recommend an artificial ventilation volume of 10 ml/kg bodyweight (equivalent to a tidal volume of 700-1000 ml) without the use of supplemental oxygen in adults with respiratory arrest. For first aid providers using the mouth-to-mouth or mouth-to-nose-ventilation technique, respectively, a ventilation volume of approximately 9.6 l/min results. Additionally, a deep breath is recommended before each ventilation to increase the end-expiratory oxygen concentration of the air exhaled by the first aid provider. To investigate the effects of these recommendations in healthy volunteers, test persons were asked to ventilate an artificial lung model for a period of up to 10 min. The tidal volume was set at 800 ml at a breathing rate of 12/min. End-tidal carbon dioxide, oxygen saturation (measured by pulse oximetry), and heart rate were measured continuously. Capillary blood gas samples were collected and non-invasive blood pressure readings were recorded prior to the start of ventilation and immediately after the end of the measuring period. The data reveal a statistically significant and clinically relevant decrease in end-tidal carbon dioxide pressure (P<0.001, median decrease 14 mmHg), and the occurrence of hyperventilation-associated symptoms such as paraesthesia, dizziness, and carpopedal spasms in more than 75% of the participants. Clinically and statistically significant hyperventilation results in first aid providers performing artificial ventilation according to the guidelines. This artificial ventilation is associated with a significant decrease in capillary and end-tidal carbon dioxide pressure as well as with multiple symptoms of an acute hyperventilation syndrome. Ventilation performed according to these guidelines may cause injury to the health of the first aid provider. Rescuers ventilating the victim should be replaced at regular intervals and the recommendation to take a deep breath before each ventilation should not be upheld in order to minimise the risk of hyperventilation.
《2000年心肺复苏和心血管急救指南——国际科学共识》建议，对于呼吸骤停的成年人，在不使用补充氧气的情况下，人工通气量为10毫升/千克体重（相当于潮气量700 - 1000毫升）。对于分别采用口对口或口对鼻通气技术的急救人员，通气量约为9.6升/分钟。此外，建议在每次通气前深呼吸，以提高急救人员呼出气体的呼气末氧浓度。为了研究这些建议对健康志愿者的影响，要求测试人员为人工肺模型通气长达10分钟。潮气量设定为800毫升，呼吸频率为12次/分钟。连续测量呼气末二氧化碳、血氧饱和度（通过脉搏血氧饱和度测定法测量）和心率。在通气开始前和测量期结束后立即采集毛细血管血气样本并记录无创血压读数。数据显示，呼气末二氧化碳分压有统计学意义且具有临床相关性的下降（P<0.001，中位数下降14毫米汞柱），超过75%的参与者出现了与过度通气相关的症状，如感觉异常、头晕和手足搐搦。根据指南进行人工通气的急救人员会出现具有临床和统计学意义的过度通气。这种人工通气与毛细血管和呼气末二氧化碳压力的显著下降以及急性过度通气综合征的多种症状相关。按照这些指南进行的通气可能会对急救人员的健康造成损害。应为进行受害者通气的救援人员定期更换，并且不应坚持在每次通气前深呼吸的建议，以尽量降低过度通气的风险。
