关键词： 头部   选择性浅低温   心脏停跳   脑组织   内源性抗损伤   损伤机制   脑复苏  

摘要： 目的 研究头部选择性浅低温对犬心脏停跳复苏后脑组织内源性抗损伤机制的影响。方法 15只健康杂种犬随机分为3组:手术对照组（A组,n=4）,常规治疗组（B组,n=5）,浅低温治疗组（C组,n=6）。A组动物完成麻醉和手术后心脏不停跳观察8h。B组和C组动物心脏停跳18min,心脏复苏成功后治疗8h。B组动物接受常规脑复苏治疗,C组动物接受常规脑复苏治疗和浅低温[（34± 0.5）℃]治疗。实验结束时开颅取右顶叶脑皮质供测 SOD、MDA、GSH、GSH-PX、FFA和LA用。结果 B组动物脑内FFA、LA明显高于A组（P<0.05）,GSH、GSH-Px、T-SOD、Mn-SOD、Cu-ZnSOD明显低于A组（P<0.05或0.01）。C组动物脑内GSH、T-SOD、Cu-ZnSOD明显高于B组（P<0.05或0.01）,B（两组MDA、FFA、LA无统计学差异（P>0.05）。结论 浅低温作为一种物理治疗方法,可通过增强脑组织内源性抗损伤机制发挥脑复苏作用。

关键词： 肾上腺素   心脏复苏   心搏骤停   病例报告  

摘要： 患者，男性，26岁，药物中毒致昏迷2小时收住。就诊时深昏迷，肺水肿，立即清水电动泡胃，吸氧，纠正肺水肿等治疗，抢救20分钟后呼吸停止，立即气管插管人工呼吸，自主呼吸停止5分钟后心音消失。心电监护示室性自主节律，继之为“心室蠕动波”。立即胸外按压，首次静注肾上腺素5mg，阿托品1mg，3分钟后心电监护仍为室性蠕动波。再次给肾上腺素5mg，异丙肾上腺素1mg，利多卡因50mg，并用250J电降颤，3分钟后心电监护示室性……

关键词： 心搏呼吸骤停   心肺脑复苏   心肺复苏   人工气道   有效通气  

摘要： 目的　评价人工气道建立和有效通气在非心脏疾患引起心搏骤停患者心肺脑复苏 (CPCR)中的真正价值 ,分析与总结有效人工通气与Ⅰ、Ⅱ、Ⅲ期复苏成功率之间关系 ,探讨对这类患者采取CPCR的抢救步骤和时机 ,为临床采取切实有效CPCR步骤提供依据。方法　选择非单纯心脏疾患致心搏呼吸停止行CPCR患者 2 6例作为分析对象。按照心肺复苏(CPR)实际操作过程中所采取的方法不同 ,将患者分为CAB组 (12例 / 12例次 )和ABC组 (14例 / 18例次 )。CAB组中 ,按照C与AB步骤采取的间隔时间不同 ,分为 <5min、5～ 10min、>10min组 ;ABC组中 ,部分患者在发生心搏骤停以前 ,已经建立人工气道和接受有效通气治疗 ,一旦心搏骤停发生后 ,在AB措施已经存在条件下进行心脏复苏。统计与计算各组复苏成功率(% ) ,χ2 检验各组差异显著性。结果　CAB组患者接受C -AB间隔时间不等 ,Ⅰ、Ⅱ期复苏成功率无显著差异 ,但Ⅲ期复苏成功率差异显著 (P <0 0 5 )。ABC组Ⅲ期复苏成功率分别为 83 3% (15 / 18)、77 7% (14 / 18)、6 6 7% (12 / 18) ,与CAB组总体比较无显著差异 (P >0 0 5 )。结论　虽然CAB对非单纯心脏疾患致心搏呼吸骤停的患者也是可取的CPCR抢救步骤 ,但及时建立人工气道进行有效通气仍是不可忽视的重要步骤 ,尤其当 5min内?

