2014-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/651265摘要：維持呼吸道暢通以及正常通氣量對於心肺復甦術( Cardiopulmonary resuscitation; CPR)品質有決定性的影響，根據 2010年高級心臟就命術(ACLS)準則建議，氣管內插管前維持 30:2的壓胸對通氣比例，以及插管後獨立進行每 6-8秒鐘一次的通氣，為現今施行準則。然而，文獻回顧上卻對此建議並無明確來源以及證據，以至於通氣頻率、體積與臨床實行上對於病患自發循環回復以及預後效果尚未確立。 近期研究顯示過度換氣會降低胸腔靜脈回流而導致心輸出下降使全身血液灌流效率不佳；近來亦有證據指出，因心室震顫(Ventricular fibrillation)造成的突發性死亡病患，初期施行基礎生命支持術時(BLS)以高流量氧氣取代人工正壓氣道通氣有更好的預後，此結果與美國心臟科學會的建議互有衝突。 本研究藉由氣體流量監測儀記錄心肺復甦術中正壓呼吸給予的時間與通氣量進而與壓胸動作和病患預後比對，目的在探討氣管內插管後正壓呼吸的頻率、壓力、體積、氣體流量以及與壓胸動作配合度對於回復自主循環的影響。觀察急救過程中，不同正壓通氣與壓胸配合的情形下，以氣體流量監測求得氣道壓力，流速，體積，配合上壓胸位移監測器加以記錄，不對於現行急救流程做任何改變，進而分析各項參數對於整體預後的影響的趨勢。 本觀察性研究致力於改善高級心臟就命術準則中重要卻證據力不足的項目---正確的氣道處理方式，期望研究成果能形成臨床救護者的施行依據，以改善整體救護品質。<br> Abstract: Airway management and maintaining adequate ventilation during cardiopulmonary resuscitation (CPR) are important. The rule of 30:2 compression-to-ventilation ratios before endotracheal intubation and keeping 1 breath every 6-8 seconds with advanced airway are generally accepted according to 2010 Advanced Cardiac Life Support (ACLS) guideline. This recommendation emphasizes on the timing and frequency of ventilation during CPR. However, poor clinical evidence had been established concerning adequate volume, airway flow and pressure in each cycle. There are increasing evidence that hyperventilation during resuscitation reduces pulmonary venous return and, therefore, compromises cardiac output and circulation. Another research reported that using high flow oxygen mask alone during basic life support (BLS) results in better survival rate and overall outcome compared with conventional positive pressure ventilation. Our study applies flowmeter to measure ventilation parameters as frequency, duration, exhaled volume and airway pressure on intubated patients who received artificial ventilation during CPR. The parameters will correlate with information from accelerometry and capnometry simultaneously during resuscitation. We also focus on the influence of chest compression, which increases intra-thoracic pressure considerably. This effect may act against positive pressure ventilation and probably minimize the efficiency in each ventilation or circulation. Details about how to ventilate one patient during CPR include right timing, duration, adequate volume and coordination are in debate. Unfortunately, current practice based on clinical guidelines emphasizes little on this issue. We are committed to refine contemporary practices and hopefully improve qualities of resuscitation.