Wang Dabing, Feng Xiaonan, Han Yujuan
Department of Emergency, Shandong Provincial Mining Industry Group Company Central Hospital, Zaozhuang 277899, Shandong, China (Wang DB); Department of Geriatrics, Shandong Provincial Mining Industry Group Company Central Hospital, Zaozhuang 277899, Shandong, China (Feng XN); Department of Urology Surgery, Shandong Provincial Mining Industry Group Company Central Hospital, Zaozhuang 277899, Shandong, China (Han YJ). Corresponding author: Wang Dabing, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 May;30(5):466-470. doi: 10.3760/cma.j.issn.2095-4352.2018.05.014.
To study the impact of interposed abdominal pulling-pressing cardiopulmonary resuscitation (IAPP-CPR) for patients with cardiac arrest (CA).
A prospective study was conducted. A total of 122 CA patients admitted to Department of Emergency of Shandong Provincial Mining Industry Group Company Central Hospital from July 2013 to December 2017 were enrolled. They were divided into standard cardiopulmonary resuscitation (S-CPR) group (n = 62) and IAPP-CPR group (n = 60) according to order of admission. The patients in S-CPR group received external cardiac compression, open airway, endotracheal intubation, mechanical ventilation, routine drug rescue, and defibrillation when ventricular fibrillation was found. And the patients in IAPP-CPR group received the IAPP-CPR on the basis of the routine chest compression. During the relaxation period, the patients were subjected to abdominal lifting and compressing with amplitude of 4-5 cm, frequency of 100 times/min, and the time ratio of lifting to compressing was 1:1. The data of demographics and clinical signs of patients were collected. The markers of respiratory and circulatory performance of all patients after CPR were determined. The rates of restoration of spontaneous circulation (ROSC), successful resuscitation, and the prognosis were recorded. With the success of CRP as the dependent variable, the factors with statistical significance showed by univariate analysis were used as the independent variable to carry out two classification Logistic regression analysis for screening the influence factors of CPR success. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of various factors on the success of CPR.
122 patients were enrolled in the analysis. Compared with the S-CPR group, heart rate (HR), mean arterial pressure (MAP), arterial partial pressure of oxygen (PaO), and end-tidal carbon dioxide partial pressure (PCO) were significantly increased at 30 minutes after CPR in IAPP-CPR group [HR (bpm): 66.3±11.5 vs. 53.1±12.6, MAP (mmHg, 1 mmHg = 0.133 kPa): 65.4±6.5 vs. 53.2±5.4, PaO (mmHg): 77.7±11.8 vs. 61.8±14.3, PCO (mmHg): 45.5±9.6 vs. 31.8±8.2, all P < 0.05], and arterial partial pressure of carbon dioxide (PaCO) and lactic acid (Lac) were significantly lowered [PaCO (mmHg): 46.7±6.2 vs. 57.9±9.5, Lac (mmol/L): 2.1±1.5 vs. 4.4±2.2, both P < 0.05]. The time of CA to ROSC in IAPP-CPR group was significantly shorter than that in S-CPR group (minutes: 6.3±1.8 vs. 11.2±1.4, P < 0.05), the ROSC rate and CPR success rate were significantly higher than those in S-CPR group [ROSC rate: 61.7% (37/60) vs. 43.5% (27/62), CPR success rate: 40.0% (24/60) vs. 21.0% (13/62), both P < 0.05], and 24-hour survival rate and survival and discharge rate of patients were significantly higher than those in the S-CPR group [24-hour survival rate: 46.7% (28/60) vs. 29.0% (18/62), survival and discharge rate: 20.0% (12/60) vs. 11.3% (7/62), both P < 0.05]. Logistic regression analysis showed that PaO, PaCO and PCO were the factors that affect the success of CPR [PaO: β= -3.76, odds ratio (OR) = 0.23, 95% confidence interval (95%CI) = 0.12-0.86, P = 0.031; PaCO: β= 1.41, OR = 4.09, 95%CI = 1.70-9.82, P = 0.002, PCO: β= 0.78, OR = 2.18, 95%CI = 1.42-3.35, P = 0.000]. ROC curve analysis showed that the above three factors had good predictive value for the success of CPR. The predictive value of PaCO and PCO were better, the area under ROC curve (AUC) was 0.93 and 0.92, respectively, when the cut-off values was 46.7 mmHg and 48.8 mmHg, the sensitivity was 92.0%, 88.0%, respectively, and the specificity was both 94.3%.
