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体外心肺复苏：路在何方？
李伟
张刚
胡德亮
陈旭锋
作者及单位信息
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DOI： 10.3760/cma.j.issn.1671-0282.2025.03.002
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摘要

心搏骤停（cardiac arrest, CA）患者的救治是全球范围内的一个严峻的公共卫生问题。美国每年超过60万人发生CA，其中约35万人发生院外心搏骤停（out-of-hospital cardiac arrest, OHCA），约29万人发生院内心搏骤停（In hospital cardiac arrest, IHCA）。欧洲每年约27.5万人发生OHCA。CA患者致残率及致死率很高，仅有约10%的OHCA患者存活出院，30%的IHCA患者存活出院 [1,2,3]。《中国心脏骤停与心肺复苏报告：2022年版》报道指出我国经紧急医疗服务接诊的OHCA发病率为97.1/10万，30 d存活率1.2%，近十年改善不明显。心源性疾病（占76.1%）仍是CA发生的主要原因。IHCA发病率为8.4‰，30 d存活率9.4% [4]。

引用本文

李伟,张刚,胡德亮,等. 体外心肺复苏：路在何方？[J]. 中华急诊医学杂志,2025,34(03)：280-285.

DOI:10.3760/cma.j.issn.1671-0282.2025.03.002

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心搏骤停（cardiac arrest, CA）患者的救治是全球范围内的一个严峻的公共卫生问题。美国每年超过60万人发生CA，其中约35万人发生院外心搏骤停（out-of-hospital cardiac arrest, OHCA），约29万人发生院内心搏骤停（In hospital cardiac arrest, IHCA）。欧洲每年约27.5万人发生OHCA。CA患者致残率及致死率很高，仅有约10%的OHCA患者存活出院，30%的IHCA患者存活出院 [ 1 , 2 , 3 ]。《中国心脏骤停与心肺复苏报告：2022年版》报道指出我国经紧急医疗服务接诊的OHCA发病率为97.1/10万，30 d存活率1.2%，近十年改善不明显。心源性疾病（占76.1%）仍是CA发生的主要原因。IHCA发病率为8.4‰，30 d存活率9.4% [ 4 ]。
CA患者传统的抢救措施即胸外按压（conventional cardiopulmonary resuscitation, CCPR）。遗憾的是，CCPR并不能提供正常的压力灌注和流量灌注，而且疗效呈显著的时间和质量依赖性，间断性或者低质量CCPR都与患者预后密切相关 [ 5 , 6 ]。另一方面，CCPR还可能造成潜在医源性损伤，如肋骨骨折、气胸、肝挫伤等；同时还可能延误诊断性检验或检查的进行，甚至原发病的救治。例如，影像学检查或者冠状动脉再血管化治疗等。有数据表明，即使早期予以高级生命支持措施，仍有高达75%的OHCA患者发生顽固性CA [ 7 ]。
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备注信息
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陈旭锋，Email: mocdef.3ab61xyfxc
B
所有作者声明无利益冲突
C
江苏省科教能力提升工程-江苏省医学重点学科 (ZDXK202213)
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