呼气末二氧化碳监测在心肺复苏患者中应用的研究进展

doi:10.3761/j.issn.2096-7446.2025.07.022

摘要/Abstract

摘要：

心搏骤停是急诊科最常见且最危急的疾病之一，同时也是公众关注的重要健康问题。如果不能得到及时救治，将对人体各组织功能器官造成严重破坏，甚至威胁患者生命。心肺复苏术作为心搏骤停的重要救治方法，是挽救患者生命的关键，但现阶段复苏成功率普遍偏低。为提高心搏骤停患者救治成功率，提出高质量的心肺复苏及在心肺复苏过程中进行有效的指标监测来指导复苏质量。该文就呼气末二氧化碳分压（partial pressure of end tidal carbon dioxide，PETCO₂）监测原理及波形解读、在心肺复苏中应用指导价值，以及心肺复苏过程中影响PETCO₂因素等方面进行综述，旨在为PETCO₂监测及在心肺复苏过程中应用提供参考。

关键词: 呼气末二氧化碳, 心肺复苏, 指导价值, 影响因素, 急症护理

Abstract:

Cardiac arrest is one of the most common and critical diseases in the emergency department，and it is also an important health problem of public concern. If not treated in time，it will cause serious damage to the tissues and functional organs of human，and even threaten the lives of patients. Cardiopulmonary resuscitation，as an important treatment method for cardiac arrest，is the key to save patients’ lives，but the success rate of resuscitation is generally low at this stage. In order to improve the success rate of treatment of patients with cardiac arrest，high-quality cardiopulmonary resuscitation and effective index monitoring in the process of cardiopulmonary resuscitation to guide the quality of resuscitation were proposed. This article reviews the monitoring principle and waveform interpretation of the partial pressure of end tidal carbon dioxide （PETCO2），the application guidance value in cardiopulmonary resuscitation，and the factors affecting PETCO2 during cardiopulmonary resuscitation，in order to provide reference for the application of PETCO2 monitoring in cardiopulmonary resuscitation.

Key words: End Tidal Carbon Dioxide, Cardiopulmonary Resuscitation, Guiding Value, Influencing Factors, Emergency Nursing

陈鹏. 呼气末二氧化碳监测在心肺复苏患者中应用的研究进展[J]. 中华急危重症护理杂志, 2025, 6(7): 891-896.

CHEN Peng. Research progress of end tidal carbon dioxide monitoring in patients undergoing cardiopulmonary resuscitation[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(7): 891-896.

