关键词： 心脏停搏,原发性   心脏复苏   急救  

摘要： 心肺复苏（CPR）是因患心脏病和呼吸骤停后对其采取的一系列紧急抢救措施。心脏停搏后,停止血液输出,对此所实行的胸外心脏按压、人工呼吸、电除颤、药物使用等促进患者及早恢复自主循环及呼吸的急救技术。泛指的CPR包括院外的初级复苏及转入院内的二级复苏和后期复苏过程。本文所介绍的复苏成功病例均为院内专业人员所实行的第二、第三阶段的CPR,部分患者也有基本生命支持内容。现将10例抢救体会报告如下。

关键词： 美国心脏协会   心血管病   心肺复苏   指南   急救   ECC   CPR  

摘要： 新近，美国心脏协会更新并颁布了心肺复苏（CPR）与心血管病急救（ECC）指南。该指南充分参照近年来所获取的研究证据，对CPR与ECC技术做出了新的推荐建议。

关键词： 船员救护   心脏复苏   结构设计  

摘要： 分析了船员救护的需求,阐述了心脏复苏的基本要求,设计了一种可用于船员救护的便携式心脏复苏装置,并简要介绍了其结构设计与使用方法。

关键词： 噪声   死振   传导受阻   心脏猝死   心脏复苏  

摘要： 本文考虑神经系统的调节作用,利用张恒贵等人构建的兔子心脏窦房结-心房细胞体系的完整二维模型,将其改造为能模拟人体心脏起搏活动的在体模型,并通过计算机仿真模拟研究了环境噪声对心脏体系起搏活动的影响。模拟结果显示:一方面,利用该模型可以重现有生理缺陷的心脏体系异常搏动现象,例如老年化的心脏因细胞膜钠电流减少或部分心肌细胞死亡导致耦合强度减弱等,临床上均会导致心脏猝死现象;另一方面,更重要的是,可以通过引入适当的外界环境色噪声来消除这种死振,从而让心脏重新恢复正常搏动。同时,分析了调节色噪声参数对这种恢复作用的影响。另外还讨论了高斯白噪声的调控作用。模拟结果表明环境噪声在调控心脏窦房结起搏活动的过程中起着十分重要的调节作用,这个结果将有助于揭示临床医学上电击治疗心脏病的内在动力学机制,并为心脏复苏提供理论上的解释。

关键词： Cardiac arrest   Chest compression   Intubation   Devices   CARDIAC-ARREST  

摘要： Introduction: Automated chest-compression devices (ACCDs) have recently been proposed in the management of out-of-hospital cardiac arrest (cardiopulmonary resuscitation, CPR). During CPR, it is still unknown whether the ACCD or intubation is to be first implemented. Knowing the impact of an ACCD on intubation conditions could strongly contribute to determine the best sequence. Therefore, we undertook an experimental study on intubation conditions on a mannequin with or without the use of an ACCD. Methods: Emergency physicians and nurses experienced in the field of cardiac-arrest management (including orotracheal intubation) were randomly assigned to three scenarios to intubate a mannequin: patient lying on the floor without an ACCD (group 1), patient lying on the floor with the ACCD switched off (group 2) or switched on (group 3). The primary end point was intubation time. Estimated intubation difficulty evaluated on a visual analogue scale (VAS), ranging from 0 (easy) to 100 (impossible), number of attempts. Cormack grade and dental traumatisms associated with the intubation procedure were secondary end points. Results: A total of 44 operators performed the intubation. Times to intubation were 14(11-22), 15(10-21) and 18 (15-27)s for groups 1,2 and 3, respectively. The VAS difficulties were 12 (5-25), 15 (10-25) and 15 (5-21), respectively. Intubation conditions did not differ between the 'without an ACCD group' and the 'switched-off ACCD group'. In the 'switched-on ACCD group', time to intubation was significantly increased in comparison with groups 1 and 2 with a median difference of 4(1-10) and 3 (0-7)s, respectively. The VAS difficulty was also significantly increased in the 'switched-on ACCD group'. Other secondary end-point criteria did not differ between the three groups. Conclusion: Due to the major role of compression during CPR, we suggest that the ACCD should not be systematically switched off for routine intubation. (C) 2011 Elsevier Ireland Ltd. All ri

关键词： Cardiopulmonary resuscitation (CPR)   Automated External Defibrillator (AED)   Defibrillation   Emergency medical service (EMS)   Out-of-hospital cardiac arrest   LIFE-SUPPORT   SURVIVAL   CARE   STATEMENT   COMMITTEE   COUNCIL  

