关键词： 快通道麻醉   体外循环   心脏手术   术后复苏护理  

摘要： 目的:探讨快通道麻醉方法在体外循环下心脏手术的术后复苏护理.方法:选取我院2015年2月-2016年8月收治的行快速通道麻醉方法于体外循环下心脏手术的患儿80例,术后对所有患儿采取复苏护理.结果:术后复苏护理包括心理护理、呼吸道护理、镇静镇痛护理、出血护理以及体温、生命体征监测等等基本护理.结论;术后,对患儿实行复苏护理,可以使得惠儿更快康复,也可以提高患儿对护理工作的满意度,在临床上值得推广应用.

关键词： Cardiac arrest   Cardiopulmonary resuscitation   Electrical stimulation   Vacuolar H+-ATPase (V-ATPase)   Mild hypothermia   CARDIOPULMONARY-RESUSCITATION   H+-ATPASE   NERVE-TERMINALS   CELL-DEATH   VACUOLAR   MEMBRANE   SUBUNIT   NEUROPROTECTION   INVOLVEMENT   APOPTOSIS  

摘要： Although therapeutic hypothermia is an effective treatment for post-resuscitation brain injury after cardiac arrest (CA), the underlying mechanism remains unclear. Vacuolar H+-ATPase (V-ATPase) plays a key role in cellular adaption to a hypoxic environment. This study sought to evaluate the effect of mild hypothermia on V-ATPase and its involvement in neuroprotection after CA. Male Sprague-Dawley rats were subjected to a 6-min CA, resuscitated successfully, and then assigned to either the normothermia (NT) group or the hypothermia (HT) group. Rats were further divided into 2 subgroups based on the time of euthanasia, either 3 or 24 h after CA (NT-3 h, HT-3 h; NT-24 h, HT-24 h). Mild hypothermia was induced following CA and maintained at 33 degrees C for 2 h. Neurologic deficit scores were used to determine the status of neurological function. Brain specimens were analyzed by TUNEL assay, western blotting, and immunohistochemistry. V-ATPase activity was estimated by subtracting total ATP hydrolysis from the bafilomycin-sensitive activity. Mild hypothermia improved the neurological outcome (HT-24 h: 34.3 +/- 16.4 vs NT-24 h: 50.3 +/- 17.4) and significantly decreased neurocyte apoptosis 24 h after resuscitation. Mild hypothermia significantly increased V0a1 compared to NT-3 h; V0a1 expression was associated with a decrease in the cleaved caspase 3 expression. These findings suggested that mild hypothermia inhibits CA-induced apoptosis in the hippocampus, which may be associated with reduced V-ATPase impairment. These data provide new insights into the protective effects of hypothermia in vivo.

