呼气末二氧化碳分压监测在心搏骤停患者中的应用价值及预后评估研究

doi:10.3761/j.issn.2096-7446.2026.11.004

摘要/Abstract

摘要：

目的探讨呼气末二氧化碳分压（end-tidal carbon dioxide partial pressure，PetCO₂）监测对急诊心搏骤停患者实施心肺复苏质量及预后评估中的应用价值，为临床护理人员保证高质量心肺复苏提供参考依据。方法选取2023年11月至2025年11月安徽省某三级甲等医院急诊科收治的172例心搏骤停患者作为研究对象，根据复苏结果分为自主循环恢复（restoration of spontaneous circulation，ROSC）组（n=62）和非ROSC组（n=110），比较两组一般资料及各时间点PetCO₂数值。进一步将部分ROSC组患者按生存情况分为7 d生存组（n=18）与死亡组（n=28），分析各时间点PetCO₂数值对预后的预测价值。采用受试者操作特征曲线（receiver operator characteristic curve，ROC）曲线分析PetCO₂数值预测ROSC及生存率的最佳截断值。结果 ROSC组与非ROSC组在发病地点方面差异有统计学意义（P<0.05）。ROSC组在行心肺复苏的各时间点PetCO₂数值均显著高于非ROSC组（P<0.001）。不同时间节点PetCO₂数值与ROSC结局、7 d生存结局组间存在交互效应（P<0.05）。在复苏20 min时，当约登指数取最大值0.830时，出现ROSC的PetCO₂最佳截断值为14.5 mmHg（1 mmHg=0.133 kPa），ROC曲线下面积最大（AUC=0.980，95%CI：0.958~1.000），其灵敏度和特异度分别为90.3%和92.7%；在复苏30 min时，当约登指数取最大值0.889时，ROSC后7 d生存率的PetCO₂最佳截断值为32 mmHg，ROC曲线下面积最大（AUC=0.992，95%CI：0.967~1.000），其灵敏度和特异度分别为88.9%和100%。结论 PetCO₂监测可动态、无创地评估心肺复苏质量，对预测患者ROSC及短期生存率具有重要临床价值，建议有条件的医院可在实施心肺复苏过程中全程监测并推进其常规应用。

关键词: 心搏骤停, 呼气末二氧化碳分压, 心肺复苏, 自主循环恢复, 预后评估

Abstract:

Objective To explore the application value of end tidal carbon dioxide partial pressure（PetCO₂） monitoring in the quality and prognosis evaluation of cardiopulmonary resuscitation in patients with cardiac arrest in the emergency department，and to provide reference for clinical nurses to ensure high-quality cardiopulmonary resuscitation. Methods 172 patients with cardiac arrest admitted to the emergency department of a hospital from November 2023 to November 2025 were selected as the research objects. According to resuscitation outcomes，they were divided into the restoration of spontaneous circulation（ROSC） group（n=62） and the non-ROSC group（n=110）. The general data and PetCO₂ values at each time point were compared between the two groups. Some patients in ROSC group were further divided into a 7-day survival group（n=18） and death group（n=28） according to their survival status，and the predictive value of PetCO₂ value at each time point for prognosis was analyzed. Receiver operating characteristic（ROC） curve was used to analyze the best cut-off value of PetCO₂ in predicting ROSC and survival rate. Results There was a statistically significant difference in the location of onset between the ROSC group and non-ROSC group（P<0.05）. The PetCO₂ value of the ROSC group at each time point of CPR was significantly higher than that of non-ROSC group（P<0.001）. There was a significant interaction between PetCO₂ value and ROSC outcome and 7-day survival outcome at different time points（P<0.05）. At 20 min of resuscitation，when the maximum value of Youden index was 0.830，the best cut-off value of ROSC was 14.5 mmHg（1 mmHg=0.133 kPa），and the area under the ROC curve was the largest（AUC=0.980，95%CI：0.958-1.000）. The sensitivity and specificity were 90.3% and 92.7%，respectively. At 30 min of resuscitation，when the maximum value of Youden index was 0.889，the best cut-off value of 7-day survival rate was 32 mmHg，and the area under the ROC curve was the largest（AUC=0.992，95%CI：0.967-1.000）. The sensitivity and specificity were 88.9% and 100%，respectively. Conclusion PetCO₂ monitoring can dynamically and noninvasively evaluate the quality of cardiopulmonary resuscitation，and has important clinical value in predicting patients’ ROSC and short-term survival rate. Its continuous monitoring and wider application during cardiopulmonary resuscitation are recommended

Key words: Cardiac Arrest, End Tidal Carbon Dioxide Partial Pressure, Cardiopulmonary Resuscitation, Autonomous Circulation Recovery, Prognosis Evaluation

陈鹏, 荣娟, 吴允, 宣娇娇, 吴姚. 呼气末二氧化碳分压监测在心搏骤停患者中的应用价值及预后评估研究[J]. 中华急危重症护理杂志, 2026, 7(11): 1307-1312.