摘要： Aim: To evaluate an SMS service (SMS = short message service = text message) with which laypersons are alerted to go to patients with suspected out-of-hospital cardiac arrest and perform early cardiopulmonary resuscitation (CPR) and use an Automated External Defibrillator (AED). This study is the first to report on a program in which an emergency medical service (EMS) is able to alert citizens by sending them SMS messages on their mobile phone. Methods: Web-based questionnaires were completed by laypersons who were sent an alert by the AED-Alert system between February 1, 2010 and April 30, 2010. Questions concerned the process of training, receiving alerts, actions taken and follow-up care. Results: AED-Alert was activated for 52 patients suspected of cardiac arrest, sending 3227 alerts to 2287 laypersons. Out of 2168 eligible laypersons 1679(77%) completed 2098 questionnaires, one for each alert. Action was taken in only 579 alerts. Laypersons were not in the patient's vicinity (41%), noticed alerts too late (35%), or other reasons (24%). In 298 alerts laypersons faced problems with retrieving AEDs (51%), finding addresses (29%), traffic (5%), or other (15%). Aid was provided in 75 alerts, involving 47 patients. Laypersons started early CPR and defibrillation (49%), assisted EMS personnel (52%), or took care of family (39%). Laypersons arrived before EMS personnel in 21 patients, started CPR and defibrillation in 18, and assisted EMS personnel in 9 patients. Conclusion: Improvements of the SMS alert service by laypersons, the EMS, and through technical adjustments, could increase the number of laypersons who provide early aid. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

关键词： 心肺复苏   心脏功能   肾上腺素   血管升压素  

摘要： 目的评价血管升压素（VAP）对大鼠心肺复苏（CPR）后早期心脏收缩功能的影响。方法健康12周龄sD大鼠36只，体质量（300±20）g，随机分为二三组，每组12只。A组（假手术组）：仪气管切开插管和右颈总动脉置管；E组（肾上腺素组）：窒息致心脏骤停（CA）后用肾上腺素每次0．02mg／kg进行CPR；V组（VAP组）：窒息致CA后用VAP每次0．8U／kg进行CPR，记录坶只大鼠窒息前（T0）及自主循环恢复（ROSC）后即刻（T1）、2h（T2）、4h（T3）HR、SBP、DBP、LVSP、＋LVdp／dt及动脉血气情况，每只大鼠CA时间、ROSC时间、ROSC率，每只大鼠T3时血清心肌肌钙蛋白T（cTnT）及脑钠素（BNP）水平．结果①与V组比较，E组ROSC时间长，而ROSC率低（P〈0．05）。②E、V组ROSC后各时刻HR、SBP、LVSP、＋LVdp／dt及E组ROSC后各时刻DBP较T0降低（P〈0．05）；与V组比较，E组T1时HR，T2、T33时SBP，T1、T2、T3时DBP、LVSP、＋LVdp／dt降低（P〈0．05）。③E组ROSC后各时刻pH、PO2、PCO2与T0比较差异有统计学意义（P〈0．05）；V组ROSC后各时刻PO2、PCO2与T1比较差异有统计学意义（P〈0．05）；与V组比较，E组T1时PCO：高，T2、T3时PO2低，T1、T2、T3时pH低（P〈0．05）。④二三组cTnT水平比较以及A组与E、V组BNP水平比较差异有统计学意义（P〈0．05）。结论VAP可以明显减轻大鼠心肺复苏后早期心脏收缩功能不全的程度。

关键词： 电击伤   心脏骤停   心肺复苏术   脑复苏  

摘要： 心脏骤停临床各科都会遇到,复苏成功与否主要取决于开始实施心肺复苏术（CPR）的时间。发生于院外的心脏骤停因很难得到及时、有效的施救,因而心肺复苏尤其是脑复苏成功率很低。我科近期抢救1例发生于院外的电击伤致心脏骤停患者,心跳呼吸骤停40余min心肺脑复苏成功。现报告如下。

关键词： 电抗休克   心肺复苏术   心脏停搏   Meta分析   系统评价  

摘要： 目的评价在抢救院外心脏骤停时除颤和心肺复苏(CPR)实施顺序对患者复苏成功的影响。方法计算机检索PubMed、EMBASE、Cochrane Library、中国生物医学文献数据库、维普、中国知识资源总库、万方数据库。纳入所有有关常规抢救方案与除颤前先行CPR比较抢救院外心脏骤停的临床随机对照试验(RCTs),根据Cochrane Handbook4.2.6质量评价标准评价,并用RevMan5.0软件对数据进行Meta分析。结果最终纳入3个研究(668例患者),Meta分析结果显示与常规抢救方案相比,除颤前先行CPR在抢救院外心脏骤停患者出院存活率方面差异无统计学意义(P=0.95);在自主循环恢复(ROSC)方面差异无统计学意义(P=0.43);1年生存率方面差异亦无统计学意义(P=0.49)。亚组分析结果显示在出院存活率和ROSC方面,不论医护人员到达现场时间>5min或≤5min,Meta分析结果显示两组差异均无统计学意义。结论现有临床证据表明,除颤前先行CPR不论医护人员到达现场时间>5min或≤5min,其复苏疗效在出院存活率,ROSC及1年生存率方面与常规抢救方案无差异。由于纳入研究样本量所限,该结论尚需大样本、高质量RCT进一步证实。