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追加：第 13 节第 43、44 条，婴儿噎住与婴儿心肺复苏

完整同步原作内容。作者：eternity4719。

追加：第 13 节第 43、44 条，婴儿噎住与婴儿心肺复苏

2026-10-01。第 13 节原有第 1 条（成人心肺复苏）和第 26 条（1 岁以上和成人噎住），不满 1 岁的婴儿手法不同，一直没有单独写。两条追加在节末，没有插在中间，免得后面的条号整体顺延。第 1 条和第 26 条的备注各加一句指向新条目。

1. 美国心脏协会和美国儿科学会 2025 年儿童基础生命支持指南

  • 题录：Joyner BL 等 (2025). Part 6: Pediatric Basic Life Support. Circulation 152(suppl 2):S424–S447. DOI 10.1161/CIR.0000000000001370（Europe PMC PMID 41122891）。
  • 全文：ahajournals.org 是 Cloudflare 质询页，取不到；AHA 官网 https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/pediatric-basic-life-support 用无头 Chrome 带代理能取全文，下面的原文都从这一页逐字核对。流程图是图片，用无头 Chrome 截图后看图核对。
  • 原文（噎住）：「Suffocation (eg, FBAO) is a leading cause of death in infants and children.」「while liquids are common among infants」「For infants with severe FBAO, repeated cycles of 5 back blows alternating with 5 chest thrusts should be performed until the object is expelled or the infant becomes unresponsive.」「Abdominal thrusts are not recommended for infants, given the potential to cause abdominal organ injury.」「The heel of hand technique for chest thrusts is now recommended for infants with severe FBAO, as current CPR literature suggests that it generates greater compression depth than the previously recommended 2-finger technique.」「If infants or children with severe FBAO become unresponsive, rescuers should start CPR, beginning with chest compressions (rescuers should not perform pulse check).」「rescuers should remove any visible foreign body when opening the airway to provide breaths」「Blind finger sweeps should not be performed for infants and children with FBAO.」证据等级标为 C-LD，正文写「There are no high-quality data to support recommendations regarding FBAO in children.」
  • 原文（心肺复苏）：「survival rates of 17.3% in adolescents, 14.7% in children, and 6.6% in infants」「Lay rescuers should begin CPR immediately for any infant or child who is unresponsive, not breathing normally, and does not have signs of life; they should not check for a pulse.」「It is reasonable to use a chest compression rate of 100 to 120/min for infants and children.」「at least one-third the anterior-posterior diameter of the chest, which equates to approximately 1.5 in (4 cm) in infants」「it is reasonable for single rescuers to provide a compression-to-ventilation ratio of 30:2 and for 2 rescuers to provide a compression-to-ventilation ratio of 15:2」「For infants, rescuers should compress the sternum using either the 1-hand technique (heel of one hand on sternum) or the 2 thumb–encircling hands technique. If the rescuer cannot physically encircle the chest, it is recommended to compress the chest with the heel-of-1-hand technique.」「The use of 2 fingers along the sternum was eliminated due to ineffectiveness in achieving proper depth.」「For out-of-hospital cardiac arrest (OHCA) in infants and children, providing breaths in addition to chest compressions improves survival」。
  • 原文（要点第 1 条）：「Respiratory conditions remain the major cause of cardiac arrest in infants and children」。
  • 婴儿噎住流程图（Figure 6）里重度的表现：「Weak or absence of cough」「Unable to cry」「Change in color (cyanosis)」，之后是「Activate emergency response system.」再拍背和按胸口。
  • 单人流程图（Figure 9，给医护人员的）：没目击倒下的，先开始 CPR，「After 2 minutes, if still alone, activate emergency response system and retrieve AED/defibrillator (if not already done).」给普通人的 Figure 8 第一步就是「Call 911」，然后立即开始 CPR。
  • 没写进条目：Figure 8 图片标题印的是「1 Year of Age to Puberty」，页面图注却是「Infants to Puberty」，图里又写了「heel of 1 hand (for infants)」，前后不一，所以条目里普通人流程只引正文推荐，不引这张图。

2. 国际红十字与红新月会联合会 2025 年国际急救指南

  • URL：https://www.ifrc.org/sites/default/files/2026-03/IFRC International First Aid, Resuscitation and Education Guidelines 2025.pdf（pdftotext 有文本层）。
  • 噎住（第 238–240 页）：「If the baby cannot cough, cry or breathe, give up to five firm blows between their shoulder blades.」「If the back blows are unsuccessful, turn the baby over and lay them on your knees. Use the two-thumbs encircling technique to perform chest thrusts」「If the chest thrusts are unsuccessful, access EMS immediately.」「If the baby becomes unresponsive, start standard CPR.」「Only remove solid material in the airway with your fingers if you can see it. Do not blindly sweep the mouth with your fingers.」「Even if they are no longer choking, they may have a piece of the object in their lungs that can later cause complications.」「place small items out of reach」。它自己也写了各家不一：「Some recommendations use chest thrusts applied with two thumbs on the breastbone, while others prefer chest thrusts using the heel of one hand.」
  • 心肺复苏（第 186–188 页）：「Baby: Pick the baby up or tap on the sole of their foot.」「For a baby, chest compression depth should be at least one-third of the chest's depth or approximately four cm」「The rate of chest compressions should be 100–120 per minute for babies and children」「If you are alone, access EMS yourself, either using a telephone with the speaker function」「If you are alone and do not have a way to call EMS while performing CPR (e.g. no speakerphone), perform CPR for one minute before pausing to call for help.」「Give two initial rescue breaths using a mouth-to-mouth-and-nose technique for a baby」。它允许两指法：「For a baby, chest compressions can be performed with the two-thumb-encircling hand method or with the two-finger technique.」

