关键词： 复苏   心脏骤停   阵发性心房颤动   经导管消融治疗   参脉注射液   心房纤颤   疗效评价   索他洛尔   伊贝沙坦   评估研究  

摘要： 葛根素和参脉注射液治疗心房纤颤；小剂量索他洛尔治疗阵发性心房颤动的疗效评价；伊贝沙坦对心房颤动复发率的影响；阵发性心房颤动经导管消融治疗40例报告；心肺复苏后昏迷的评估研究。

关键词： 窒息   心脏骤停   心肺复苏术  

摘要： 患者,男,50岁,因窒息30分钟入院.30分钟前饮白酒144 g(60 V/V,300 ml),吞咽馒头时出现呼吸停止、面部发绀、呼之不应,家属见咽部被馒头堵塞,用手指抠出部分,并将头部倒立,反复拍背,无好转.既往有高血压病史20年,支气管哮喘病史10年,糖尿病史5年,冠心病心绞痛4年.查体:无呼吸,无心跳,颈动脉搏动消失,面部发绀,双侧瞳孔散大且固定,各种反射消失.心电图示直线.诊断:①窒息;②心脏骤停.立即给予心脏按压、气管插管机械通气、头部置冰帽、吸氧,静脉注射肾上腺素1 mg、地塞米松10 mg、呋塞米40 mg,静脉滴注20%的甘露醇125 ml、5%的碳酸氢钠100 ml.气管插管时,发现咽喉部已被馒头全部堵塞,并迅速取出.肾上腺素每隔3～5分钟1 mg静脉注射,共用5次.

关键词： birth asphyxia   glutathione   oxidative stress   room-air resuscitation   CARDIAC TROPONIN-T   OXIDATIVE STRESS   NEWBORN-INFANTS   SUPEROXIDE-DISMUTASE   OXIDIZED GLUTATHIONE   INJURY   ASPHYXIA   HYPOXIA   BLOOD  

摘要： Rationale: Pure oxygen causes more oxidative stress than room air in resuscitation of asphyctic neonates, and consequently could be associated with increased tissue damage. Objectives: To compare damage caused to heart and kidneys on reoxygenation in severely asphyctic term neonates resuscitated with room air (RAR) or 100% oxygen (OxR). Nonasphyctic term newborn infants served as a control group. Methods and Measurements: This is a prospective randomized clinical trial masked for the gas mixture. Reduced glutathione (GSH), oxidized glutathione (GSSG), and superoxide dismutase (SOD) activity were measured to assess oxidative stress. Plasma cardiac troponin T (cTnT) and urinary N-acetyl-glucosaminidase (NAG) assessed cardiac and renal damage, respectively. Daily determinations of NAG for a 2-wk period were performed to monitor postasphyctic renal damage. Main Results: Both asphyctic groups showed oxidative stress when compared with the control group as evidenced by diminished GSH/ GSSG ratios, adaptive increases in SOD activity, and higher values of NAG and cTnT (markers of tissue damage). However, the OxR group showed significantly higher values of NAG and cTnT, lower GSH/GSSG ratios, and higher SOD activity than the RAR group. Moreover, NAG values persisted in being higher than normal in the OxR group for 2 wk after birth, whereas NAG in the RAR group dropped to normal within the first week. A linear correlation between cTnT or NAG and GSSG was found. Conclusions: The use of room air on resuscitation causes less oxidative stress and damage to heart and kidney than pure oxygen.

关键词： 肥厚型心肌病   致心律失常性   右室心肌病   二尖瓣脱垂   心脏复苏   诊断标准   预防措施  

摘要： There is only a few data on sudden unexpected death (SUD) in the pediatric population, as well as the role of sport. Materials and methods. - Between 1980 and 2003, 2220 autopsies were performed at the Lyon’s forensic institute for SUD (all ages) as defined by world health organization. Results. - Fifty-seven cases of SUD of cardiac origin concerned 6 to 18- year-old children. Hypertrophic cardiomyopathy and arhythmogenic right ventricular cardiomyopathy remained the main causes of SUD. Mitral valve prolapse were frequently observed and for the most part of the cases associated with other diseases. Twenty-four were observed during physical activity. Conclusion. - Our study confirms the low incidence of SUD and its male predominance in the pediatric population (47 males, 10 females). It seems that physical activity is not the decisive factor for SUD. The authors emphasized the necessity to get a rapid access to cardiac resuscitation devices, as well as the formation of collaborators. Some preventive measures could be done.