CHEN Peng, RONG Juan, WU Yun, XUAN Jiaojiao, WU Yao. Application value and prognosis evaluation of end tidal carbon dioxide partial pressure monitoring in patients with cardiac arrest[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(11): 1307-1312.

图/表 5

表1

表2

图1

表3

图2

参考文献 26

[1]	Liu S, Zhu HD, Zhang N. Description of current status of im-plementation and management of cardiac arrest in China[J]. Sci Rep, 2025(15):3471.
[2]	Martin SS, Aday AW, Allen NB, et al. 2025 heart disease and stroke statistics:a report of US and global data from the American Heart Association[J]. Circulation,2025, 151(8):e41-e660.
[3]	Greif R, Bray JE, Djärv T, et al. 2024 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations:summary from the basic life support;advanced life support;pediatric life support;neonatal life support;education,implementation,and teams;and first aid task forces[J]. Resuscitation,2024, 205:110414.
[4]	孙峰, 王亚, 马士程, 等. 《急诊呼气末二氧化碳监测专家共识》解读[J]. 中国急救医学, 2017, 37(7):590-592.
	Sun F, Wang Y, Ma SC, et al. Interpretation of the expert consensus on end-tidal carbon dioxide monitoring in emergen-cy department[J]. Chin J Crit Care Med, 2017, 37(7):590-592.
[5]	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 P. Research progress of end tidal carbon dioxide moni-toring in patients undergoing cardiopulmonary resuscitation[J]. Chin J Emerg Crit Care Nurs, 2025, 6(7):891-896.
[6]	Wigginton JG, Agarwal S, Bartos JA, et al. Part 9:adult advan-ced life support:2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2025, 152(16_suppl_2):S538-S577.
[7]	Greif R, Lauridsen KG, Djärv T, et al. European Resuscitation Council guidelines 2025 executive summary[J]. Resuscitation, 2025, 215:110770.
[8]	Merchant RM, Topjian AA, Panchal AR, et al. Part 1:executive summary:2020 American Heart Association guidelines for car-diopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2020, 142(16_suppl_2):S366-S468.
[9]	Kleinman ME, Buick JE, Huber N, et al. Part 7:Adult basic life support:2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2025, 152(16_suppl_2):S448-S478.
[10]	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.
[11]	王晓蕾, 王秋艳, 于美军, 等. 心脏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 relation-ship between partial pressure of end-expiratory carbon dioxi-de and recovery of autonomic circulation in patients with cardiac arrest[J]. Chin J Health Care Med, 2024, 26(2):159-161.
[12]	中国老年保健协会第一目击者现场救护专业委员会, 现场救护第一目击者行动专家共识组. 现场救护第一目击者行动专家共识[J]. 中华危重病急救医学, 2019, 31(5):513-527.
	First Aid Professional Committee of Chinese Aging Well Association, Expert Consensus Group for First Responder Action on First Aid. Expert consensus on the first responder of the first aid[J]. Chin Crit Care Med, 2019, 31(5):513-527.
[13]	杨爱祥, 方强, 杨静, 等. 心电监护对心脏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 resuscita-tion:a clinical analysis[J]. Chin J Crit Care Med, 2011, 31(5):454-456.
[14]	Eberle B, Dick WF, Schneider T, et al. Checking the carotid pulse check:diagnostic accuracy of first responders in patients with and without a pulse[J]. Resuscitation, 1996, 33(2):107-116.
[15]	Vaillancourt C, Petersen A, Meier EN, et al. The impact of increased chest compression fraction on survival for out-of-hospital cardiac arrest patients with a non-shockable initial rhythm[J]. Resuscitation, 2020, 154:93-100.
[16]	Shepard LN, DeVivo A, Abella BS, et al. Physiology-guided CPR[J]. Crit Care Clin, 2026, 42(1):1-21.
[17]	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 extubated patients during emergence from general anesthesia[J]. J Nurs Sci, 2022, 37(12):36-38.
[18]	Morgan RW, Reeder RW, Bender D, et al. Associations between end-tidal carbon dioxide during pediatric cardiopulmonary re-suscitation,cardiopulmonary resuscitation quality,and survival[J]. Circulation, 2024, 149(5):367-378.
[19]	Crickmer M, Drennan IR, Turner L, et al. The association bet-ween end-tidal CO₂ and return of spontaneous circulation after out-of-hospital cardiac arrest with pulseless electrical activity[J]. Resuscitation, 2021, 167:76-81.
[20]	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.
[21]	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.
[22]	Wang CH, Lu TC, Tay J, et al. Association between trajectories of end-tidal carbon dioxide and return of spontaneous circu-lation among emergency department patients with out-of-hospital cardiac arrest[J]. Resuscitation, 2022, 177:28-37.
[23]	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.
[24]	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]. Prehospital Emerg Care, 2016, 20(3):369-377.
[25]	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 resuscitation:an observational study[J]. Crit Care, 2007, 11(2):R39.
[26]	Wang CH, Lu TC, Tay J, et al. End-tidal carbon dioxide tra-jectory-based prognostication of out-of-hospital cardiac arrest[J]. West J Emerg Med, 2024, 25(4):521-532.