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目的探讨心肺复苏术(CPR)中有效的徒手人工通气法。评估不加口对口单独胸外按压CPR肺通气效果。告世人Zhang’sECPC为举世首创成功的不加口对口单独胸外按压的新CPR,能实现有效的肺通气。方法对1982～2007年115例心性猝死行单独胸外肺心同步按压不加口对口通气的ECPC,本法应用全手掌(指)按压胸骨中下段,压幅深(4～6cm),频率慢50～70(80)次/min,每次压胸起到了人工循环兼有效的人工通气的双重作用,潮气量达350ml,其是举世首创成功的不加口对口徒手单独胸外按压CPR,也是人类第一次把徒手高频人工通气法应用于CPR成功的创举。1982年笔者应用ECPC急救首例心性猝死成功。1991年应用ECPC急救复苏一例冠心病心脏骤停,连续单独压胸49min而复活,向世人揭示了ECPC胸外按压本身兼有良好的肺通气作用。1990～1992年张氏实验观测4例亡尸行ECPC,收集每压胸呼出气体测得潮气量为350ml(275～400ml),则ECPC每分肺泡通气量Mv=[潮气量(350ml)-无效腔(150ml)]×压频60/min=12L。大于正常人静息分通气量4.2L的2倍,从实验角度证实了ECPC单独胸外按压的本身可实现有效的肺通气,不必另加口对口通气。1990～1999年张氏举世首先报告应用三个换算公式评估徒手CPR胸外按压人工通气和人工循环效果。包括:①每分肺泡通气量(Mv);②肺通气/血流比率;③自创公式肺换气指数(LAI)。2003年《中国危重病急救医学》发表王丽娟撰文称ECPC为Zhang’sECPC,并报道张氏提出将当今世界徒手CPR发展划分为:①1960年传统胸外心脏按压(T-CPR);②80～90年加口对口的标准胸外按压(ECC);③90年后不加口对口单独胸外肺心同步按压(ECPC)与加口对口的标准心脏按压ECC相结合三个时期的构想。结果我院1982～2007年应用ECPC急救心性猝死115例,33例存活(28.7%)近10年65例配合电除颤,27例存活(41.5%)。ECPC经国内查新属首创1999年获吉林省及松原市科技进步奖。结论 1982年ECPC首创成功开拓了单独胸外按压CPR(ECPC)取得有效肺通气的新时期,其疗效与加口对口标准CPR存活率相仿,而单独胸外按压CPR急救者更乐于采用。张氏指出胸外按压压频>100次/min反不利于推动血流,>80次/min减少了肺通气,故建议修改《国际CPR指南》采用全手掌、深幅(4～6cm),兼顾通气与血流,压频以80次/min较为适宜。而目前应用的标准CPR(ECC)如不加口对口实际即是高频ECPC。Zhang’sECPC为降低人类心性猝死病死率贡献卓著。
Objective To investigate the effective manual ventilation in cardiopulmonary resuscitation (CPR). Assess CPR pulmonary ventilation without chest-sole chest compressions. The world’s Zhang’sECPC is the world’s first successful CPR without mouth alone chest compressions, enabling effective lung ventilation. Methods A total of 115 cases of sudden cardiac death from 1982 to 2007 underwent single chest X-ray and simultaneous heart-lung press without mouth-to-mouth ventilation. This method applied the full palm (finger) press to the middle and lower sternum with deep compression (4-6cm) 50 ~ 70 (80) times / min, each time the chest has played a combination of artificial circulation and effective dual effect of artificial ventilation, tidal volume of 350ml, which is the world’s first successful non-mouth-to-mouth single chest compressive CPR alone The first human hand freehand high-frequency artificial ventilation method used in CPR successful initiative. In 1982, I applied the first case of emergency ECPC sudden cardiac death success. Application of ECPC emergency rescue in 1991, a case of coronary heart disease cardiac arrest, continuous chest compression alone 49min and resurgence, to the world revealed ECPC chest compressions have both good pulmonary ventilation. From 1990 to 1992, 4 cadaveric corpses with ECPC were collected from Zhang corpses. The tidal volume of exhaled air was measured at 350ml (275 ~ 400ml) Cavity (150ml)] xfrequency 60 / min = 12L. Greater than normal resting venous volume 4.2L 2 times, from an experimental point of view confirmed ECPC chest compressions alone can achieve effective pulmonary ventilation, without additional mouth-to-mouth ventilation. From 1990 to 1999, Zhang reported the world’s first report using three conversion formula to assess the free hand CPR chest compressive ventilation and artificial circulation effect. Including: ① minute alveolar ventilation (Mv); ② pulmonary ventilation / blood flow rate; ③ own formula lung ventilation index (LAI). In 2003, Wang Lijuan, author of the Chinese Critical Care Medicine published an article entitled ECPC as Zhang’sECPC, and reported that Zhang proposed to divide the development of unprotected CPR in the world into: ① traditional chest compressions (T-CPR) in 1960; ② 80 to 90 years Plus standard chest compressions (ECC) plus mouth-to-mouth; ③The concept of combining three stages of ECPC with standard cardiac ECC without mouth-to-mouth interaction after 90 years. Results From 1982 to 2007, 115 cases of sudden cardiac death were treated with ECPC, 33 cases survived (28.7%) and 65 cases received defibrillation in the past 10 years, and 27 cases survived (41.5%). ECPC is the first domestic innovation through new search in 1999 by Jilin Province and Songyuan City Science and Technology Progress Award. Conclusion The first successful ECPC in 1982 opened up a new period of effective pulmonary ventilation for chest compressions (CPR). The curative effect was similar to the standard CPR survival rate of mouth-opening CPR, while the CPR emergency chest compressions alone were more likely to be used. Zhang pointed out that the extracorporeal compression pressure frequency> 100 beats / min is not conducive to promoting blood flow,> 80 beats / min reduced pulmonary ventilation, it is proposed to amend the “International CPR Guide” full palm, deep (4 ~ 6cm) Taking into account ventilation and blood flow, pressure frequency to 80 times / min is more appropriate. The current application of the standard CPR (ECC), if not plus the actual mouth is the high-frequency ECPC. Zhang’sECPC contributes significantly to reduce the mortality rate of sudden cardiac death in human.