关键词： cardiac arrest   cardiopulmonary resuscitation   resuscitation  

摘要： This paper describes the major findings in a descriptive study on factors that lead to an unexpected cardiac arrest in a general population served by a major public hospital and factors that influence the outcome of the cardiopulmonary resuscitation. The cases collected over a period of 2 years in the Emergency Department of “Saint Pantelimon” Hospital, were analysed. There were 164.670 presentations, 195 being patients who developed cardiac arrest and were included in the study. The return of the spontaneous circulation occurred in 40% of the cases and 11.53% of them survived to discharge. In younger patients, the outcome was poor due to the long delays in making the call for help. It was noted that none of the patients who underwent post-traumatic cardiac arrest survived. The limits of the study are primarily related to the single-centre status of the study, but the results encourage further studies. [ABSTRACT FROM AUTHOR]

关键词： ICU   心脏骤停   心肺复苏   CCRRT  

摘要： 目的:分析影响ICU心脏骤停患者心肺复苏的相关因素。方法:收集我院内科ICU收住的116例心脏骤停进行心肺复苏抢救的患者,分为自主循环恢复组和未恢复组两组,对其临床资料进行统计分析。结果:原发疾病中心脑血管疾病、呼吸系统疾病及意外中毒三项,心脏骤停形式中快速型心律失常,以及存在目击觉察,恢复组所占百分比大于未恢复组,差异均有统计学意义。结论:对自主循环恢复产生影响的因素主要有心脑血管疾病、呼吸系统疾病及意外中毒为原发疾病,快速型心律失常的心脏骤停形式,以及存在目击觉察。

关键词： 乡镇小学   心脏复苏   心脏病史   心跳停止   张老师   汗多   面色苍白   白内障术   冠心病心绞痛   昏迷不醒  

摘要： 年过六旬的张女士退休前是一名乡镇小学教师,既往身体＂健康＂,无高血压和心脏病史。前不久的一个夜晚,她在家洗澡后突然感到胸口疼痛,并逐渐加剧,痛甚时双手紧握拳头,伴面色苍白,出汗多。丈夫以为是小毛病,扶她到床上,用风油精涂在她胸前,但症状无缓解,过了一会儿,她突然昏迷不醒,家属急忙拨打＂120＂,当救护车到达时,患者已呼吸心跳停止。医生立即给予心脏复苏,结果回天无术。事后尸解证实,张老师死于冠心病合并急性大面积心肌梗死。

关键词： 心肺复苏   心跳骤停   亚低温   室颤  

摘要： 目的通过建立大鼠心跳骤停与复苏模型,探讨亚低温治疗可能通过保护心脏功能,改善模型动物生存预后。方法雄性SD大鼠18只,随机分为常温对照组和亚低温治疗组。通过建立经右室电诱发室颤模型,对复苏后大鼠实施亚低温治疗。用超声评估复苏后大鼠的第1~4小时动物左室射血分数(EF)和心肌表现指数(MPI)等心脏功能变化;观察复苏后大鼠第24小时、72小时生存率,及每24小时神经功能缺损评分。结果两组共18只动物全部复苏成功,ROSC成功率、心肺复苏时间、首次除颤成功率等均无显著性差异。复苏后心脏彩超示,对照组动物在复苏后1~4小时心功能进行性受损,左室射血分数(EF)从基础值的(74.9±2.2)%,降低至(59.8±6.52)%,(50.4±4.4)%,(48.8±4.8)%,(47.8±6.1)%。而低温治疗组动物EF值从(73.9±2.5)%变化为(76.2±3.0)%,(75.1±3.5)%,(71.9±4.7)%,(64.1±3.1)%,两组间由统计学差异;心肌表现指数(MPI),对照组动物从基础值的0.6±0.1增高至1.1±0.1,1.2±0.1,1.3±0.2,1.4±0.3,较亚低温治疗组动物显著恶化,而低温组MPI则从0.6±0.1升高至0.7±0.1,0.8±0.1,0.8±0.1,0.9±0.1。亚低温治疗组动物在复苏后72小时存活数显著高于对照组,复苏后24、48、72小时的神经功能缺损评分均显著性低于对照组。结论在本大鼠心跳骤停与复苏模型中,亚低温治疗能够显著保护心脏功能,从而显著改善动物生存及神经功能预后。