3. 欧洲复苏委员会 2025 年指南（普通人版）

  • URL：https://www.erc.edu/media/p5ymaeej/gl2025_layperson_book_ipdf-v11-e.pdf（cprguidelines.eu 同路径返回 HTML，换 www.erc.edu 域名能下到 PDF）。专业版全文 DOI 10.1016/j.resuscitation.2025.110767 是 Cloudflare 质询页，取不到，只用了 Europe PMC 的摘要确认存在。
  • 原文：「If you are alone, make the call, put in speaker mode and place the phone near to you.」「the operator will direct the rescuer to start by immediately performing five rescue breaths. (This is different from CPR on adults.)」「The ERC recommends the two-thumb encircling technique for performing chest compressions on infants」「ratio of 30 compressions to two rescue breaths」。

4. Naim 2017（美国 CARES 登记）

  • 题录：JAMA Pediatrics 171(2):133–141，DOI 10.1001/jamapediatrics.2016.3643，PMID 27837587。卷期页码由 Europe PMC 核对。摘要原文逐字核对。
  • 原文：「Of the 3900 children younger than 18 years with OHCA, 2317 (59.4%) were infants」「BCPR was independently associated with improved overall survival (adjusted proportion, 13.2%; 95% CI, 11.81-14.58; adjusted odds ratio, 1.57; 95% CI, 1.25-1.96)」「compared with no BCPR (overall survival: adjusted proportion, 9.5%」「Among infants, conventional BCPR was associated with improved overall survival and neurologically favorable survival while compression-only CPR had similar outcomes to no BCPR.」
  • 未取得：婴儿亚组的具体数字。全文在 JAMA 网站，没取；条目只写方向，不写婴儿单独的数字。

5. 国内来源

  • 福州市卫健委转福州晚报（2026-01-08）https://www.fuzhou.gov.cn/zgfzzt/swjw/fzwj/jkkp/202601/t20260108_5268351.htm：「1岁以下婴儿：采用"5次背部拍击+5次胸部冲击"的循环操作（让婴儿俯卧于前臂，头低于躯干，用手掌根部拍击肩胛间区5次；若无效，翻转为仰卧位，用单手掌根在胸部正中进行5次快速按压），严禁使用腹部冲击」；「这次新版指南修改的地方就是1岁以下婴儿胸外按压由二指改为单手掌根。福建省红十字应急救护培训中心也将根据中国红十字会总会发布的急救培训指南进行教学更改。」
  • 首都儿科研究所（2022-10-17，北京市卫健委转载）https://wjw.beijing.gov.cn/bmfw_20143/jkzs/jksh/202210/t20221017_2837684.html：「如果只有1个人在场，先进行2分钟的心肺复苏后呼叫120救护车。如果有2人在场，则1人开始心肺复苏，另一人呼叫救护车。」「按压幅度约为胸部前后径1/3，也就是婴儿4cm」「按压频率为100－120次/分」「如果是单人施救，按压30次，人工呼吸2次。如果是双人施救，按压15次，人工呼吸2次。」「1岁以内：口对口鼻」。这篇还写「1岁以下婴儿……一般用食指及中指两根手指并拢按压」，并让人「用手指深入口腔，清理口腔分泌物及呕吐物」，两处都和 2025 年中外指南冲突，条目没有引。
  • 未取得：中国红十字会总会 2025 年版急救培训指南原文。福州那篇只转述了它的改动，没找到能逐字核对的总会原文，所以条目只引福州这篇的转述。

中外指南不一致之处与处理

  • 婴儿胸部按压手法：美国 2025 用单手掌根或双拇指环抱，取消两指；欧洲用双拇指环抱；国际红十字双拇指或两指都行；首都儿科研究所 2022 科普教两指；福州转述的国内新版教学改为单手掌根。条目说人话写「两个拇指，抱不住就用掌根」，这两种手法美国、欧洲、国际红十字和国内新版里至少各有一家认可；备注说明两指法已被美国指南去掉。
  • 噎住时按胸口：美国和国内新版用单手掌根，国际红十字用双拇指。说人话只写「在胸口正中快速按 5 下」，不规定手法，备注列出各家写法。
  • 先按还是先吹：美国先按后吹，欧洲先吹 5 口，国际红十字两种都接受。条目按先按写（和第 1 条一致，也是首都儿科研究所的顺序），备注写明欧洲的做法。
  • 一个人时先打 120 还是先按：欧洲、国际红十字都说开免提边打边按；没法边按边打时，国际红十字先按 1 分钟，美国医护单人流程和首都儿科研究所先按 2 分钟。条目标题和说人话写「开免提打 120，手不停」，备注写明 1 分钟和 2 分钟两种说法。

证据等级与收益量级

  • 第 43 条：B。美国指南自己标 C-LD，正文明说没有高质量数据，支撑的主要是病例报告。收益「大」凭判断：完全堵住的气道几分钟内就会导致心跳骤停，和第 26 条（成人与 1 岁以上噎住，B 级、收益大）同一档。没有能套阈值的相对降幅。
  • 第 44 条：B。存活数字只来自一个登记研究，是只跟踪记录、没有分组对照的观察数据，而且算的是 18 岁以下全体；婴儿单独只给了方向。收益「大」按死亡率口径机械套：活着出院从 9.5% 到 13.2%，相对多约 39%，超过 20% 的「大」档阈值。
  • 受益人：两条的受益人几乎都在第 ① ② 档（自家孩子），备注里写明。