参考文献 35

[1]	Martin SS, Aday AW, Almarzooq ZI, et al. 2024 eart disease and stroke statistics:a report of US and global data from the American Heart Association[J]. Circulation, 2024, 149(8):e347-e913.
[2]	Holmberg MJ, Ross CE, Fitzmaurice GM, et al. Annual inciden-ce of adult and pediatric in-hospital cardiac arrest in the Uni-ted States[J]. Circ Cardiovasc Qual Outcomes, 2019, 12(7):e005580.
[3]	Considine J, Gazmuri RJ, Perkins GD, et al. Chest compression components(rate,depth,chest wall recoil and leaning):a scop-ing review[J]. Resuscitation, 2020,146:188-202.
[4]	杨爱祥, 方强, 杨静, 等. 心电监护对心搏骤停时胸外按压复苏效果的分析[J]. 中国急救医学, 2011, 31(5):454-456.
	Yang AX, Fang Q, Yang J, et al. Effects of chest compressions directed by ECG monitoring on cardiopulmonary resuscitation:a clinical analysis[J]. Chin J Crit Care Med, 2011, 31(5):454-456.
[5]	Soar J, Berg KM, Andersen LW, et al. Adult advanced life support:2020 international consensus on cardiopulmonary re-suscitation and emergency cardiovascular care science with treatment recommendations[J]. Resuscitation,2020,156:A80-A119.
[6]	Sutton RM, French B, Meaney PA, et al. Physiologic monitoring of CPR quality during adult cardiac arrest:a propensity-matched cohort study[J]. Resuscitation, 2016,106:76-82.
[7]	代恒茂, 明伟, 周志强, 等. 呼气末二氧化碳分压监测在全麻拔管后苏醒期患者中的应用[J]. 护理学杂志, 2022, 37(12):36-38.
	Dai HM, Ming W, Zhou ZQ, et al. Application of end-tidal carbon dioxide partial pressure monitoring to postoperative extu-bated patients during emergence from general anesthesia[J]. J Nurs Sci, 2022, 37(12):36-38.
[8]	Godden B. Where does capnography fit into the PACU?[J]. J Perianesth Nurs, 2011, 26(6):408-410. doi: 10.1016/j.jopan.2011.09.004 pmid: 22099134
[9]	孙峰, 马士程, 王亚. 急诊呼气末二氧化碳监测专家共识[J]. 中国急救医学, 2017, 37(7):585-589.
	Sun F, Ma SC, Wang Y. Expert consensus on emergency end-expiratory carbon dioxide monitoring[J]. Chin J Crit Care Med, 2017, 37(7):585-589.
[10]	Kalenda Z. The capnogram as a guide to the efficacy of cardiac massage[J]. Resuscitation, 1978, 6(4):259-263. pmid: 755268
[11]	Truhlář A, Deakin CD, Soar J, et al. European resuscitation coun-cil guidelines for resuscitation 2015:section 4. cardiac arrest in special circumstances[J]. Resuscitation, 2015,95:148-201.
[12]	Neumar RW, Shuster M, Callaway CW, et al. Part 1:executive summary:2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascu-lar care[J]. Circulation, 2015, 132(18 Suppl 2):S315-S367.
[13]	Eberle B, Dick WF, Schneider T, et al. Checking the carotid pulse check:diagnostic accuracy of first responders in pa-tients with and without a pulse[J]. Resuscitation, 1996, 33(2):107-116. pmid: 9025126
[14]	Al-Subu AM, Hacker TA, Eickhoff JC, et al. Two-site regional oxygen saturation and capnography monitoring during resusci-tation after cardiac arrest in a swine pediatric ventricular fibrillatory arrest model[J]. J Clin Monit Comput, 2020, 34(1):63-70. doi: 10.1007/s10877-019-00291-2 pmid: 30820870
[15]	Sheak KR, Wiebe DJ, Leary M, et al. Quantitative relationship between end-tidal carbon dioxide and CPR quality during both in-hospital and out-of-hospital cardiac arrest[J]. Resusci-tation, 2015,89:149-154.
[16]	Murphy RA, Bobrow BJ, Spaite DW, et al. Association between prehospital CPR quality and end-tidal carbon dioxide levels in out-of-hospital cardiac arrest[J]. Prehosp Emerg Care, 2016, 20(3):369-377. doi: 10.3109/10903127.2015.1115929 pmid: 26830353
[17]	Alenazi A, Alshibani A. Confirmatory methods for endotracheal tube placement in out-of-hospital settings:A systematic review of the literature[J]. Heliyon, 2024, 10(7):e28479.
[18]	Russotto V, Myatra SN, Laffey JG, et al. Intubation practices and adverse peri-intubation events in critically ill patients from 29 countries[J]. JAMA, 2021, 325(12):1164-1172. doi: 10.1001/jama.2021.1727 pmid: 33755076
[19]	Silvestri S, Ladde JG, Brown JF, et al. Endotracheal tube place-ment confirmation:100% sensitivity and specificity with sus-tained four-phase capnographic waveforms in a cadaveric ex-perimental model[J]. Resuscitation, 2017,115:192-198.
