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Objective@#To explore the difference in ultrasonic monitoring in carotid blood flow, resuscitation effects and prognosis between interposed abdominal pulling-pressing cardiopulmonary resuscitation (IAPP-CPR) and standard cardiopulmonary resuscitation (STD-CPR).@*Methods@#Seventy-five cardiac arrest (CA) patients admitted to emergency department of Shijingshan Teaching Hospital of Capital Medical University from June 2015 to December 2017 were enrolled. The patients were divided into STD-CPR group and IAPP-CPR group according to the treatment orders of them and the desire of relatives. All patients were given persistent external compression, airway open, tube intubation, and mechanical ventilation, vasoactive drugs application, defibrillation if required. STD-CPR group was operated according to the 2015 American Heart Association (AHA) CPR guidelines. On the basis of the standard CPR, IAPP-CPR group was recovered using abdominal lifting and compressing CPR instrument to press down to lift the upper abdomen continuously, when the chest compressing relaxed (frequency 100 times/min, down and lift time ratio 1:1, compressing strength 50 kg, lifting strength 30 kg). The patients' gender, age and CA etiology were recorded in the two groups. The vital signs and blood flow of carotid artery were monitored with ultrasonic Doppler during the CPR. The return of spontaneous circulation (ROSC) rate and 48-hour survival rate were observed in patients. The influence factors of ROSC were screened by Logistic regression analysis.@*Results@#The data of 75 patients with CA were enrolled finally, with STD-CPR group of 38 patients and IAPP-CPR group of 37 patients. There were no significant differences in patients' gender, age or CA etiology between the two groups. Comparing with STD-CPR group, the peak blood flow velocity of carotid artery in IAPP-CPR group was speeded up significantly (cm/s: 107.16±13.75 vs. 78.99±14.77, P < 0.01), the overall blood flow volume of carotid artery was increased significantly (mL/min: 989.06±115.88 vs. 751.62±118.92, P < 0.01), but there was no significant difference in inner diameter of carotid artery between the two groups (mm: 4.55±0.25 vs. 4.61±0.21, P > 0.05) . During the CPR, the mean arterial pressure (MAP) and the transcutaneous oxygen saturation (SpO2) in IAPP-CPR group were significantly higher than those of STD-CPR group, but no significant difference was found in heart rate between the two groups. Four patients in STD-CPR group got ROSC, and 3 survived over 48 hours (1 myocardial infarction patient died of ventricular fibrillation) while 6 patients in IAPP-CPR group got ROSC and survived over 48 hours. There was no significant difference in ROSC rate or 48-hour survival rate between the two groups, but data of IAPP-CPR group was slightly higher than that of STD-CPR group [ROSC rate: 16.22% (6/37) vs. 10.53% (4/38), 48-hour survival rate: 16.22% (6/37) vs. 7.89% (3/38), both P > 0.05]. Multivariate Logistic regression analysis showed that the higher the MAP during CPR, the greater the possibility of ROSC was [odds ratio (OR) = 1.361, 95% confidence interval (95%CI) = 1.182-1.669, P = 0.030].@*Conclusions@#IAPP-CPR was superior to traditional STD-CPR in improving arterial blood flow and resuscitation effect, but no superiority was found in ROSC rate and survival rate, which may be relate to the small number of patients that included in this study. More clinic trials are needed.
