腹部cpr与海姆立克急救法.pdf

腹部腹部CPRCPR与海姆立克急救法与海姆立克急救法 陈彦陈彦 海姆立克急救法 1974年，亨利·海姆立克发明了利用腹部 冲击解除气道异物的急救方法 1975年10月，美国医学会以他的名字命 名了该急救方法 《世界名人录》：海姆立克为“世界上拯救生命最多的人”！ J Am Med Assoc. 1975;234:398–401.Published 2014 by Prometheus Books 清醒清醒 昏迷昏迷 自救自救 原理 异物导致气道梗阻 冲击中上腹 膈肌上抬 肺内残留气体形成气流 气体冲出气道排出异物 腹部CPR Lifestick resuscitator [Abstract] The method utilizes standard CPR techniques with the addition of manual abdominal compressions (congruent to 100 mm Hg) interposed between chest compressions, and is termed interposed abdominal compression-CPR (IAC-CPR). Ventricular fibrillation was induced electrically in 10 anesthetized dogs. In each dog, trials of IAC-CPR and standard CPR were alternated every five minutes during a 30-minute period. Arterial and central venous blood pressures, oxygen consumption, and Fick cardiac output were monitored. The addition of interposed abdominal compression significantly (P 0.50). CONCLUSION:The increase in the ETCO2 during IAC-CPR is an indicator of the increase in cardiac output following the use of this method of CPR. 窒息是心跳呼吸骤停的重要原因之一 02 OPTION 腹部按压有利于气道异物 排出，解除气道梗阻，保 持气道通畅。

开放气道 METHODS: Twelve swine were anesthetized, intubated and allowed to breathe spontaneously. Physiologic dead space, resting tidal volume, compression-induced lung air flow, and blood pressures were recorded. Ventricular fibrillation was electrically induced and subjects were treated with either standard CPR or OAC- CPR at various force and rate settings. Minute alveolar ventilation (MAV) and mean coronary perfusion pressure (CPP) were compared. RESULTS: For OAC-CPR, ventilation per compression tended to increase with increasing force and decreasing rate. Chest only compressions produced no MAV, while OAC-CPR at 80 cycles/min or less, matched the MAV for spontaneous respiration. For all rates, abdominal compressions met, or exceeded, the CPP of chest compressions performed at 100lbs. CONCLUSIONS:OAC-CPR generated ventilatory volumes significantly greater than the dead space and produced equivalent, or larger, CPP than with chest compressions.Thus, OAC-CPR ventilates a subject, eliminating the need for mouth-to-mouth breathing, and effectively circulates blood during VF without breaking ribs. Furthermore, this technique is simple to perform, can be administered by a single rescuer, and should reduce bystander reluctance to administer CPR. Resuscitation. 2008 Dec;79(3):460-7. Rhythmic abdominal compression CPR ventilates without supplemental breaths and provides effective blood circulation. 缩短除颤准备时间 2015 AHA CPR指南 可以立即取得AED时，对于有目击的成人心脏骤停，应尽快使用除 颤器。

若无法立即取得AED，或无人目击，应在他人获取及准备 AED时开始心肺复苏，并且视患者情况，在设备可供使用后尽快尝 试进行除颤 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132:S315-573. 03 OPTION 除颤前准备： 暴露胸部清洁皮肤贴电极片 耗费时间耗费时间 影响按压影响按压 拓展了CPR的应用范围 合并胸肋骨骨折、胸廓畸形、血气胸、胸部外伤等情形的心 跳呼吸骤停患者，禁忌胸外按压，而腹部CPR可弥补其不足 腹部CPR禁用于腹部外伤、腹腔脏器出血、膈肌破裂、腹腔 巨大肿物等情况 04 OPTION 胸部CPR和腹部CPR相辅相成，互为补充！ However……  Am J Emerg Med. 2011 Jul;29(6):665-9. Abdominal compressions do not achieve similar survival rates compared with chest compressions: an experimental study. CONCLUSIONS:Abdominal compression CPR does not improve survival and neurologic outcome in this swine model of cardiac arrest and CPR.  Emerg Med J. 2014 May;31(5):394-400. Comparison of CPR outcome predictors between rhythmic abdominal compression and continuous chest compression CPR techniques. CONCLUSIONS:Although OAC-CPR appeared superior to CC-CPR by pressure and ventilation metrics, lower carotid flow and longer delay until ROSC raise concerns about overall performance. These paradoxical observations suggest that the evaluation of efficacious alternative CPR techniques may require more direct measurements of vital organ perfusion. 急救科普视频 Thank you 。