Cobo-Vázquez Carlos, De Blas Gemma, García-Canas Pablo, Del Carmen Gasco-García María
Master in Oral Surgery and Implantology, School of Dentistry, Universidad Complutense de Madrid, Spain.
Chairman Neurophysiology Service, Ramon y Cajal Hospital, Madrid, Spain.
Anesth Prog. 2018 Spring;65(1):30-37. doi: 10.2344/anpr-65-01-06.
Cardiopulmonary resuscitation requires the provider to adopt positions that could be dangerous for his or her spine, specifically affecting the muscles and ligaments in the lumbar zone and the scapular spinal muscles. Increased fatigue caused by muscular activity during the resuscitation could produce a loss of quality and efficacy, resulting in compromising resuscitation. The aim of this study was to evaluate the maximum time a rescuer can perform uninterrupted chest compressions correctly without muscle fatigue. This pilot study was performed at Universidad Complutense de Madrid (Spain) with the population recruited following CONSORT 2010 guidelines. From the 25 volunteers, a total of 14 students were excluded because of kyphoscoliosis (4), lumbar muscle pain (1), anti-inflammatory treatment (3), or not reaching 80% of effective chest compressions during the test (6). Muscle activity at the high spinal and lumbar (L5) muscles was assessed using electromyography while students performed continuous chest compressions on a ResusciAnne manikin. The data from force exerted were analyzed according to side and muscle groups using Student's t test for paired samples. The influence of time, muscle group, and side was analyzed by multivariate analyses ( p ≤ .05). At 2 minutes, high spinal muscle activity (right: 50.82 ± 9.95; left: 57.27 ± 20.85 μV/ms) reached the highest values. Activity decreased at 5 and 15 minutes. At 2 minutes, L5 activity (right: 45.82 ± 9.09; left: 48.91 ± 10.02 μV/ms) reached the highest values. After 5 minutes and at 15 minutes, activity decreased. Fatigue occurred bilaterally and time was the most important factor. Fatigue began at 2 minutes. Rescuers exert muscular countervailing forces in order to maintain effective compressions. This imbalance of forces could determine the onset of poor posture, musculoskeletal pain, and long-term injuries in the rescuer.
心肺复苏要求施救者采取可能对其脊柱有危险的姿势，特别会影响腰椎区域的肌肉和韧带以及肩胛脊柱肌。复苏过程中肌肉活动导致的疲劳增加可能会使操作质量和效果下降，从而影响复苏。本研究的目的是评估施救者在不出现肌肉疲劳的情况下能够正确进行不间断胸外按压的最长时间。这项初步研究在马德里康普顿斯大学（西班牙）进行，招募的人群遵循CONSORT 2010指南。在25名志愿者中，共有14名学生被排除，原因分别是脊柱侧弯（4人）、腰肌疼痛（1人）、正在接受抗炎治疗（3人）或在测试期间胸外按压有效率未达到80%（6人）。当学生们在复苏安妮模拟人上进行持续胸外按压时，使用肌电图评估高位脊柱肌和腰（L5）肌的肌肉活动。根据用力的方向和肌肉群，使用配对样本的学生t检验分析所施加力的数据。通过多变量分析（p≤0.05）分析时间、肌肉群和用力方向的影响。在2分钟时，高位脊柱肌活动（右侧：50.82±9.95；左侧：57.27±20.85微伏/毫秒）达到最高值。在5分钟和15分钟时活动下降。在2分钟时，L5肌活动（右侧：45.82±9.09；左侧：48.91±10.02微伏/毫秒）达到最高值。5分钟后及15分钟时，活动下降。疲劳双侧出现，时间是最重要的因素。疲劳在2分钟时开始出现。施救者为了维持有效的按压会施加肌肉平衡力。这种力的不平衡可能会导致施救者出现不良姿势、肌肉骨骼疼痛和长期损伤。