关键词： 心肺复苏   心脏骤停综合征   乌司他汀   实验药理  

摘要： 目的：背景心脏骤停（cardiac arrest，CA）是急诊患者中严重威胁生命的事件，心肺复苏后绝大多数的患者预后并不理想，机体将发生一系列复杂的病理生理改变，包括心脏骤停后脑损伤、心肌功能障碍、全身性缺血－再灌注损伤和持续诱发性病变,称为心脏骤停后综合征（post-cardiac arrest syndrome，PCAS）[1]，如何防治PCAS一直是急诊医学工作者的研究热点。目的本实验通过复制程控刺激法建立猪CA的模型,检测炎症因子、自由基因子及心肌缺血标志物，评价乌司他汀（UTI）对猪心肺复苏后PCAS的防治作用。　　方法：3-4个月雄性北京长白猪12只，按随机数字表分为两组，对照组和实验组，通过程控刺激法复制心室纤颤(室颤)动物模型，室颤5min后开始CPR，UTI组复苏同时给予UTI100kU溶于生理盐水5ml，缓慢注射，3h1次，直到复苏后12h（第12h不给药）;对照组复苏开始时应用生理盐水5ml作为对照。分别于室颤前基础状态及ROSC后2、4、6、12h抽取家猪静脉血，采用酶联免疫吸附试验(ELISA)测定肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超氧化物歧化酶（SOD）、丙二醛（MDA），缺血修饰白蛋白（IMA）。因IMA反应灵敏，升高较快，ROSC后1h即抽取静脉血检测，余取血点同其余因子。ROSC后12h处死实验猪，留取心、肺、肾组织进行HE染色光镜下观察。　　结果：12只实验猪经过5min室颤后复苏成功11只。UTI组6只和对照组5只，均存活12h。心脏骤停模型较稳定，复苏成功率高。复苏后两组炎症因子、氧化应激指标、心肌缺血标志物均变化明显;UTI组2h起TNF-α(ng／L)、IL-6(ng／L)水平明显低于对照组(TNF-α：7.19±0.65比9.38±0.40，p<0.05;IL-6：12.81±0.34比13.89±0.31，p<0.05);UTI组4h起MDA(U/mL)水平明显低于对照组（5.82±0.42比7.34±0.48，p<0.05）;UTI组4h起SOD(U/mL)水平明显高于对照组（15.28±1.24比12.86±0.73，p<0.05）;IMA(U/mL)在ROSC后1h即明显升高，UTI组1h起水平明显低于对照组（5.85±0.21比6.46±0.38，p<0.05），但12h检测时两组比较无统计学意义(5.24±1.06比5.71±0.36，p＞0.05)。组织切片HE染色结果显示：ROSC后12h时UTI组心、肺、肾组织损伤程度明显轻于对照组。　　结论：心脏骤停经ROSC后猪机体内发生了强烈的炎症反应、氧化应激反应及心肌缺血。心肺复苏时应用UTI可以拮抗炎症反应，减轻氧化应激反应;IMA为心肌缺血的敏感指标，可以预测ROSC后心肌缺血程度。应用UTI可以改善心、肺、肾组织的损伤，可以有效预防心肺复苏后PCAS的发生。

关键词： INTENSIVE-CARE UNITS   THERAPEUTIC HYPOTHERMIA   CARDIOPULMONARY-RESUSCITATION   EMERGENCY-DEPARTMENT   ADHERENCE   OUTCOMES   TRANSLATION   FOCUS  

摘要： Objectives: To identify the barriers to and facilitators of implementing guidelines for targeted temperature management (TTM) after cardiac arrest perceived by hospital resuscitation champions and to investigate the changes in their perceptions over the early implementation period. Design: A longitudinal qualitative study (up to 2 serial semistructured interviews over 1 year and focus groups). The individual interviews and focus groups were transcribed and coded by 2 independent assessors. Contents were analysed thematically; group interaction was also examined. Setting: 21 hospitals, including community and tertiary care centres in South Korea. Participants: 21 hospital champions (14 acting champions and 7 managerial champions). Results: The final data set included 40 interviews and 2 focus groups. The identified barriers and facilitators could be classified into 3 major themes: (1) healthcare professionals' perceptions of the guidelines and protocols, (2) interdisciplinary and interprofessional collaboration and (3) organisational resources. Lack of resources was the most commonly agreed on barrier for the acting champions, whereas lack of interdisciplinary collaboration was the most common barrier for the managerial champions. Educational activities and sharing successfully treated cases were the most frequently identified facilitators. Most of the participants identified and agreed that cooling equipment was an important barrier as well as a facilitator of successful TTM implementation. Perception of the guidelines and protocols has improved with the accumulation of clinical experience over the study period. Conclusions: Healthcare professionals' internal barriers to TTM implementation may be influenced by new guidelines and can be changed with the accumulation of successful clinical experiences during the early implementation period. Promoting interprofessional and interdisciplinary collaboration through educational activities and the use of cooling equipment w