关键词： resuscitation   defibrillation   heart arrest  

摘要： Background-Early defibrillation is the most important intervention affecting survival from sudden cardiac arrest (SCA). To improve public access to early defibrillation, we established Piacenza Progetto Vita (PPV), the first system of out-of-hospital early defibrillation by first-responder volunteers. Methods and Results-The system serves a population of 173 114 residents in the Piacenza region of Italy. Equipment for the system comprises 39 semiautomatic external biphasic defibrillators (AEDs): 12 placed in high-risk locations, 12 in lay-staffed ambulances, and 15 in police cars;1285 lay volunteers trained in use of the AED, without traditional education in cardiac pulmonary resuscitation, responded to all cases of suspected SCA, in coordination with the Emergency Medical System (EMS). During the first 22 months, 354 SCA occurred (72+/-12 years, 73% witnessed). The PPV volunteers treated 143 SCA cases (40.4%), with an EMS call-to-arrival time of 4.8+/-1.2 minutes (versus 6.2+/-2.3 minutes for EMS, P=0.05). Overall survival rate to hospital discharge was tripled from 3.3% (7 of 211) for EMS intervention to 10.5% (15 of 143) for PPV intervention (P=0.006). The survival rate for witnessed SCA was tripled by PPV: 15.5% versus 4.3% in the EMS-treated group (P=0.002). A "shockable" rhythm was present in 23.8% (34 of 143) of the PPV patients versus 15.6% (33 of 211) of the EMS patients (P=0.055). The survival rate from shockable dysrhythmias was higher for PPV versus EMS: 44.1% (15 of 34) versus 21.2% (7 of 33), P=0.046. The neurologically intact survival rate was higher in PPV-treated versus EMS-treated patients: 8.4% (12 of 143) versus 2.4% (5 of 211), P=0.009. Conclusions-Broad dissemination of AEDs for use by nonmedical volunteers enabled early defibrillation and tripled the. survival rate for out-of-hospital SCA.

关键词： 心脏骤停   复苏成功   康复护理  

关键词： 高原地区   心脏骤停   复苏  

摘要： 患者,男,45岁,79 kg.3 a前行直肠癌前切除术,因局部复发于2001年4月4日行腹、会阴联合根治术.既往有甲亢病史,术前ECG、电解质等各项化验检查基本正常.选择连续硬膜外麻醉,腰3～4、胸11～12置管给药,麻醉效果满意.手术进行2.5 h后突然出现血压下降,心率减慢,分2次静推麻黄素20 mg、多巴胺3 mg、阿托品1 mg无效,继而出现室颤,立即静注肾上腺素1 mg、气管插管、行胸外按压后心跳未恢复.

关键词： 心脏骤停   心肺复苏步骤   心脏复苏  

摘要： 目的:评价早期心肺复苏(CPR)中A(气道)、B(呼吸)、C(循环)抢救步骤的价值。方法:收集132例心跳、呼吸骤停行CPR患者的临床资料,对43例复苏成功病例,按原发疾病进行分类统计以及实施心肺复苏所采取C、CAB及ABC的步骤,比较各组的成功率。结果:心源性疾患所引起心跳、呼吸骤停C组复苏成功率为50.0％明显高于其他各组(P<0.05)。C组与ABC组比较复苏成功率有显著性差异(P<0.05)。结论:C及CAB是各种原因引起的心跳、呼吸骤停患者CPR中有效的抢救步骤。

关键词： cardiopulmonary resuscitation   heart arrest   reperfusion   inflammation   interleukins  

摘要： Background-We investigated the immunoinflammatory profile of patients successfully resuscitated after cardiac arrest, representing a model of whole-body ischemia/reperfusion syndrome. Methods and Results-Plasma cytokine, endotoxin, and ex vivo cytokine production in whole-blood assays was assessed in 61, 35, and 11 patients, respectively. On admission, high levels of plasma interleukin (IL)-6, IL-8, IL-10, and soluble tumor necrosis factor (TNF) receptor type 11 could discriminate between survivors and nonsurvivors. Among nonsurvivors, the initial need for a vasopressor agent was associated with higher levels of IL-1 receptor antagonist, IL-10, and IL-6 on day 1. Plasma endotoxin was detected in 46% of the analyzed patients within the 2 first days. Endotoxin-induced TNF and IL-6 productions were dramatically impaired in these patients compared with healthy control subjects, whereas an unaltered production was observed with heat-killed Staphylococcus aureus. In contrast, IL-1 receptor antagonist productions were enhanced in these patients compared with healthy control subjects. The productions of T-cell-derived IL-10 and interferon-gamma were also impaired in these patients. Finally, using in vitro plasma exchange between healthy control subjects and patients, we demonstrated that the endotoxin-dependent hyporeactivity was an intrinsic property of patients' leukocytes and that an immunosuppressive activity was also present in their plasma. Conclusions-Altogether, the high levels of circulating cytokines, the presence of endotoxin in plasma, and the dysregulated production of cytokines found in these patients recall tire immunological profile found in patients with sepsis.

关键词： 病例报告   复苏术/方法   心肌梗死/治疗   心脏停搏/治疗   人类  

关键词： 心脏骤停   病例分析   心脏复苏   再灌注性心律失常   治疗  

摘要： 心脏骤停患者于心脏复苏后出现再灌注性心律失常(反复发作性心动过速及室颤),经常规应用利多卡因基础上加用钙拮抗剂收到了较好疗效,现报告如下: