关键词： 心脏呼吸骤停   萨勃心肺复苏机(Thumper)   治疗  

摘要： 目的:研究萨勃心肺复苏机(Thumper)在心脏呼吸骤停治疗中的应用效果。方法:研究对象取本院外伤所致心脏呼吸骤停50例,依照治疗不同分成两组。25例应用萨勃机,入组研究组;余25例入组对照组,接受徒手心肺复苏。观察评估疗效,组间对比。结果:组间相比,研究组成功率高,撤机及心跳恢复时间短,收缩压、血氧饱和度、心率及呼吸频率等指标优,有显著性差异(P<0.05)。结论:萨勃心肺复苏机(Thumper)在心脏呼吸骤停治疗中有很大应用意义,治疗效果佳,可推广。

关键词： 心肺复苏术   ECMO   出院生存率   神经功能状态   meta  

摘要： 目的评价体外膜肺氧合辅助下心肺复苏(ECPR)对成年心脏骤停患者的生存影响。方法计算机检索CNKI、PubMed等数据库在2015年3月之前公开发表的相关文献,并对获得文献进行严格的筛选和质量评价,提取相关数据,使用STATA13.0软件进行统计分析。结果纳入五个研究,共计1 305人,其中ECPR组295人,传统心肺复苏(CCPR)组1 010人。meta分析结果显示:与CCPR相比,ECPR可以提高成年心脏骤停患者的出院生存率[相对危险度2.74,95%可信区间(2.03,3.70),P<0.001]和神经功能状态[相对危险度2.65,95%可信区间(1.86,3.77),P<0.001]。在纳入的5项研究中,4项建立了倾向评分匹配的队列,其中ECPR组与CCPR组各182人。meta分析结果同样表明:在提高成年心脏骤停患者的出院生存率[相对危险度2.53,95%可信区间(1.52,4.20),P<0.001]和神经功能状态方面[相对危险度3.27,95%可信区间(1.74,6.15),P<0.001],ECPR具有较为显著的优势。结论 ECPR在提高成年心脏骤停患者的出院生存率和神经功能状态方面,效果优于CCPR。

关键词： 心肺复苏   低血钾   无创呼吸机辅助呼吸   心脏骤停   双侧瞳孔散大固定   持续胸外心脏按压   肾上腺素注射液   实验室检查  

摘要： 患者男，33岁。主因鼻塞、流涕2～3 d，全身乏力1 d，四肢瘫痪13 h，于16：30就诊于我院急诊科，实验室检查K＋2.01 mmol/L，给予0.3％氯化钾注射液常规静脉滴注，共补钾3 g，症状无改善。于20：00收入我科。入院时查体：体温36.0℃，心率21次/min，血压110/60 mmHg（1 mmHg=0.133 kPa），脉搏62次/min，神清语利，精神差，急性重症面容，双肺呼吸音粗，未闻及干湿口罗音，心率62次/min，律齐，各瓣膜听诊区未闻及杂音，腹平软，肝脾未及，全腹无压痛，双下肢无浮肿，四肢肌力1级，肌张力减低。患者既往有类似发作史，其双胞胎弟弟也有类似发作史，其舅舅有类似发作史已猝死。入院诊断：低钾血症原因待查，周期性麻痹待除外，上呼吸道感染。入院后继续给予0.3％氯化钾注射液静脉滴注，复查血钾，20：03患者呼吸困难加重，不能平卧，头部不能直立，考虑低血钾导致呼吸肌麻痹，给予无创呼吸机辅助呼吸，并急行深静脉穿刺置管超常规补钾（1.5 g/h），21：00患者心率减慢，心电监护心率波动于45～55次/min之间，血压60/40 mmHg，随之心律转为室性心动过速，即刻给予“利多卡因注射液100 mg”静脉滴注，多巴胺注射液升压，加大补钾速度为2.0 g/h，复查血钾回报：1.74 mmol/L，21：10心跳骤停，心电图呈直线，即刻胸外心脏按压，肾上腺素注射液静脉注射，行气管插管，有创呼吸机辅助呼吸，每隔3 min给予肾上腺素注射液1 mg静脉注射，于21：30心电图仍呈直线，双侧瞳孔散大固定，对光反射消失，皮肤花斑，继续给予持续胸外心脏按压，呼吸机辅助呼吸，肾上腺素注射液1 mg每隔3 min静脉注射，期间患者多次心室颤动给予360瓦秒非同步直流电除颤，于22：48心电图恢复窦性心动过速，心率波动于150～160次/min，血压90/60 mmHg，大动脉搏动可触及，鼻翼微弱煽动，患者皮肤转暖，瞳孔回缩，给予多巴胺注射液静脉滴注维持血压，后补钾速度调整为1 g/h。3 h共补钾5.5 g，23：30复查血钾3.2 mmol/L，实验室检查心肌酶明显升高，22：57测血压110/70 mmHg，血氧饱和度93％，于次日凌晨1：10复查血钾4.3 mmol/L，，体温39.0℃，给予复苏后脑保护治疗，防止继发性脑损害，患者意识逐渐恢复，自主呼吸恢复，5：55实验室检查血气分析提示：氧分压59 mmHg，pH 7.33，停止呼吸机辅助呼吸，7：30患者神志清楚，能回答问话，四肢肌力4级，后患者出现心肺复苏术后综合征，多器官功能衰竭（MODS），出现心功能不全、肾功能不全、呼吸功能不全、肝功能不全。给予纠酸、改善微循环、糖皮质激素、强心利尿扩血管及持续静脉泵入“心活素”等治疗，效果差，予床旁血滤后症状明显好转，住院12 d出院。出院时患者神清语利，各项指标均正常，四肢肌力肌张力正常。因经济原因拒绝进一步检查，建议其出院后赴上级医院进一步查明原因，并建议其弟弟行相应检查。