[20]	Paiva EF, Paxton JH, O’Neil BJ. Data supporting the use of end-tidal carbon dioxide(ETCO₂) measurement to guide ma-nagement of cardiac arrest:a systematic review[J]. Data Brief, 2018,18:1497-1508.
[21]	Poppe M, Stratil P, Clodi C, et al. Initial end-tidal carbon dio-xide as a predictive factor for return of spontaneous circu-lation in nonshockable out-of-hospital cardiac arrest patients:a retrospective observational study[J]. Eur J Anaesthesiol, 2019, 36(7):524-530.
[22]	王飞, 徐亮, 王斌, 等. 连续呼气末二氧化碳监测在心肺复苏患者中应用价值研究[J]. 创伤与急危重病医学, 2020, 8(6):446-449.
	Wang F, Xu L, Wang B, et al. Application value of continuous end tidal CO₂ in patients with cardiopulmonary resuscitation[J]. Trauma Crit Care Med, 2020, 8(6):446-449.
[23]	张春艳, 池菲, 梁建琴, 等. 呼气末二氧化碳在心肺复苏中的临床价值[J]. 中国医刊, 2021, 56(11):1207-1210.
	Zhang CY, Chi F, Liang JQ, et al. Continuous monitoring of end-tidal carbon dioxide in cardiopulmonary resuscitation[J]. Chin J Med, 2021, 56(11):1207-1210.
[24]	王晓蕾, 王秋艳, 于美军, 等. 心搏骤停患者呼气末二氧化碳分压与自主循环恢复关系的研究[J]. 中华保健医学杂志, 2024, 26(2):159-161.
	Wang XL, Wang QY, Yu MJ, et al. A study of the rela-tionship between partial pressure of end-expiratory carbon dioxide and recovery of autonomic circulation in patients with cardiac arrest[J]. Chin J Health Care Med, 2024, 26(2):159-161.
[25]	Wang AY, Huang CH, Chang WT, et al. Initial end-tidal CO₂ partial pressure predicts outcomes of in-hospital cardiac arrest[J]. Am J Emerg Med, 2016, 34(12):2367-2371.
[26]	陈苗妙, 潘柳华, 李坤旺. 呼气末二氧化碳分压监测用于心搏骤停患者对心肺复苏质量和预后的临床评价意义[J]. 中国现代医生, 2020, 58(16):83-87,封3.
	Chen MM, Pan LH, Li KW. Clinical value of end-expiratory carbon dioxide partial pressure monitoring for the evaluation of cardiopulmonary resuscitation quality and prognosis in patients with cardiac arrest[J]. China Mod Dr, 2020, 58(16):83-87,cover 3.
[27]	徐伟, 林文风, 张洪辉, 等. 呼气末二氧化碳分压监测用于心肺复苏及预后评估研究[J]. 护理学杂志, 2023, 38(24):32-36.
	Xu W, Lin WF, Zhang HH, et al. Application of end-tidal carbon dioxide partial pressure monitoring in cardiopulmo-nary resuscitation and prognosis assessment[J]. J Nurs Sci, 2023, 38(24):32-36.
[28]	Gazmuri RJ, Ayoub IM, Radhakrishnan J, et al. Clinically plau-sible hyperventilation does not exert adverse hemodynamic effects during CPR but markedly reduces end-tidal PCO₂[J]. Resuscitation, 2012, 83(2):259-264. doi: 10.1016/j.resuscitation.2011.07.034 pmid: 21854734
[29]	Ruiz de Gauna S, Gutiérrez JJ, Ruiz J, et al. The impact of ventilation rate on end-tidal carbon dioxide level during manual cardiopulmonary resuscitation[J]. Resuscitation, 2020, 156:215-222. doi: 10.1016/j.resuscitation.2020.06.007 pmid: 32622015
[30]	Savastano S, Baldi E, Raimondi M, et al. End-tidal carbon dio-xide and defibrillation success in out-of-hospital cardiac arrest[J]. Resuscitation, 2017,121:71-75.
[31]	Chicote B, Aramendi E, Irusta U, et al. Value of capnography to predict defibrillation success in out-of-hospital cardiac arrest[J]. Resuscitation, 2019,138:74-81.
[32]	Hubble MW, Van Vleet L, Taylor S, et al. Predictive utility of end-tidal carbon dioxide on defibrillation success in out-of-hospital cardiac arrest[J]. Prehosp Emerg Care, 2021, 25(5):697-705.
[33]	Grabman B, Bulger NE, Harrington BM, et al. Increase in end-tidal carbon dioxide after defibrillation predicts sustained return of spontaneous circulation during out-of-hospital car-diac arrest[J]. Resuscitation, 2022,181:48-54.
[34]	Mally S, Jelatancev A, Grmec S. Effects of epinephrine and vasopressin on end-tidal carbon dioxide tension and mean arterial blood pressure in out-of-hospital cardiopulmonary resu-scitation:an observational study[J]. Crit Care, 2007, 11(2):R39.
[35]	Roh YI, Kim HI, Kim SJ, et al. End-tidal carbon dioxide after sodium bicarbonate infusion during mechanical ventilation or ongoing cardiopulmonary resuscitation[J]. Am J Emerg Med, 2024,76:211-216.