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。

关键词： 凝血途径   成功心肺复苏   心脏骤停   凝血异常   抗凝血酶   抗凝作用   脓毒症患者   纤溶酶   酶复合物   全身性炎症反应  

摘要： OBJECTIVES: We investigated coagulation abnormalities in out-of-hospital cardiac arrest(OHCA) patients, with special attention to the protein C anticoagulant pathway. BACKGROUND: Successfully resuscitated cardiac arrest is followed by a systemic inflammatory response and by activation of coagulation, both of which may contribute to organ failure and neurological dysfunction. METHODS: Coagulation parameters were measured in all patients admitted after successfully resuscitated OHCA. RESULTS: At admission, 67 patients had a systemic inflammatory response with increased interleukin-6 and coagulation activity(thrombin-antithrombin complex), reduced anticoagulation(antithrombin, protein C, and protein S), activated fibrinolysis(plasmin-antiplasmin complex), and, in some cases, inhibited fibrinolysis(increased plasminogen activator inhibitor-1 with a peak on day 1). These abnormalities were more severe in patients who died within two days(50 of 67, 75%) and were most severe in patients dying from early refractory shock. Protein C and S levels were low compared to healthy volunteers and discriminated OHCA survivors from nonsurvivors. Furthermore, a subgroup of patients had a transient increase in plasma-activated protein C at admission followed by undetectable levels. This, along with an increase in soluble thrombomodulin over time, suggests secondary endothelial injury and dysfunction of the protein C anticoagulant pathway similar to that observed in severe sepsis. CONCLUSIONS: Major coagulation abnormalities were found after successful resuscitation of cardiac arrest. These abnormalities are consistent with secondary down-regulation of the thrombomodulin-endothelial protein C receptor pathway.

关键词： cardiac arrest   DTH   glucocorticoids   humoral immunity   immune   sudden death   INFLUENZA VACCINATION   CARDIOPULMONARY-RESUSCITATION   REDUCED RISK   STROKE   ARREST   RESPONSES   STRESS   DISEASE   LATERALIZATION   ASSOCIATION  

摘要： Immune system activation has implications for cerebrovascular health, but little is known about the function of the immune system after a major cerebrovascular event, such as cardiac arrest and cardiopulmonary resuscitation (CA/CPR). Cardiac arrest and cardiopulmonary resuscitation damages the hippocampus, an important component of the hypothalamic-pituitary-adrenal (HPA) axis, and alterations in HPA axis activity can affect immune function. We tested the hypothesis that CA/CPR (approximately 8 mins) would cause HPA axis dysregulation and alter the delayed type hypersensitivity (DTH) response to antigenic challenge. We also assessed the primary and secondary antibody response of mice exposed to CA/CPR. Of the mice exposed to CA/CPR, half had brains protected by hypothermia to isolate the effects of the CA/CPR procedure from the effects of CA/CPR-induced neuronal damage. Cardiac arrest and cardiopulmonary resuscitation-induced neuronal damage resulted in a persistent elevation of blood corticosterone concentration and a concomitant augmentation of the DTH response to antigenic challenge. Furthermore, immune activation before CA/CPR decreased survival after global ischemia. These data highlight the potential impact of neuronal damage on cell-mediated immune function and the role of humoral immune activation in outcome after global ischemia.

关键词： 窒息法   大鼠   心脏骤停   动物模型   心肺复苏  

摘要： 目的观察心肺复苏(CPR)效果,并探讨窒息时间及CPR时间对大鼠自主循环恢复(ROSC)率和6h生存率的影响。方法采用呼气末夹闭气管窒息法,建立大鼠心脏停搏(A)模型。30只SpragueDawley(SD)大鼠随机分2组,窒息7min组(n=15),窒息9min组(n=15)。观察大鼠窒息及心肺复苏期间平均动脉压(MAP)、心电图(ECG)、心率(HR)和动脉血pH值的变化,比较各组的ROSC率和6h生存率。结果窒息7min组ROSC率和6h存活率与窒息9min组比较,差异无显著性(P>0.05);CPR时间<5min者6h生存率显著高于CPR时间>5min者(P<0.05);存活时间大于6h者CPR时间与存活时间小于6h者CPR时间比较有显著性差别(P<0.05)。结论该复苏模型制作简单,重复性好,可观察多个指标,能满足心肺复苏实验研究的需要;窒息时间选择应控制在7～9min以内;CPR时间是预测CPR成功率的重要指标。