[窒息性心脏骤停时主动腹部按压-减压心肺复苏与标准心肺复苏的神经学预后比较]
[Comparison of neurologic outcome between active abdominal compression-decompression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation in asphyxia cardiac arrest].
作者信息
Cen Yingxin, Zhang Sisen, Jiao Xianfa, Wang Hongwei, Sha Xin, Zhao Longxian, Liu Ting, Wang Lixiang, Li Jing
机构信息
Department of Emergency and Intensive Care Unit, Affiliated Zhengzhou People's Hospital, Southern Medical University, Zhengzhou 450003, Henan, China (Cen YX, Zhang SS, Jiao XF, Wang HW, Sha X, Liu T); Department of Emergency, Sanmenxia Central Hospital, Sanmenxia 472000, Henan, China (Zhao LX); Emergency Medical Center, Chinese People's Armed Police General Hospital, Beijing 100039, China (Wang LX); Beijing GMR Medical Equipment Company, Ltd, Beijing 100038, China (Li J). Corresponding author: Zhang Sisen, Email:
出版信息
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Jun;30(6):549-553. doi: 10.3760/cma.j.issn.2095-4352.2018.06.009.
OBJECTIVE
To compare the neurologic outcome after the active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and chest compression cardiopulmonary resuscitation (STD-CPR) in asphyxia cardiac arrest (CA).
METHODS
A prospective multicenter randomized controlled trial (RCT) was conducted. Adult patients with CA because of asphyxia such as drowning, airway obstruction admitted to Zhengzhou People's Hospital and Sanmenxia Central Hospital from June 2014 to December 2017 were enrolled. With the informed consent of patients' families, patients were divided into AACD-CPR group and STD-CPR group according to random number table method. The blood from median cubital vein or basilic vein were extracted at 1, 6, 12, 24 and 48 hours after the return of spontaneous circulation (ROSC), and the levels of S100B protein and neuron-specific enolase (NSE) were detected by enzyme linked immunosorbent assay. Neurological outcome was classified according to cerebral performance classification (CPC) after 3 months.
RESULTS
A total of 183 patients were selected, including 78 ROSC patients after CPR. Patients with CA > 8 minutes and rescue time > 1 hour were excluded, 69 ROSC patients (36 in STD-CPR group and 33 in AACD-CPR group) were finally included. After ROSC, the levels of S100B protein and NSE in blood of two groups were increased gradually, reaching the peak at 6 hours, and then decreased gradually. The levels of S100B protein and NSE in AACD-CPR group at different time points after ROSC were significantly lower than those in STD-CPR group [S100B protein (μg/L): 1.62±0.52 vs. 1.88±0.46 at 1 hour, 1.71±0.41 vs. 2.02±0.58 at 6 hours, 1.24±0.37 vs. 1.52±0.59 at 12 hours, 1.05±0.23 vs. 1.28±0.37 at 24 hours, 0.82±0.29 vs. 1.05±0.36 at 48 hours; NSE (μg/L): 24.76±3.02 vs. 26.78±4.29 at 1 hour, 58.78±5.58 vs. 61.68±5.44 at 6 hours, 53.87±4.84 vs. 56.78±5.68 at 12 hours, 40.96±3.52 vs. 43.13±4.50 at 24 hours, 33.23±2.89 vs. 35.54±3.44 at 48 hours; all P < 0.05]. 3 months after ROSC, the CPC classification of AACD-CPR group was lower than that of the STD-CPR group (average rank: 28.86 vs. 42.46, Z = -3.375, P < 0.001).
CONCLUSIONS
After suffering asphyxia CA, patients who accepted AACD-CPR had better neurologic outcome than STD-CPR.
目的
比较主动腹部按压-减压心肺复苏（AACD-CPR）与标准胸外按压心肺复苏（STD-CPR）用于窒息性心脏骤停（CA）后的神经功能结局。
方法
进行一项前瞻性多中心随机对照试验（RCT）。纳入2014年6月至2017年12月期间因窒息（如溺水、气道梗阻）导致心脏骤停而入住郑州市人民医院和三门峡市中心医院的成年患者。在患者家属知情同意后，根据随机数字表法将患者分为AACD-CPR组和STD-CPR组。在自主循环恢复（ROSC）后1、6、12、24和48小时采集肘正中静脉或贵要静脉血，采用酶联免疫吸附测定法检测S100B蛋白和神经元特异性烯醇化酶（NSE）水平。3个月后根据脑功能分类（CPC）对神经功能结局进行分类。
结果
共入选183例患者，其中心肺复苏后有78例恢复自主循环。排除心脏骤停时间>8分钟且抢救时间>1小时的患者，最终纳入69例恢复自主循环的患者（STD-CPR组36例，AACD-CPR组33例）。ROSC后，两组患者血液中S100B蛋白和NSE水平逐渐升高，6小时时达到峰值，随后逐渐下降。ROSC后不同时间点AACD-CPR组的S100B蛋白和NSE水平均显著低于STD-CPR组[S100B蛋白（μg/L）：1小时时为1.62±0.52比1.88±0.46，6小时时为1.71±0.41比2.02±0.58，12小时时为1.24±0.37比1.52±0.59，24小时时为1.05±0.23比1.28±0.37，48小时时为0.82±0.29比1.05±0.36；NSE（μg/L）：1小时时为24.76±3.02比26.78±4.29，6小时时为58.78±5.58比61.68±5.44，12小时时为53.87±4.84比56.78±5.68，24小时时为40.96±3.52比43.13±4.50，48小时时为33.23±2.89比35.54±3.44；均P<0.05]。ROSC后3个月，AACD-CPR组的CPC分类低于STD-CPR组（平均秩次：28.86比42.46，Z=-3.375，P<0.001）。
结论
窒息性心脏骤停患者接受AACD-CPR后的神经功能结局优于STD-CPR。
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