PaO, PaCO and PCO are the factors that influence the success of CPR. PaCO and PCO have great value in predicting the success of CPR. Compared with the S-CPR group, IAPP-CPR group results in better hemodynamic and pulmonary ventilation effects, and remarkably improve ROSC and successful resuscitation. IAPP-CPR has obvious clinical value for CA patients.
研究腹部提压心肺复苏术（IAPP-CPR）对心脏骤停（CA）患者的影响。
进行一项前瞻性研究。选取2013年7月至2017年12月在山东省矿业集团公司中心医院急诊科收治的122例CA患者。根据入院顺序将其分为标准心肺复苏（S-CPR）组（n = 62）和IAPP-CPR组（n = 60）。S-CPR组患者接受胸外心脏按压、开放气道、气管插管、机械通气、常规药物抢救，发现心室颤动时进行除颤。IAPP-CPR组患者在常规胸外按压基础上接受IAPP-CPR。在按压放松期，对患者进行腹部提压，幅度为4 - 5 cm，频率为100次/分钟，提压时间比为1:1。收集患者的人口统计学和临床体征数据。测定所有患者心肺复苏后呼吸和循环功能指标。记录自主循环恢复（ROSC）率、复苏成功率及预后情况。以心肺复苏成功作为因变量，将单因素分析中有统计学意义的因素作为自变量进行二分类Logistic回归分析，筛选影响心肺复苏成功的因素。绘制受试者工作特征（ROC）曲线，分析各因素对心肺复苏成功的预测价值。
122例患者纳入分析。与S-CPR组相比，IAPP-CPR组心肺复苏后30分钟时心率（HR）、平均动脉压（MAP）、动脉血氧分压（PaO）和呼气末二氧化碳分压（PCO）显著升高[HR（次/分钟）：66.3±11.5比53.1±12.6，MAP（mmHg，1 mmHg = 0.133 kPa）：65.4±6.5比53.2±5.4，PaO（mmHg）：77.7±11.8比61.8±14.3，PCO（mmHg）：45.5±9.6比31.8±8.2，均P < 0.05]，动脉血二氧化碳分压（PaCO）和乳酸（Lac）显著降低[PaCO（mmHg）：46.7±6.2比57.9±9.5，Lac（mmol/L）：2.1±1.5比4.4±2.2，均P < 0.05]。IAPP-CPR组CA至ROSC的时间显著短于S-CPR组（分钟：6.3±1.8比11.2±1.4，P < 0.05），ROSC率和心肺复苏成功率显著高于S-CPR组[ROSC率：61.7%（37/60）比43.5%（27/62），心肺复苏成功率：40.0%（24/60）比21.0%（13/62），均P < 0.05]，患者24小时生存率及生存出院率显著高于S-CPR组[24小时生存率：46.7%（28/60）比29.0%（18/62），生存出院率：20.0%（12/60）比11.3%（7/62），均P < 0.05]。Logistic回归分析显示，PaO、PaCO和PCO是影响心肺复苏成功的因素[PaO：β = -3.76，比值比（OR） = 0.23，95%置信区间（95%CI） = 0.12 - 0.86，P = 0.031；PaCO：β = 1.41，OR = 4.09，95%CI = 1.70 - 9.82，P = 0.002，PCO：β = 0.78，OR = 2.18，95%CI = 1.42 - 3.35，P = 0.000]。ROC曲线分析显示，上述三个因素对心肺复苏成功有较好的预测价值。PaCO和PCO的预测价值更好，当截断值分别为46.7 mmHg和48.8 mmHg时，ROC曲线下面积（AUC）分别为0.93和0.92，灵敏度分别为92.0%、88.0%，特异度均为94.3%。
PaO、PaCO和PCO是影响心肺复苏成功的因素。PaCO和PCO对预测心肺复苏成功有重要价值。与S-CPR组相比，IAPP-CPR组血流动力学和肺通气效果更好，显著提高ROSC率和复苏成功率。IAPP-CPR对CA患者有明显临床价值。
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