关键词： Pulmonary edema   Cardiopulmonary resuscitation   Ventilation   Prognosis  

摘要： Objective Pulmonary edema is frequently observed after a successful resuscitation in out-of-hospital cardiac arrest (OHCA) patients. Currently, its risk factors and prognostic implications are mostly unknown. Methods Adult OHCA patients with a presumed cardiac etiology who achieved sustained return of spontaneous circulation (ROSC) in emergency department were retrospectively analyzed. The patients were grouped according to the severity of consolidation on their initial chest X-ray (group I, no consolidation;group II, patchy consolidations;group III, consolidation involving an entire lobe;group IV, total white-out of any lung). The primary objective was to identify the risk factors of developing severe pulmonary edema (group III or IV). The secondary objective was to evaluate the association between long-term prognosis and the severity of pulmonary edema. Results One hundred and seven patients were included. Total duration of cardiopulmonary resuscitation (CPR) and initial pCO(2) level were both independent predictors of developing severe pulmonary edema with their odds ratio (OR) being 1.02 (95% confidence interval [CI], 1.00 to 1.04;per 1 minute) and 1.04 (95% CI, 1.01 to 1.07;per 1 mmHg), respectively. The long term prognosis was significantly poor in patients with severe pulmonary edema with a OR for good outcome (6-month cerebral performance category 1 or 2) being 0.22 (95% CI, 0.06 to 0.79) in group III and 0.16 (95% CI, 0.04 to 0.63) in group IV compared to group I. Conclusion The duration of CPR and initial pCO(2) level were both independent predictors for the development of severe pulmonary edema after resuscitation in emergency department. The severity of the pulmonary edema was significantly associated with long-term outcome.

关键词： 心肺复苏术   心脏骤停   院前急救   腹部提压CPR法  

摘要： 目的：总结院前急救中规范运用心肺复苏术（CPR）对心脏骤停（CA）患者抢救成功的体会。方法：回顾性分析我科2010~2014年行院前急救的54例CA患者,在院前对其行规范运用CPR,包括电话指导患者家属或周围目击者早期胸外按压、早期电除颤、及时气管内插管术进行机械通气、持续长时间胸外按压、适当延长CPR时间,规范运用复苏药物等。结果：院前急救中抢救成功13例,3个院前急救CPR开始时间（〈5min、5~10min、〉10min）及实施与未实施早期电除颤、插管与未插管人工气道抢救成功率的比较,差异均有统计学意义（均P〈0.05）。结论：指导现场目击者初步救援、及早介入CPR时间、规范运用实施专业化CPR操作及复苏药物在院前急救中有着重要意义。

关键词： 院前   心脏骤停   旁观者CPR(BCPR)  

摘要： 目的：探讨院外心脏骤停病例中旁观者心肺复苏（ by－stander CPR， BCPR）的现状及其对心肺复苏（ CPR）成功率的影响。方法对2012－04－01～2013－03－31上海市闵行区急救中心接诊的1040例院外心脏骤停患者资料进行BCPR回顾性分析研究。对BCPR实施率、复苏成功率和旁观者特征等数据进行统计分析。结果 BCPR实施率为5．87％。获得BCPR的院前心脏骤停病例复苏成功率和1个月存活率显著高于未获得BCPR的病例（ P＜0．05），旁观者单纯胸外按压的复苏成功率与传统CPR间差异无统计学意义（ P＞0．05）；实施BCPR群体的年龄、职业、教育背景、经济能力、获取CPR知识的渠道等社会特征之间具有相似性。结论提高BCPR实施率可以提高院前CPR成功率和1个月生存率；简化CPR操作流程，有针对性地选择具备一定能力和意愿的社会特征的人群作为培训目标，可能获得更显著的社会经济效益。

关键词： 心肺复苏程序   院前急救   心脏骤停  

摘要： 目的分析不同心肺复苏程序对院前急救心脏骤停影响。方法回顾性分析2013年11月~2014年11月本院收治的128例院前心脏停博患者的临床资料,按照数字表法将患者分成两组,研究组采用气囊面罩通气法进行复苏,对照组采用气管插管法进行复苏,比较两组复苏成功率及复苏时间。结果研究组患者心肺复苏成功几率37.50%优于对照组21.87%,比较差异均具统计学意义（P〈0.05）。结论气囊面罩通气法较气管插管通气法疗效更佳,且成功率更高。