关键词： 心脏病,先天性,复杂性   经皮氧饱和度   复苏囊   婴儿,新生  

摘要： 目的探讨经皮脉搏氧饱和度(SpO2)监测结合新生儿复苏囊在早期筛查新生儿复杂性先天性心脏病(CCHD)中的临床应用价值。方法选择2013年1月至2014年9月在我院分娩后即入住我科的新生儿,入院后监测并记录生后24 h的SpO2(SpO2-Ⅰ),同时完善胸部X线片检查以排除存在肺炎、气胸、新生儿呼吸窘迫综合征、胎粪吸入综合征、重度湿肺等的患儿。选择SpO2-Ⅰ≤85%的患儿予以新生儿复苏囊接空气源进行通气30 s后并记录SpO2值(SpO2-Ⅱ),根据SpO2-Ⅱ结果将患儿分为下降组(SpO2-Ⅱ较SpO2-Ⅰ下降的患儿)和上升组(SpO2-Ⅱ较SpO2-Ⅰ上升的患儿)。上升组患儿予以新生儿复苏囊接氧气源(流量2L/min,氧浓度30%)进行通气30 s后再次记录SpO2值(SpO2-Ⅲ)。所有入选新生儿住院期间同时行心脏彩超检查以明确是否存在先天性心脏病及其类型。选取同期入院心脏彩超结果正常、SpO2≤85%的肺炎患儿为对照组,用同样方法测量并记录对照组患儿的SpO2-Ⅰ、SpO2-Ⅱ和SpO2-Ⅲ。比较分析三组患儿SpO2-Ⅰ、SpO2-Ⅱ和SpO2-Ⅲ值;对上升组和下降组患儿的CCHD类型、例数和SpO2结果进行分类比较。结果上升组(39例)和下降组(30例)SpO2-Ⅰ、SpO2-Ⅱ及SpO2-Ⅰ与SpO2-Ⅱ差值均低于对照组,差异有统计学意义(P<0.01),上升组和下降组差异无统计学意义(P>0.05);上升组SpO2-Ⅲ低于对照组,差异有统计学意义(P<0.01)。下降组心脏彩超均提示为CCHD,其SpO2下降幅度约7.8%;上升组33例心脏彩超提示为CCHD,5例为单纯性先天性心脏病,1例正常,33例CCHD患儿SpO2上升幅度约8.1%。结论 SpO2监测结合新生儿复苏囊对于新生儿CCHD筛查具有较高的临床应用价值,是一项安全、非侵入性、可行且合理的检测技术,在无法实行床边心脏彩超检查时可初步筛查新生儿临床疑诊的CCHD。

关键词： Coronary Angiogram   Cardiac Arrest   Resuscitation   STEMI   ECG Changes   Predictors  

摘要： Out-of-hospital cardiac arrest is a common cause of death. Some therapeutic strategies performed daily are still debated, including particularly emergency coronary angiography independently of the clinical pattern. Primary percutaneous coronary intervention seems the strategy of choice in ST-segment elevation myocardial infarction but in other clinical presentations, benefit of coronary angiogram remains controversial. To improve management of out-of-hospital cardiac arrest and define the best timing to perform coronary angiogram, we suggest a study design based on ECG evaluation to define predictors of coronary artery disease after resuscitated cardiac arrest by distinguishing 3 groups according to ECG after resuscitation: ST segment elevation and LBBB;repolarisation disorder or no repolarisation disorder. Evaluation of ECG changes may still be useful as a triage method for establishing the indication for emergency coronary angiogram due to easy, non invasive and quick method and thus for limiting complications associated with this exam in acute phase.

