将胸部按压改为腹部按压可能可以改善心肺复苏的效率

kingburg

纽约（路透社）9月份的美国急诊医学期刊报道根据动物实验的研究单纯的有节律的腹部按压（OAC）而不是胸部按压可能可以改善心肺复苏中的冠脉灌注。

本文的主要作者印第安纳州的Purdue大学Dr. Leslie Geddes告诉我们他们最大的发现是OAC-CPR 能提供血流灌注和人工呼吸，它不需要胸部按压也不需要口对口呼吸，这样就能降低肋骨骨折和接触感染的风险。

以前的研究表明传统的CRP仅有5%到10%的成功率，而且在CRP开始前每断气一分钟，成功的概率就下降10%。

换句话说，如果停止呼吸十分钟没有抢救，以后的复苏都是无效的，Dr. Geddes 强调：任何成功率很低的医疗步骤都应该立即被取消，但我们的可供选择又不是很好：不进行心肺复苏病人就会死亡。

单纯腹部按压可以挤出占整个血量25%的腹部器官血管床中的血。这些血然后可以转向其他地方，包括冠脉循环。

在他们的研究中，Dr. Geddes的团队用猪做实验，这些猪被诱导室颤。他们的主动脉和右房压曲线这些冠脉灌流指针被用来评价灌流效率。

研究者发现与标准的胸部按压相比，单纯腹部按压的成功率超过60%。而且，没有任何证据表明OAC损伤内脏器官，自然也就可以避免肋骨骨折。


译文 http://www.dxy.cn/bbs/post/view? ... amp;tpg=1&age=0
原文 http://www.medscape.com/viewarticle/563180

Trading Chest for Abdominal Compressions May Improve CPR Efficacy

By Anthony J. Brown, MD

NEW YORK (Reuters Health) Sept 21 - Performing \"only rhythmic abdominal compression\" (OAC) rather than standard chest compressions may improve the coronary perfusion achieved during cardiopulmonary resuscitation (CPR), according to an animal study reported in the September issue of the American Journal of Emergency Medicine.

\"The biggest finding is that OAC-CPR provides blood flow AND artificial respiration,\" lead author Dr. Leslie Geddes, from Purdue University in West Lafayette, Indiana, told Reuters Health. As such, \"OAC-CPR does not require chest compression, nor does it require mouth-to-mouth breathing,\" which \"eliminates the risk of rib fractures and transfer of infection.\"

Previous research has shown that conventional CPR has success rates of just 5% to 10%. Moreover, for every 1 minute that transpires before CPR is started, the chance of success falls 10%.

\"In other words, at 10 minutes, the resuscitation is absolutely ineffective,\" Dr. Geddes said in a statement. \"Any medical procedure that had that low a success rate would be abandoned right away. But the alternative is not very good, either: don't do CPR and the person is going to die.\"

With OAC CPR, the compressions work by forcing blood out of the vascular bed supplying the abdominal organs, which is known to contain about 25% of the total blood volume. This blood is then redirected to other sites, including the coronary circulation.

In their study, Dr. Geddes' team tested OAC CPR on pigs with experimentally induced ventricular fibrillation. The coronary perfusion index, which is calculated using aortic and right-atrial pressure curves, was used to assess perfusion effectiveness.

The researchers found that 60% more coronary perfusion was achieved with OAC CPR than with standard chest-compression CPR, using the same amount of effort. Moreover, there was no evidence that OAC damaged the visceral organs, and it naturally avoided the risk of rib fracture.

Am J Emerg Med 2007.