关键词： HOSPITAL CARDIAC-ARREST   OUTCOMES   EXPERIENCE   SURVIVAL   IMPACT   VOLUME  

摘要： Background. Procurement of hearts from cardiopulmonary arrest and resuscitated (CPR) donors for transplantation is suboptimal. We studied the influences of donor factors and regional wait times on CPR donor heart utilization. Methods. From UNOS database (1998 to 2012), we identified 44,744 heart donors, of which 4,964 (11%) received CPR. Based on procurement of heart for transplantation, CPR donors were divided into hearts procured (HP) and hearts not procured (HNP) groups. Logistic regression analysis was used to identify predictors of heart procurement. Results. Of the 4,964 CPR donors, 1,427 (28.8%) were in the HP group. Donor characteristics that favored heart procurement include younger age (25.5 +/- 15yrs versus 39 +/- 18 yrs, p <= 0.0001), male gender (34% versus 23%, p <= 0.0001), shorter CPR duration (< 15 min versus >30 min, p <= 0.0001), and head trauma (60% versus 15%). Among the 11 UNOS regions, the highest procurement was in Region 1 (37%) and the lowest in Region 3 (24%). Regional transplant volumes and median waiting times did not influence heart procurement rates. Conclusions. Only 28.8% of CPR donor hearts were procured for transplantation. Factors favoring heart procurement include younger age, male gender, short CPR duration, and traumatic head injury. Heart procurement varied by region but not by transplant volumes or wait times.

关键词： TREATMENT of cardiac arrest   HEMODYNAMICS   PREGNANCY complications   CPR (First aid)   ABDOMINAL surgery   CESAREAN section  

摘要： The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early "separation" between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC) in the mother. This treatment, called Perimortem Cesarean Section (PMCS), is now termed as Resuscitative Hysterotomy (RH) to better address the issue of an early Cesarean section (C-section). This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR) maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C) section of a foetus at 36 weeks of gestation after the mother's traumatic cardiac arrest. Despite the negative outcome of the mother, the choice of performing a RH seems to represent up to date the most appropriate intervention to improve the outcome in both mother and foetus.

关键词： 心脏骤停   心肺复苏   急救分析  

摘要： 目的：回顾性观察与分析80例急诊科心脏骤停患者心肺复苏过程及结果，提高心肺复苏成功率。方法：选取符合研究条件的80例心脏骤停患者，对患者相关病历资料、治疗措施、其效果进行观察，然后分析结果。结果：80例实施心肺复苏术患者共成功31例，占38.75%。结论：患者年龄、病种以及实施心肺复苏术时间可影响复苏成功率。心肺复苏术是心脏骤停患者的重要抢救措施，规范及提高心肺复苏术技术是提高抢救成功率重要因素。

关键词： Out-of-hospital cardiac arrest   Cardiopulmonary resuscitation   Extracorporeal cardiopulmonary resuscitation   Cardiac arrest bypass  

摘要： Background: In a rural region with few medical resources, we have promoted the strategy that if an out-of-hospital cardiac arrest (OHCA) patient is likely reversible, he or she should be transported directly from the scene of cardiac arrest to the only tertiary care center where extracorporeal cardiopulmonary resuscitation (ECPR) is readily available. We investigated 1-month survival and neurological outcomes after ECPR in OHCA patients at this center. Methods: We implemented a retrospective review of OHCA patients of heterogeneous origin in whom ECPR was performed. Demographic characteristics, cardiopulmonary resuscitation, ECPR details, and neurological outcomes were evaluated. Cerebral performance categories were used to assign each patient to favorable or unfavorable outcome groups. Results: Fifty OHCA patients underwent ECPR. Presumed causes of OHCA were cardiac etiology in 32 patients, accidental hypothermia in 7 patients, and other causes in 11 patients. Overall, 13 patients (26%) survived and 10 patients (20%) had favorable outcomes. Of the 32 patients with OHCA of cardiac origin, 5 patients (16%) had favorable outcomes. Of the seven patients with OHCA of hypothermic origin, five patients (71%) had favorable outcomes. No clinically reliable predictors to identify ECPR candidates were found. However, all nine OHCA patients over 70 years of age had unfavorable outcomes (P = 0.224). In addition, all seven patients who satisfied the basic life support termination-of-resuscitation rule had unfavorable outcomes (P = 0.319). Conclusions: ECPR can be a useful means to rescue OHCA patients who are unresponsive to conventional cardiopulmonary resuscitation in a rural tertiary care center, in a manner similar to that observed in the urban regions.

摘要： The following are highlights from the Circulation: Cardiovascular Quality and Outcomes Topic Review series. This series summarizes the most important articles, as selected by The Editor, that have been published in the Circulation portfolio. The objective of this series is to provide our readership with a timely, comprehensive selection of important articles that are relevant to the quality and outcomes, and general cardiology audience. The studies included in this article represent the most significant research related to cardiac arrest and cardiopulmonary resuscitation. © 2014 American Heart Association, Inc.

关键词： 复苏术   急救/护理   手术后期间   心肺复苏术   心脏停搏   研究对象   人类  

摘要： 目的:心脏骤停患者在实施复苏急救后的护理,可以使大多数患者可以获得良好的术后恢复。方法:对院内的93例心脏骤停的患者中选取31例作为研究对象进行讨论研究,护理方法的效果体会和分析结果;在进行较为全面系统的复苏后护理以及心肺复苏的药物治疗后,患者可以得到较为满意的治疗效果。

关键词： 心肺复苏   心脏骤停  

摘要： 前晚,家住秦淮区的爷爷与往常一样陪着老伴在家中看电视,当63岁的陈爷爷从沙发上起身的瞬间,忽然感觉到胸闷、胸痛、呼吸困难。老伴赶紧拨打了120,陈爷爷被紧急送往了附近的454医院,入院后不到一分钟,陈爷爷发生了心脏骤停的症状,经过紧急抢救,陈爷爷终于脱离了危险。但是,像陈爷爷这样幸运的只是少数,大部分患者,都因错失了最佳的抢救时间而停止了呼吸。解放军第454医院急诊科主任陈

关键词： 心脏骤停患者   心肺复苏   护理体会  

摘要： 目的:心脏骤停疾病发生时间短,发病突然,留给医生的抢救时间短,抢救心脏骤停患者的首选方法之一就是及时恢复患者的心肺。方法:对2010年3月-2014年3月在我院治疗的心脏骤停患者的护理工作进行回顾性分析并做一总结。结果:2010年3月-2014年3月期间在我院治疗的482例心脏骤停患者中经心脏复苏抢救以后成功的患者一共36例。结论:通过分析这些抢救成功的患者复苏后的护理策略,提高了心脏骤停患者心肺复苏的抢救成功率。

关键词： 心脏骤停   急性肾损伤   心室纤颤   窒息   中性粒细胞明胶酶相关脂质运载蛋白   胱抑素C   肾损伤分子-1   N-乙酰-β-氨基葡萄糖苷酶   肌酐  

摘要： 目的： 研究室颤型心脏骤停和窒息型心脏骤停动物模型在复苏后肾功能的变化，评估新型急性肾损伤生物标记物在心脏骤停中的应用价值。 方法: 健康近交系五指山小型猪32头随机分为窒息型心脏骤停（ASCA组，n=16）和室颤型心脏骤停（VFCA组，n=16）2组。VFCA组采用右心室程控电刺激法制作心脏骤停模型，ASCA组采用气管插管堵塞法制做心脏骤停模型。在成功制模非干预8分钟后，均给予两组标准心肺复苏，复苏成功动物给予监护和治疗6小时。分别记录每小时尿量，记录在基础状态、复苏后即刻、1小时、2小时、3小时、4小时和6小时记录血流动力学参数、留取相应时间点静脉血、尿液标本用于新型急性肾损伤（AKI）生物标记物及肌酐检测。并于复苏后6小时予以实验动物安乐死，留取肾脏组织标本，行病理检查。 结果: 自主循环的恢复率VFCA组为100%（16/16），ASCA组为50%（8/16），有显著统计学意义（P＜0.01）。新型AKI生物标记物在成功复苏后均出现了升高，出现变化的时间点明显早于肌酐。在ASCA组，AKI生物标记物浓度明显高于VFCA组（P＜0.01）。在成功复苏的21只实验动物中，有17只出现了少尿，达到了AKI诊断标准。所有实验动物肾组织病理在光学显微镜和电子显微镜下分析都出现了损伤，并且ASCA组的病理损伤较VFCA组更为严重。 结论: AKI在心脏骤停复苏后普遍存在，并且在复苏后早期即可能出现。窒息型心脏骤停导致的AKI比室颤型心脏骤停导致的AKI更为严重。

关键词： 心肺复苏   肾上腺素   血管加压素   PI3K/Akt  

摘要： 目的：在大鼠窒息动物模型中，通过血管加压素、肾上腺素以及联合用药治疗，观察心肺脑复苏后大鼠心肌病理组织变化及对心肌细胞中p-p38，caspase-3，IkB-α蛋白表达的影响。 方法：选取75只Wistar大鼠（雌雄各半）随机分为5组（n=15只/组）。分组为：①对照组（control group，Con组）：只进行气管插管，不造成窒息，不进行心肺复苏。②心脏骤停组（sudden cardiac arrest，SCA组）：制作窒息模型，导致心脏骤停后，人工心肺复苏并注射生理盐水1ml。③肾上腺素组（epinephrine group，EP组）：制作窒息模型，导致心脏骤停后，给予心肺复苏，复苏时给予其等容量的肾上腺素0.2mg/Kg。④血管加压素（vasopressin group，VP组）：制作窒息模型，导致心脏骤停后，给予心肺复苏，复苏时给予其等容量血管加压素0.8U/Kg，余同肾上腺组。⑤联合用药组（E+V组）：制作窒息模型，导致心脏骤停后，给予心肺复苏，复苏时给予等剂量的肾上腺素0.2mg/kg+血管加压素0.8U/kg。因SCA组大鼠只进行心肺复苏，不给予药物，成活概率极低。其他治疗组复苏成功后的大鼠于1、3、6、12小时处死，留取心肌组织，通过HE染色法观察细胞形态学;通过免疫组化方法检测大鼠心肌组织p-p38，caspase-3，IkB-α蛋白的表达以及用TUNEL法检测心肌凋亡程度。 结果： 1、EP组、VP组、E+V组各组复苏成功率分别为33.33%、66.67%、80.0%。自主循环恢复率比较，EP组与VP组、E+V组相较，差异有统计学意义（P＜0.05），但VP组与E+V组对比，差异无统计学意义（P＞0.05）。 2、心肌细胞HE染色形态学观察：Con组正常形态的心肌细胞，心肌纤维排列整齐，横纹清楚，细胞结构清晰胞膜完整，未见细胞浸润，坏死和纤维化;SCA组显示心肌纤维部分浓缩，细胞结构混乱，发生核固缩，心肌细胞间隙无水肿。EP组心肌细胞不规则，核皱缩，细胞结构紊乱，组织间隙水肿;VP组及联合用药组有部分正常的心肌细胞，心肌纤维紊乱，心肌细胞无明显水肿。 3、免疫组化法检测心肌细胞中p-p38，caspase-3，IkB-α蛋白表达：与Con组相比，SCA组心肌细胞中p-p38，caspase-3，IkB-α蛋白表达明显增高;与SCA组相比，EP组心肌细胞中p-p38，caspase-3，IkB-α表达较略有降低（P<0.05），而VP组蛋白表达明显降低（P<0.01）;与EP组相比，E+V组心肌细胞中p-p38，caspase-3，IkB-α表达降低（P<0.01），VP组蛋白表达明显升高（P<0.01）;VP组与E+V组相比，表达差异不明显。 4、TUNEL法检测心肌细胞凋亡：与Con组相比， SCA组荧光强度明显增强（P<0.01）;与SCA组相比，EP组荧光显色强度减弱（P<0.05），VP组和E+V组荧光显色强度明显减弱（P<0.01）;与EP组相比，VP组和E+V组荧光显色强度减弱（P<0.01）。VP组与E+V组相比，荧光强度差异不明显。 结论在大鼠窒息动物模型中，血管加压素联合肾上腺素可明显提高自主循环恢复率，提高复苏成功率;肾上腺素能增加心肌的损伤，提高细胞炎症反应的发生和增加凋亡的发生率;血管加压素和血管加压素联合肾上腺素能够增加心肌供血，减少心肌细胞炎症反应和凋亡的发生。