关键词： 心脏复苏   肾上腺素   新生儿   抢救成活率   心肺复苏   临床经验   住院病历   回顾分析   儿科  

摘要： 新生儿心肺复苏是儿科经常面对的难题,抢救成活率低.肾上腺素(AD)是目前心脏复苏的首选药,用在成人已有较成熟的经验,但新生儿应用的临床经验报道较少,现回顾分析儿科近10年中应用AD心脏复苏的新生儿住院病历49份,结合文献探讨AD在新生儿心脏复苏中的应用。

关键词： 重症瓣膜置换   心脏复苏   处理   多巴胺   起搏器  

摘要： 目的探讨重症瓣膜置换病人心脏复苏困难的处理.方法 11例重症瓣膜置换病人,术毕开放升主动脉后,11例均不能自动复跳,多次反复除颤仍不能复跳,既采取再次阻断升主动脉,同时灌注高钾温血停跳液至心电机械活动完全停止,3～5min后开放升主动脉,开放后7例自动复跳,3例除颤1次复跳,1例开放后除颤3次未能复跳,再次阻断升主动脉,同时灌注高钾停跳液至心电机械活动停止,5min后开放升主动脉,除颤1次复跳.结果复苏成功后均顺利脱离CPB.给予多巴胺维持,循环稳定.4例安装了临时起搏器,术后恢复满意.结论 对多次反复除颤不能复跳的重症瓣膜病患者,高钾温血再次阻断停跳,不失为一项有效措施.

关键词： INDUCED CORONARY VASOCONSTRICTION   EXPERIMENTAL AMITRIPTYLINE INTOXICATION   SEVERE ACCIDENTAL HYPOTHERMIA   RESPIRATORY-DISTRESS-SYNDROME   INTENSIVE-CARE PATIENTS   IN-WATER RESUSCITATION   NEAR-FATAL ASTHMA   CARDIOPULMONARY-RESUSCITATION   SODIUM-BICARBONATE   TRAUMA PATIENTS  

关键词： HOSPITAL CARDIAC-ARREST   BIPHASIC WAVE-FORMS   PROLONGED VENTRICULAR-FIBRILLATION   PERSISTENT ATRIAL-FIBRILLATION   POTENTIAL FIRE HAZARD   BASIC LIFE-SUPPORT   CARDIOPULMONARY-RESUSCITATION   TRANSTHORACIC IMPEDANCE   CHEST COMPRESSIONS   MONOPHASIC SHOCKS  

关键词： AUTOMATED EXTERNAL DEFIBRILLATORS   MEDICAL EMERGENCY TEAM   CARDIOPULMONARY-RESUSCITATION   SURVIVAL   CARE   RECOMMENDATIONS   GUIDELINES  

摘要： Aim To assess the frequency of cardiac arrest and outcomes and predictors of survival after cardiopulmonary resuscitation in hospitalized patients. Methods We prospectively analyzed the data on all patients who experienced cardiac arrest while hospitalized at the Split University Hospital between January and December 2003. Data were collected on patients' demographic characteristics, etiology and presentation of cardiac arrest, time, site, methods, and outcomes of cardiopulmonary resuscitation. Results Out of 120 cases of cardiac arrest among 32,861 hospitalized patients, 76.7% were witnessed. Ninety-six (80.0%) patients with cardiac arrest underwent resuscitation, and 22.5% of them were discharged alive. The survival rate was 20.0% at the Department of Internal Medicine, 29.2% in the Coronary Care Unit, and only 7.1% in other departments (P=0.058, chi(2) test). Out of 92 patients with witnessed cardiac arrest, 28.3% survived to discharge, whereas only one of 28 patient with unwitnessed cardiac arrest survived to discharge (P=0.004, Fisher's exact test). More patients with cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia survived than patients with asystole and pulseless electrical activity (47.6% vs 10.7%, respectively, P < 0.001, Fisher's exact test). None of the patients with unclassified cardiac arrest survived until discharge. Cardiac arrest survivors were significantly younger(60.8 +/- 12.9 vs 71.1 +/- 11.7 years, P < 0.001, Student t-test). Sex had no influence on survival. There were no significant circadian or hospital shift differences in the frequency rate of cardiac arrest, but the rate of successful resuscitation was lower during the flight shift. Conclusion The rate of successful resuscitation was higher in the coronary care unit, during the day and in younger witnessed cardiac arrest patients with ventricular fibrillation or pulseless ventricular tachycardia.

关键词： 病人出院   存活率   复苏术   钙   回顾性研究   急救   心肺复苏术   心脏停搏   人类  

摘要： 目的:回顾分析4年来我院收治的120例复苏病例效果,探讨复苏成败原因,提高复苏成功率。方法:回顾分析120例发生在医院内CA患者的临床抢救资料,分析抢救顺序、抢救用药及复苏成功后并发症的处理。结果:120例中25例存活出院,60例自动放弃,35例失败。结论:抢救中抓住抢救黄金时间、及早除颤、合理用药以及再发CA的预防均很重要。