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題 名 | Results and Implications of Active Compression-Decompression Cardiopulmonary Resuscitation in an Emergency Room in Taiwan=在急診部研究攜帶式心肺復甦器的結果及暗示 |
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作 者 | 王立敏; 彭子琴; 羅鴻彰; 顏鴻章; 胡勝川; 李建賢; | 書刊名 | 中華民國急救加護醫學會雜誌 |
卷 期 | 10:3 1999.09[民88.09] |
頁 次 | 頁97-108 |
分類號 | 415.22 |
關鍵詞 | 攜帶式心肺復甦器; 心肺復甦術; 再灌流損傷; 先決條件; Active compression-decompression; ACD; CPR; Reperfusion injury; Preconditioning; |
語 文 | 英文(English) |
中文摘要 | 背景:自從醫界介紹攜帶式心肺復甦器以來,臺灣很快地接收此種急救方法。在急診部,我們使用亂數方式來支配研究,評估使用此種攜帶式心肺復甦器之效果。研究目的乃是比較對急診室內發生心跳停止病人給予攜帶式心肺復甦器和傳統心肺復甦術之療效差異。方法:在醫學中心(2800床)之急診室,取40位心跳停止病人,以亂數表分配使用攜帶式心肺復甦器和傳統式心肺復甦術。此方法為1992年美國心臟學會所推薦,即使用攜帶式復甦器取代徒手操作心肺復甦術,將攜帶式復甦器放置胸骨中線且在劍突上方約2.5至5.0公分,施壓方式依照美國心臟學會建議每分鐘80至100下,上下各施力百分之五十,且深度為3.75至5.0公分,其他步驟皆與傳統復甦術相同。結果:急救初步成功之定義,為恢復自發性循環(ROSC),此二組獲效之結果皆相同(6.25%)。然而,在 8小時內百分之七十之病患死亡,存活率明顯的下降。在恢復自發性循環後之40小時,使用攜帶式復甦器之病患較使用傳統復甦術顯示出較佳之存活現象。血鉀大於或等於5mmol/L之病人的存活率為小於5mmol/L者之1.4倍(RR=1.35,95% CI:0.88,2.17)。僅有二位使用傳統心肺復甦術之病人出院。結論:此研究顯示,在治療過程中,接受攜帶式心肺復甦器之療效,較使用傳統心肺復甦術稍佳,惟最終結果顯示兩者並無差異。再灌流損傷和先決條件對臨床表現相當重要,其可能導致無法預期之結果,惟其機轉目前無法確知,使用多學門方法,並結合分子及細胞心臟學研究於臨床觀察,或有助於解此迷惑。 |
英文摘要 | Background: Since it was first introduced, active compression-decompression cardiopulmonary resuscitation (ACD-CPR) quickly grabbed the medical community’s attention in Taiwan. To assess the effectiveness of this new ACD-CPR method for patients and its applicability in ERs, we conducted a randomized controlled trial. The purpose of this study was prospectively to compare ACD-CPR with conventional CPR (Con-CPR) on Chinese patients who developed cardiac arrest during their emergency room (ER) stay. Methods: Forty cardiac arrest patients were randomly assigned to either ACD-CPR or the Con-CPR groups in an emergency room of a 2800-bed tertiary-care hospital. Recommendations from the American Heart Association (the 1992 new CPR-guidelines) were followed. Whenever a patient was assigned to ACD-CPR, a hand-held ACD device was used instead of the bare hands as in Con-CPR. The ACD device was placed over the lower sternum, approximately 2.5 to 5 cm above the border of the lower rib cage. Compressions were performed according to the American Heart Association recommendations at a rate of 80 to 100/mm using a 50% duty cycle and a depth of 3.75 to 5 cm; the other procedures were the same as in Con-CPR. Results: The initial success of resuscitation, defined as return of spontaneous circulation (ROSC), was the same at 62.5% for both groups. However, the survival rate dropped significantly with 70% of study subjects dying within 8 hours. The ACD-CPR group patients showed a better continued survival than those of the Con-CPR group patients, up to 40 hours after ROSC. Patients with a serum potassium level greater than or equal to 5 mmol /L were 1.4 times (RR = 1.38, 95% CI. 0.88, 2.17) more likely to survive. Only two patients who received Con-CPR survived to hospital discharge, one signed out against medical advice, and the other was discharged without neurological deficit. Conclusion: This trial demonstrated slightly better intermediate outcomes among patients who received ACD- CPR, but the final results showed no differences. Reperfusion injury and preconditioning may have important clinical relevance to the unanticipated results, but their underlying mechanisms are far from clear. A combined effort using a multidisciplinary approach to link molecular and cellular cardiology studies with clinical observation may help to clarify the puzzle. |
本系統中英文摘要資訊取自各篇刊載內容。