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OBJECTIVE@#To explore the difference in ultrasonic monitoring in carotid blood flow, resuscitation effects and prognosis between interposed abdominal pulling-pressing cardiopulmonary resuscitation (IAPP-CPR) and standard cardiopulmonary resuscitation (STD-CPR).@*METHODS@#Seventy-five cardiac arrest (CA) patients admitted to emergency department of Shijingshan Teaching Hospital of Capital Medical University from June 2015 to December 2017 were enrolled. The patients were divided into STD-CPR group and IAPP-CPR group according to the treatment orders of them and the desire of relatives. All patients were given persistent external compression, airway open, tube intubation, and mechanical ventilation, vasoactive drugs application, defibrillation if required. STD-CPR group was operated according to the 2015 American Heart Association (AHA) CPR guidelines. On the basis of the standard CPR, IAPP-CPR group was recovered using abdominal lifting and compressing CPR instrument to press down to lift the upper abdomen continuously, when the chest compressing relaxed (frequency 100 times/min, down and lift time ratio 1:1, compressing strength 50 kg, lifting strength 30 kg). The patients' gender, age and CA etiology were recorded in the two groups. The vital signs and blood flow of carotid artery were monitored with ultrasonic Doppler during the CPR. The return of spontaneous circulation (ROSC) rate and 48-hour survival rate were observed in patients. The influence factors of ROSC were screened by Logistic regression analysis.@*RESULTS@#The data of 75 patients with CA were enrolled finally, with STD-CPR group of 38 patients and IAPP-CPR group of 37 patients. There were no significant differences in patients' gender, age or CA etiology between the two groups. Comparing with STD-CPR group, the peak blood flow velocity of carotid artery in IAPP-CPR group was speeded up significantly (cm/s: 107.16±13.75 vs. 78.99±14.77, P < 0.01), the overall blood flow volume of carotid artery was increased significantly (mL/min: 989.06±115.88 vs. 751.62±118.92, P < 0.01), but there was no significant difference in inner diameter of carotid artery between the two groups (mm: 4.55±0.25 vs. 4.61±0.21, P > 0.05). During the CPR, the mean arterial pressure (MAP) and the transcutaneous oxygen saturation (SpO2) in IAPP-CPR group were significantly higher than those of STD-CPR group, but no significant difference was found in heart rate between the two groups. Four patients in STD-CPR group got ROSC, and 3 survived over 48 hours (1 myocardial infarction patient died of ventricular fibrillation) while 6 patients in IAPP-CPR group got ROSC and survived over 48 hours. There was no significant difference in ROSC rate or 48-hour survival rate between the two groups, but data of IAPP-CPR group was slightly higher than that of STD-CPR group [ROSC rate: 16.22% (6/37) vs. 10.53% (4/38), 48-hour survival rate: 16.22% (6/37) vs. 7.89% (3/38), both P > 0.05]. Multivariate Logistic regression analysis showed that the higher the MAP during CPR, the greater the possibility of ROSC was [odds ratio (OR) = 1.361, 95% confidence interval (95%CI) = 1.182-1.669, P = 0.030].@*CONCLUSIONS@#IAPP-CPR was superior to traditional STD-CPR in improving arterial blood flow and resuscitation effect, but no superiority was found in ROSC rate and survival rate, which may be relate to the small number of patients that included in this study. More clinic trials are needed.
Assuntos
Humanos , Reanimação Cardiopulmonar , Cardioversão Elétrica , Parada Cardíaca , Ultrassom , Fibrilação VentricularRESUMO
Objective To discuss the reasons of false judgments of localization of the rupture aneurysms and find the way to fix this problem in patients with multiple intracranial aneurysms. Methods The clinical data of 25 consecutive patients, who presented with their first spontaneous subarachnoid hemorrhage and had multiple intracranial aneurysms from 2003 to 2009 in our hospital, were analyzed retrospectively. The rupture aneurysms were determined according to Nehls' method that reported before, and the supposed responsible rupture aneurysms w0ere clipped within 48 hours after hemorrhage in all patients. More aneurysms that could not be accessed in the same surgical session were surgically terated later. Results The location of the rupture aneurysm was verified at the time of surgery in all 25 patients. The concordance rate of the prediction and the reality of the rupture aneurysm was 80% (20/25). Four patients ( 16% ) ,in whom the ruptured aneurysm was not correctly identified,rebled after surgery,and 2 patients died as a result of the rebleeding One patients had no clear diagnosis at the end. Conclusion In the reported cases, about 80% rupture aneurysms could be correctly diagnosed before treatment according to the CT and DSA examinations. If clear diagnosis couldn't be made,additional examinations should be considered, such as CTA or MRI. Rupture aneurysms must be confirmed during the operation and the other aneurysms should be checked to exclude additional responsible aneurysms in all cases.
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Objective To evaluate the effect of computer-aided design of composite materials with epoxide acrylate maleic (E) and hydroxyapatite (H) in cranioplasty. Methods A total of 45 patients with cranium defects were treated with cranioplasty by using skull bone flaps made of composite materials including epoxide acrylate maleic (E) and hydroxyapatite (H) ,which was designed with computer aid according to individual requirements. The patients were followed up for 6-36 months. Results After cranioplasty with composite EH, there occurred subcutaneous fluid in one patient and mild bone collapse in one. The composite EH showed good histocompatibility, with no infection or rejection. Conclusion During cranioplasty, use of computer-aided design of composite EH takes advantages of good accuracy, short operation time, good biocompatibility and good clinical efficiency.