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中华妇幼临床医学杂志(电子版) ›› 2016, Vol. 12 ›› Issue (05) : 510 -516. doi: 10.3877/cma.j.issn.1673-5250.2016.05.004

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《2015美国心脏学会心肺复苏与心血管急救指南(更新版) 》儿童基础生命支持部分解读
潘玲丽1, 李熙鸿1,()   
  1. 1. 610041 成都,四川大学华西第二医院急诊科、出生缺陷与相关妇儿疾病教育部重点实验室
  • 收稿日期:2016-05-30 修回日期:2016-09-08 出版日期:2016-10-01
  • 通信作者: 李熙鸿

Highlights of pediatric basic life support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Lingli Pan1, Xihong Li1,()   

  1. 1. Department of Emergency, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2016-05-30 Revised:2016-09-08 Published:2016-10-01
  • Corresponding author: Xihong Li
  • About author:
    Corresponding author: Li Xihong, Email:
引用本文:

潘玲丽, 李熙鸿. 《2015美国心脏学会心肺复苏与心血管急救指南(更新版) 》儿童基础生命支持部分解读[J/OL]. 中华妇幼临床医学杂志(电子版), 2016, 12(05): 510-516.

Lingli Pan, Xihong Li. Highlights of pediatric basic life support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2016, 12(05): 510-516.

2015年10月公布了最新的《2015美国心脏病协会心肺复苏及心血管急救指南(更新版)》(以下简称为《2015更新》)。本指南采用了新的系统性审查流程和新的建议级别(COR)及证据水平(LOE)。同时,对其中儿童基础生命支持(PBLS)部分的内容,也进行了调整。为了加强儿科医务人员的心肺复苏(CPR)急救技能的掌握,笔者拟简要介绍《2015更新》中,关于PBLS部分的主要更新内容,包括:①明确PBLS的适用人群;②重申胸外按压-开放气道-人工通气(C-A-B)的CPR操作顺序;③提供新的专业人员单人和多人施救流程;④限定胸外按压深度:青少年不超过6 cm;⑤建议按压频率为100~120次/min;⑥比较传统CPR与单纯胸外按压式CPR的优势与劣势;⑦强调高质量的CPR等,旨在提高临床对患儿进行CPR的成功率及患儿生存率。

The newest 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (hereinafter referred to 2015 Update) had been published in October 2015, which had adopted new systematic review process and new American Heart Association (AHA) classification system for classes of recommendation (COR) and levels of evidence (LOE). So the part of pediatric basic life support (PBLS) had been adjusted. In order to strengthen the first aid cardiopulmonary resuscitation (CPR) skills of pediatric doctors, the authors introduce briefly the highlights of PBLS and CPR quality in 2015 Update. Compared with the 2010 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, the updated contents are as follows. ①Identifying of the population of PBLS application; ②Reaffirming chest compressions-airway-ventilation (C-A-B) as the CPR operation sequence; ③Providing the pediatric cardiac arrest algorithms for a single rescuer and for 2 or more rescuers; ④Limiting the depths of chest compression: no more than 6 cm for adolescents; ⑤Recommending the frequency of chest compression: 100 to 120 beats/min; ⑥Comparing the advantages and disadvantages of traditional CPR and chest compressions alone of CPR; ⑦Emphasizing high quality CPR and so on, which are aimed to improve the success rate of CPR and survival of children of respiratory and cardiac arrest.

表1 《2015美国心脏学会心肺复苏与心血管急救指南(更新版) 》中儿童基础生命支持部分使用的建议级别(强度)及证据水平(质量)分级体系(一)a
表2 《2015美国心脏学会心肺复苏与心血管急救指南(更新版) 》中儿童基础生命支持部分使用的建议级别(强度)及证据水平(质量)分级体系(二)a
图1 儿童基础生命支持中医务人员单人施救儿童心脏骤停的流程图
图2 儿童基础生命支持医务人员多人施救儿童心脏骤停的流程图
表3 《2015美国心脏学会心肺复苏与心血管急救指南(更新版) 》中儿童基础生命支持部分的关键点
内容 青少年(与成年人的相同) 儿童(≥1岁至青春期) 婴儿(<1岁,新生儿除外)
现场安全 确保现场对施救者和患儿均是安全的 ? ?
识别心脏骤停 患儿昏迷无反应,呼吸异常(无呼吸或仅喘息),10 s内不能明确感觉到有脉搏(10 s内可同时检查呼吸和脉搏) ? ?
对心脏骤停者启动应急反应系统 发现患儿猝倒时,若现场目击者为独自一人,而且无手机拍照、不能联系他人,则离开患者,就近寻求他人帮助。若目击者为多人,则有救治经验者尽快启动应急反应系统,设法获取AED,然后开始实施CPR救治。或者请其他人设法获取AED,有救治经验者则立即开始对猝倒者采取CPR策略救治;待AED可用后,则尽快使用 对于现场有目击者的猝倒:若猝倒者为成年人和青少年,则遵照左侧的步骤实施救治 ?
? 对于现场无目击者的猝倒:若猝倒者为儿童,目击者应于第一时间给予2 min的CPR,然后离开患儿去启动应急反应系统,并获取AED后,回到该患儿身边并继续CPR;待AED可用后尽快使用 ?
? 现场有目击者的猝倒:遵照左侧的步骤实施救治 ?
? 单人施救者:呼叫旁人帮助,通过手机立即启动应急反应系统,若无手机,则离开患者,就近寻求他人帮助启动应急反应系统。若AED可立即获取时,则自己取AED,返回后实施CPR救治,在AED可用后尽快使用;AED不能立即获取时,请他人去取AED,自己立即开始CPR救治,待AED可用后尽快使用 现场无人目击者的猝倒:包括下列2种情况 ?
? ? 单人施救者:第一时间立即给予2 min的CPR,然后离开患者去启动应急反应系统,并获取AED或手动除颤仪后,回到该儿童身边并继续CPR,待除颤仪可用后,则尽快使用 ?
? ? 多人施救者:一人尽快启动应急反应系统,设法获取AED或手动除颤仪,另一人立即开始CPR,待除颤仪可用后尽快使用 ?
? 多人施救者:一人尽快启动应急反应系统,设法获取AED,另一人立即开始CPR救治,待AED可用后,则尽快使用 ? ?
心脏骤停者无高级气道的按压-通气比 1或2位施救者时,对心脏骤停患儿实施CPR救治的按压-通气比为30∶2 1位施救者时,对心脏骤停患儿的CPR救治的按压-通气比为30∶2 ?
超过2位施救者时,对心脏骤停患儿的CPR救治的按压-通气比为15∶2 ? ? ?
心脏骤停者有高级气道的按压-通气比 胸外按压频率为100~120次/min,每6 s给予1次呼吸(频率为10次/min) ? ?
按压频率 100~120次/min ? ?
按压深度 5~6 cm 至少为胸部前、后径的1/3,约为5 cm 至少为胸部前、后径的1/3,约为4 cm
手的位置 施救者将双手放在猝倒患儿胸骨的下半部分 施救者将双手或一只手(对于很小的儿童可用) ?
放在猝倒患儿胸骨的下半部 若现场仅有1位施救者,则施救者将2根手指放在婴儿胸部中央,乳线正下方 ? ?
若现场仅有2位以上施救者,则施救者将双手拇指环绕放在婴儿胸部中央,乳线正下方 ? ? ?
胸廓回弹 每次按压后,使胸廓充分回弹;切不可在每次按压后倚靠在患儿胸上,尽量减少按压过程的无故中断 按压过程的中断时间要求限制在10 s以内 ?
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