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   COUNCIL GUIDELINES   RECOMMENDED GUIDELINES   HEALTH-CARE   SECTION 4   SURVIVAL   ASSOCIATION   MORTALITY   SWEDEN  

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 ph

关键词： family   patient-centered care   resuscitation   CARDIOPULMONARY-RESUSCITATION   INVASIVE PROCEDURES   EMERGENCY-DEPARTMENT   OUTCOMES   PERFORMANCE   REGISTRIES   SURVIVAL   MEMBERS   NURSES  

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.

关键词： cardiopulmonary resuscitation   out-of-hospital cardiac arrest   ventricular fibrillation   AMERICAN-HEART-ASSOCIATION   STROKE-FOUNDATION   TASK-FORCE   SURVIVAL   PROFESSIONALS   GUIDELINES   STATEMENT   COUNCIL   TRENDS   CANADA  

摘要： Background-It is well known that cardiopulmonary resuscitation (CPR) should be attempted as early as possible after out-of-hospital cardiac arrest (OHCA). However, it is unclear about the impact of time to CPR on OHCA outcome by first documented rhythm (pulseless ventricular tachycardia/ventricular fibrillation [pVT/VF], pulseless electric activity [PEA], and asystole). Methods and Results-We enrolled 257 354 adult witnessed OHCA patients between 2007 and 2012 from a prospective nationwide population-based cohort database in Japan. We evaluated relationships between time from collapse to first CPR and neurologically favorable 1-month survival defined as Glasgow-Pittsburg cerebral performance category 1 or 2 by first documented rhythm after witnessed OHCA. We used logistic model for the estimation of prognosis. The number of OHCA patients with pVT/VF, PEA, and asystole were 38 661, 96 906, and 121 787, respectively. The overall neurologically favorable 1-month survival rates were 21.3% in patients with pVT/VF, 2.7% PEA, and 0.6% asystole. The proportion of asystole increased as the time from collapse to CPR delayed, whereas those of pVT/VF and PEA decreased (trend P< 0.001). Estimated incidences of end-point after OHCA became lower as first CPR delayed irrespective of type of first documented rhythm, but were different by the rhythm. The average percentage point decreases in neurologically favorable 1-month survival probability for each incremental minute of CPR delay were 8.3%, 4.4%, and 6.4% for patients with pVT/VF, PEA, and asystole, respectively. Conclusions-The OHCA outcome differed by time to first CPR and first documented rhythm. Shortening of time to first CPR is crucial for improving the OHCA outcome.

关键词： 心脏骤停   心肺复苏   院前急救  

摘要： 目的:分析余杭区第三人民医院院前心脏骤停和院内心脏骤停患者心肺复苏(CPR)后进入ICU的预后及影响因素。方法:对该院ICU 72例经过心肺复苏(CPR)成功后的患者,按心脏骤停的地点分为院前组和院内组,比较两组的年龄、基础疾病、开始心肺复苏的时间、心肺复苏成功的时间、气管插管时间、复苏成功时肾上腺素累积量、胺碘酮累积量、乳酸、存活率之间的关系。结果:两组在CPR开始时间、气管插管开始时间、除颤开始时间、入ICU时乳酸水平、存活率等比较差异有统计学意义(P<0.05);同时院内组存活率(16.67%)与院前组存活率(4.76%)比较差异有统计学意义(P<0.05)。而两者在年龄、CPR持续时间、胺碘酮累积量、肾上腺素累积量等方面差异无统计学意义(P>0.05)。结论:心脏骤停患者的存活率很低,而院前心脏骤停的存活率明显低于院内心脏骤停的存活率,与第一现场目击者未及时进行有效的院前急救有关,加强全民急救知识普及,早期心肺复苏、早期气管插管、早期除颤,尽快恢复重要脏器的灌注是提高复苏存活率的重要措施。