关键词： 心源性心脏骤停   心肺复苏   集中护理  

摘要： 目的:对集中护理管理模式对心源性心脏骤停心肺复苏患者应激反应的情况进行分析.方法 :对在我院心源性心脏骤停心肺复苏治疗102例,进行分组常规护理组50例,给予常规的护理措施;集中护理组患者52例,给予集中护理干预措施,对护理中患者应激反应情况进行分析.结果 :组间对比患者整体成功复苏的患者比例、复苏操作前血清应急因子的水平、血氧饱和度和收缩期血压(P>0.05).集中护理干预患者复苏操作时间、复苏操作30分钟及60分钟后应激炎性因子、预后情况等均明显优越于常规护理患者,(P<0.05).结论 :对心源性心脏骤停心肺复苏治疗患者给予集中护理干预措施,能够在常规护理干预基础上更好地缩短复苏操作时间、平衡应激炎性因子水平、改善患者的生活质量,提高整体的治疗效果.

关键词： 便携式心脏复苏机   心搏骤停   复苏成功率  

摘要： 目的:对便携式心脏复苏机在心搏骤停患者急救中的应用效果.方法:随机择取我院2014-2015年收治的108例心搏骤停患者作为本次研究对象,将本组病例分为使用便携式心脏复苏机抢救的观察组与徒手胸外按压抢救的对照组,比较两组复苏成功率.结果:观察组复苏成功率为59.3%高于对照组38.9%,差异有统计学意义(P<0.05).结论:在心搏骤停抢救中使用便携式心脏复苏机能显著提高患者复苏成功率,该抢救手段所受到的外界影响因素小,临床应用效果肯定.

关键词： 心脏停搏   便捷式胸腔按压机   心肺复苏  

摘要： 目的探讨并分析在心脏停搏的患者中使用便捷式胸腔按压机实施急救的疗效与临床应用价值。方法选取我院2013年1月;015年1月治疗的出现心脏停搏患者60例为研究对象,利用随机抽样法将其随即分为对照组与实验组,各30例。对照组采用传统徒手心肺复苏方法,实验组采用便捷式胸腔按压机实施心肺复苏急救治疗,对两组结果进行对比。结果急救治疗后,实验组患者的总有效率为30%,对照组的总有效率为20%,实验组没有肋骨骨折情况,对照组出现肋骨骨折1例情况,差异有统计学意义（P<0.05）。结论针对心脏停搏患者采用传统的徒手心肺复苏方法不仅疗效低下,且容易出现不良情况,而采用便捷式胸腔按压机进行心肺复苏则高效、安全、节省时间,该种急救方法值得临床广泛应用。

关键词： 心肌梗死   心脏骤停   复苏  

摘要： 急性心梗(AMI)已成为一种常见病,多发病,是指因持久而严重的心肌缺血所致的部分心肌急性坏死。在临床上常表现为胸痛、急性循环功能障碍以及反映心肌损伤、缺血和坏死等一系列特征,如不及时抢救,猝死率极高。故及时有效的抢救、治疗及护理对患者至关重要。我院2014年3月成功抢救1例急性心梗突发心脏骤停的患者,现将护理内容报告如下。1临床资料患者,男,67岁,冠心病史3年,于2014年3月突发胸闷。

关键词： AHA Scientific Statements   cardiac arrest   duration   heart arrest   hypothermia   resuscitation   temperature management   timing   PREHOSPITAL THERAPEUTIC HYPOTHERMIA   COMATOSE SURVIVORS   MILD HYPOTHERMIA   INDUCTION   HYPERTHERMIA   33-DEGREES-C   CONSENSUS   OUTCOMES   IMPACT   BRAIN  

摘要： For more than a decade, mild induced hypothermia (32 degrees C-34 degrees C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 degrees C or 36 degrees C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32 degrees C and 36 degrees C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document.

关键词： 心源性心脏骤停   六西格玛管理   心肺复苏   液体复苏   心排量   医学技术   凝血机制障碍   高渗盐水   测量技术   血乳酸水平  

摘要： 心源性心脏骤停是循环突然完全停止的一种临终前状态,为心脏急症中最严重的情况,是当今对人类危害最大的疾病之一[1]。随着医学技术的发展,目前急诊复苏技术得到了广泛的进步。