关键词： 心脏复苏术   心跳呼吸骤停   急救技术   医护人员   手术室  

摘要： 急救技术在病房、手术室以及医院外的各种场合均可出现．医护人员和百姓都应掌握心跳呼吸骤停抢救的基本钳l识和方法，才能达到预期的目的。

关键词： 烧伤   延迟复苏   甘精胰岛素   应激性高血糖   氧化应激  

摘要： 目的：探讨甘精胰岛素对延迟复苏烧伤大鼠心脏、肾脏组织的保护作用。方法24只雄性SD大鼠按随机数字表法分为假伤组、烧伤对照组、烧伤＋胰岛素组，每组各8只。假伤组浸入37℃温水中15 s模拟烫伤。烧伤对照组、烧伤＋胰岛素组（95．0±0．5）℃热水中15 s制作烧伤总面积（ TBSA）30％、Ⅲ度烫伤模型，伤后6 h腹腔注射生理盐水（40 mL／kg）。烧伤＋胰岛素组于伤后2 h皮下注射甘精胰岛素[1．0 U／（kg· d）]，烧伤对照组同法注射等量生理盐水。烧伤各组于伤后24 h采集腹主动脉血及心脏、肾脏组织标本。采用分光光度法测定血糖、乳酸脱氢酶（LDH）、α－羟丁酸脱氢酶（α－HBDH）、肌酸激酶（CK）、尿素氮（BUN）、肌酐（Cr）、丙二醛（MDA）、黄嘌呤氧化酶（XO）、髓过氧化物酶（MPO）、超氧化物歧化酶1（SOD1）、过氧化氢酶（ CAT）、谷胱甘肽过氧化物酶（ GPx）、总抗氧化能力（ T－AOC）；免疫抑制法测定肌酸激酶同工酶（ CK－MB）。结果①烧伤对照组LDH、α－HBDH、CK、CK－MB、BUN、Cr均显著高于假伤组（P＜0．05）；与烧伤对照组比较，烧伤＋胰岛素组LDH、α－HBDH、CK、CK－MB、BUN、Cr均显著降低（P＜0．05）。②与假伤组比较，烧伤对照组心脏、肾脏组织的MDA、XO、MPO均显著升高（P＜0．05），SOD1、CAT、GPx、T－AOC均显著降低（P＜0．05）；与烧伤对照组比较，烧伤＋胰岛素组心脏、肾脏组织的MDA、XO、MPO均显著降低（P＜0．05），SOD1、CAT、GPx、T－AOC均显著升高（ P＜0．05）。③烧伤对照组、烧伤＋胰岛素组血糖水平均显著高于假伤组，而烧伤＋胰岛素组显著低于烧伤对照组（ P＜0．05）。结论甘精胰岛素对延迟复苏烧伤大鼠心脏、肾脏组织的保护作用可能与早期血糖控制、减轻组织脂质过氧化损伤有关。

关键词： Cardiac Arrest   Resuscitation Manoeuvres   Sudden Death   Portugal  

摘要： Cardiac Arrest (CA) is a major health problem, due to short and long-term sequel? and to associated mortality. Despite the improvement of out-of-hospital and in-hospital resuscitation manoeuvres, unexpected sudden fatal events occur. The authors reported the features of a series of sudden death (SD) cases where cardiopulmonary resuscitation (CPR) was performed. Files of 1053 medico-legal autopsies, from victims aged ≥18 years-old, were reviewed. Cardiac Arrest leading to Sudden Death were found in 477 cases (45.3%), but only 199 (42%) of these had been submitted to resuscitation manoeuvres. There was an elderly male predominance. Both non-cardiac and cardiac CA/SD causes were present, despite the higher coronary artery disease incidence. Both out-of-hospital and in-hospital events took place. Age, severity of the disease, comorbidities and predominance of out-of-hospital CA were obstacles to successful CPR, leading to SD. Knowing the population characteristics may help to improve Emergency Assistance.

关键词： Mild hypothermia   Cardiac arrest   Recovery   Glasgow coma scale (GCS)   APACHE score   Lactic acid   Endotoxin receptor   S100 beta protein   Tumor necrosis factor-alpha   Survival rate   CARDIOPULMONARY   CARE  

摘要： OBJECTIVE: To investigate the clinical significance of mild hypothermia therapy in patients with resuscitation of cardiac arrest and analyze the possible molecular mechanism. PATIENTS AND METHODS: Ninety-six patients with successful resuscitation of cardiac arrest in ICU were hospitalized from June 2009 to July 2014. They were divided into a control group (n= 37 cases) and an observation group (n= 59 cases). All patients received high-grade life support treatment immediately after resuscitation. The treatment for the control group was combined with normal temperature treatment while the treatment for the observation group was combined with mild hypothermia therapy. RESULTS: 1. Glasgow coma scale (GCS) scores of the patients in the two groups increased gradually after treatment as the APACHE II scores decreased. Comparisons within the group showed significant differences (p < 0.05). The GCS scores of the observation group were significantly increased compared to those in the control group, and the APACHE score decreased significantly. The differences between the groups were statistically significant (p < 0.05). 2. The serum lactic acid, sCD14, S100 beta protein and TNF-alpha level of patients in two groups all decreased after treatment. The difference was statistically significant (p < 0.05 =. 3. The 24h and 7d survival rates of patients in the observation group are higher than that in the control group (p < 0.05). CONCLUSIONS: The early treatment of hypothermia, can improve the outcome of patients with cardiac arrest.