关键词： 窒息   心脏骤停   碳酸氢钠   心肌代谢   正电子发射型计算机断层显像   高钠血症   自主循环恢复   复苏  

摘要： 目的 研究碳酸氢钠（sodium bicarbonate,SB）在窒息心脏骤停（asphyxiation cardiac arrest,ACA）动物模型中对复苏预后的影响.方法 32只五指山幼猪随机（随机数方法）平均分成SB组（n=16）和对照组（n=16）,通过在呼吸末堵塞气管插管方法制作窒息型的心脏骤停模型,在成功制作心脏骤停模型后8 min后行标准心肺复苏.SB组在复苏即刻予以SB（1.0 mEq/kg稀释到40 mL）静脉推注,对照组予以40 mL生理盐水静脉推注.比较两组实验动物的自主循环恢复（return of spontaneous circulation,ROSC）率,复苏前和复苏后6h内血压,心排血量（cardiac output,CO）血液pH值,血清钠离子浓度变化.在基础状态以及复苏后6h利用正电子发射型计算机断层显像（positron emission tomography,PET）测定左心室心肌代谢最大标准化摄取值（themaximum standardized uptake value,SUVmax）.结果 SB组复苏成功率（10/16）较对照组复苏成功率（8/16）高,6h生存时间均值SB组较对照组长（3.63±0.76） hvs.（2.45±0.70）h,但差异均无统计学意义;两组实验动物在复苏前后血清钠离子比较差异无统计学意义;复苏后6h两组左心室心肌代谢SUVmax比较：SB组较对照组要高（1.32±0.20）vs.（1.10±0.14）,P=0.035.结论 窒息心脏骤停在复苏过程中使用SB可能会增加复苏成功率以及改善复苏后心肌代谢,且没有发生高钠血症.

关键词： 心脏停搏   心肺复苏   尼莫地平   脑血流   神经功能  

摘要： 目的探讨心脏停搏患者心肺复苏后早期应用尼莫地平对脑血流及神经功能的影响。方法 130例心脏停搏患者随机分为实验组80例,心肺复苏成功后即刻使用尼莫地平10mg/d缓慢静滴;对照组50例,心肺复苏成功后未使用尼莫地平。其余治疗方案相同。治疗3d检测2组大脑中动脉血动力学参数(包括平均血流速度Vm和搏动指数PI),并进行美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分。结果治疗3d后实验组较对照组的搏动指数及NIHSS评分均较低,平均血流速度指数较高。结论心脏停搏患者心肺复苏后早期应用尼莫地平者脑血流及神经功能恢复情况均优于未应用尼莫地平者。

关键词： 心脏骤停   心肺复苏   护理干预  

摘要： 目的:探讨心脏骤停患者急救中,实施心肺复苏护理干预的方法及效果。方法:从我院2013年1月-2014年10月急诊科接诊的心脏骤停患者中选取54例,对其复苏方法及护理情况进行回顾分析,观察复苏成功率及存活率。结果:37例复苏成功,成功率为68.52%;9例在存活12-34h后死亡;立刻复苏的成功率达到了95.00%,存活率为85.00%。结论:有效的急救和护理干预可提高心脏骤停患者的心肺复苏成功率,但需要把握复苏的最佳时间,才能够在保证成功率的同时,提高存活率。

关键词： 心脏骤停   院前   心肺复苏   影响因素  

摘要： 目的总结院前心脏骤停患者心肺复苏方法,分析影响心肺复苏成功的影响因素。方法回顾分析505例院前心脏骤停患者的院前急救资料,总结心肺复苏流程,按心肺复苏(CPR)成功与否分为复苏成功组和复苏失败组,探讨与复苏成功相关的影响。结果 505例院前心脏骤停患者中41例复苏成功(8.12%),464例复苏失败(91.88%),年龄、基础疾病、复苏前心律类型、群众性的CPR、CPR开始时间、电除颤开始时间是影响心肺复苏成功的影响因素。结论院前心脏骤停患者心肺复苏成功的影响因素较为复杂。应通过完善急救网络、普及急救常识、完善院前急救流程和规范化救治措施及加强基础疾病的治疗,才能提高院前心脏骤停患者心肺复苏的成功率。

关键词： 濒死体验   心搏停止   南安普顿大学   心跳停止   实验鼠   神经学家   波季   心脏复苏   帕尼亚   脑电图仪  

摘要： 据新华社消息,英国媒体2014年10月7日报道,英国南安普顿大学的科学家们在一项历时4年的研究中,通过采访那些有“濒死体验”的人,发现人在心搏停止后的一段时间内,意识可能仍然存在。这一颇具轰动效应的报道发布后,一些人把这种意识称为“死后意识”,甚至还有人声称这是“灵魂”存在的证据。那么,这一研究真能证明“死后意识”的存在吗？