关键词： 心脏骤停   心肺复苏   B型钠尿肽   肌钙蛋白I   生存率   病死率   预后  

摘要： 目的 探讨在心脏骤停心肺复苏（CPR）成功患者CPR后不同时间血清B型钠尿肽（BNP）与肌钙蛋白I（TNI）的水平变化及其与近期预后的关系。方法 分别检测60例心脏骤停CPR成功患者CPR后即刻、3 h、12-24 h的血清BNP与TNI水平,根据CPR后不同时间点血清BNP的变化特点分为3组,A组为各时间点血清BNP水平一直小于200 pg/ml,B组为CPR后即刻BNP水平小于200 pg/ml,3 h和12-24 h BNP水平持续升高,且大于200 pg/ml;C组为CPR后即刻BNP水平小于200 pg/ml,3 h BNP水平大于200 pg/ml,但12-24 h BNP水平较3 h时降低。随访三组患者CPR后6个月的死亡情况。结果 BNP和TNI具有交互作用（P〈0.05）,即TNI表达水平随着血清BNP水平变化而变化。BNP高表达组（〉400 pg/ml）、TNI高表达组（〉1.5 ng/ml）患者病死率分别高于BNP、TNI低表达组（P〈0.05）。B组病死率明显高于A组和C组（P〈0.05）;生存分析结果显示,B组患者6个月生存率低于A组及C组（P〈0.05）,A组和C组比较,差异无统计学意义（P〉0.05）。结论 血清BNP与TNI水平变化能较好地评估心脏骤停CPR成功患者的近期临床预后。

关键词： cardiac arrest   health care   outcome assessment  

摘要： Background-Studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centers. The aim was to examine the level-of-care at tertiary centers compared with nontertiary hospitals and the association with outcome after out-of-hospital cardiac arrest. Methods and Results-Consecutive out-of-hospital cardiac arrest patients (n= 1078) without ST-segment-elevation myocardial infarction admitted to tertiary centers (54%) and nontertiary hospitals (46%) were included (2002-2011). Patient charts were reviewed focusing on level-of-care and comorbidity. Survival to discharge differed significantly with 45% versus 24% of patients discharged alive (P< 0.001), and after adjustment for prognostic factors admissions to tertiary centers were still associated with lower 30-day mortality (hazard ratio, 0.78 [0.64-0.96;P= 0.02]), independent of comorbidity. The adjusted odds of predefined markers of level-of-care were higher in tertiary centers: admission to intensive care unit (odds ratio [OR], 1.8 [95% confidence interval, 1.2-2.5]), temporary pacemaker (OR, 6.4 [2.2-19]), vasoactive agents (OR, 1.5 [1.1-2.1]), acute (< 24 hours) and late coronary angiography (OR, 10 [5.3-22] and 3.8 [2.5-5.7]), neurophysiological examination (OR, 1.8 [1.3-2.6]), and brain computed tomography (OR, 1.9 [1.4-2.6]), whereas no difference in therapeutic hypothermia was noted. Patients at tertiary centers were more often consulted by a cardiologist (OR, 8.6 [5.0-15]), had an echocardiography (OR, 2.8 [2.1-3.7]), and survivors more often had implantable cardioverter defibrillator's implanted (OR, 2.1 [1.2-3.6]). Conclusions-Admissions to tertiary centers were associated with significantly higher survival after out-of-hospital cardiac arrest in patients without ST-segment-elevation myocardial infarction in the Copenhagen area even after adjustment for prognostic factors including comorbidity. Level-of-care seems higher in tertiary centers both in the early pha

关键词： family   patient-centered care   resuscitation  

摘要： Background-A growing number of hospitals have begun to implement policies allowing for family presence during resuscitation (FPDR). However, the overall safety of these policies and their effect on resuscitation care is unknown. Methods and Results-We conducted an observational cohort study of 252 hospitals in the United States with 41 568 adults with cardiac arrest. Multivariable hierarchical regression models were used to evaluate patterns of care at hospitals with and without an FPDR policy. Primary outcomes included return of spontaneous circulation and survival to discharge. Secondary outcomes included resuscitation quality, interventions, and facility-reported potential resuscitation systems errors. There were no significant differences in facility characteristics between hospitals with and without an FPDR policy, nor were there significant differences in return of spontaneous circulation (adjusted risk ratio, 1.02;95% confidence interval, 0.95-1.06) or survival to discharge (adjusted risk ratio, 1.05;95% confidence interval, 0.95-1.15). There was a small, borderline significant decrease in the mean time to defibrillation at hospitals with an FPDR policy compared with hospitals without the policy (mean difference, 0.32 minutes;95% confidence interval, -0.01 to 0.64). Resuscitation quality, interventions, and facility-reported potential resuscitation systems errors did not meaningfully differ between hospitals with and without an FPDR policy. Conclusions-Hospitals with an FPDR policy generally have no statistically significant differences in outcomes and processes of care as hospitals without this policy, suggesting such policies may not negatively affect resuscitation care. Further study is warranted about the direct effect of FPDR attempts on adult patients with an in-hospital cardiac arrest and their families.