关键词： 心脏性猝死   心肺复苏术   除颤   人工呼吸   院内心脏性猝死   初级   高级心血管生命支持   复苏成功率   早期除颤   现场复苏  

摘要： 目的探讨院内心脏性猝死初级心肺复苏患者的临床特点及救治经验,以提高心肺复苏成功率。方法详细回顾性分析71例患者治疗监护过程中的临床资料。结果本组复苏成功28例,复苏成功率为39%(28/71),其中存活15例,存活率为21%(15/71),早期除颤组心肺复苏成功率与延迟除颤组有明显区别(P<0.01)。及时插管组心肺复苏成功率与延迟插管组有明显区别(P<0.01)。结论心脏性猝死初级心肺复苏术成功的关键主要有三点:①确保“四早”(早期识别求救、及早CPR、及早高级心血管生命支持)的有效实施。②现场复苏的基本程序的合理安排。③熟记现场复苏的操作要点,进行正确的复苏操作。

关键词： 血钾异常   复苏成功   心脏骤停   早期   2004年   1999年   血生化检查   复苏后   患者  

摘要： 我院1999年4月至2004年8月共有6例心脏骤停患者复苏成功,在复苏后早期对6例患者做血生化检查,均有血钾异常,现报告如下。

关键词： 气管插管   电击除颤   时机选择   心复复苏  

摘要： 目的探讨气管插管与心脏电击除颤时机选择对心肺复苏(CPR)的影响。方法将130例急诊心肺复苏病人,随机分为选择顺序复苏组(A组,68例),常规CPR复苏程序组(B组,62例),对两组复苏成功率进行回顾性分析。结果选择顺序复苏组CPR成功32例(47.1%),高于传统的常规复苏组13例(20.9%),P>0.05。结论气管插管与心脏电击除颤随不同的病因而作出顺序选择时机,能大大提高CPR的成功率。

关键词： cardiac arrest   electrocardiography   free radical   metabolism   open-chest cardiac compression (OCCC)   stunning   myocardial   ENERGY PHOSPHATE-METABOLISM   BETA-ADRENERGIC INOTROPISM   CONTRACTILE FUNCTION   MYOCARDIAL DYSFUNCTION   ANTIOXIDANT PROPERTIES   VENTRICULAR-FUNCTION   STUNNED MYOCARDIUM   HYDROGEN-PEROXIDE   HEART   POTENTIATION  

摘要： Severe depletion of myocardial energy and antioxidant resources during cardiac arrest culminates in electromechanical dysfunction following recovery of spontaneous circulation (ROSC). A metabolic fuel and natural antioxidant, pyruvate augments myocardial energy and antioxidant redox states in parallel with its enhancement of contractile performance of stunned and oxidant-challenged hearts. This study tested whether pyruvate improves post-arrest cardiac function and metabolism. Beagles were subjected to 5 min cardiac arrest and 5 min open-chest cardiac compression (OCCC: 80 compressions min(-1); aortic pressure 60-70 mmHg), then epicardial dc countershocks (5-10J) were applied to restore sinus rhythm. Pyruvate was infused i.v. throughout OCCC and the first 25 min ROSC to a steady-state arterial concentration of 3.6 +/- 0.2 mM. Control experiments received NaCl infusions. Phosphocreatine phosphorylation potential (similar to PCr) and glutathione/glutathione disulfide ratio (GSH/GSSG), measured in snap-frozen left ventricle, indexed energy and antioxidant redox states, respectively. In control experiments, left ventricular pressure development, dP/dt and carotid flow initially recovered upon defibrillation, but then fell 40-50% by 3 It ROSC. ST segment displacement in lead II ECG persisted throughout ROSC. similar to PCr collapsed and GSH/GSSG fell 61% during arrest. Both variables recovered partially during OCCC and completely during ROSC. Pyruvate temporarily increased -PCr and GSH/GSSG during OCCC and the first 25 min ROSC and enhanced pressure development, dP/dt and carotid flow at 15-25 min ROSC. Contractile function stabilized and ECG normalized at 2-3 h ROSC, despite post-infusion pyruvate clearance and waning of its metabolic benefits. In conclusion, intravenous pyruvate therapy increases energy reserves and antioxidant defenses of resuscitated myocardium. These temporary metabolic improvements support post-arrest recovery of cardiac electromechanical performance. (c) 2005 Elsevier Ireland Ltd. All rights re

关键词： 心脏骤停   心肺复苏   胸部按压   美国心脏学会   国际指南   自主循环   美国心脏病学会   传感功能   芝加哥大学   前瞻性观察  

摘要： Context: The survival benefit of well-performed cardiopulmonary resuscitation(CPR) is well-documented, but little objective data exist regarding actual CPR quality during cardiac arrest. Recent studies have challenged the notion that CPR is uniformly performed according to established international guidelines. Objectives: To measure multiple parameters of in-hospital CPR quality and to determine compliance with published American Heart Association and international guidelines. Design and Setting: A prospective observational study of 67 patients who experienced in-hospital cardiac arrest at the University of Chicago Hospitals, Chicago, Ill, between December 11, 2002, and April 5, 2004. Using a monitor/-defibrillator with novel additional sensing capabilities, the parameters of CPR quality including chest compression rate, compression depth, ventilation rate, and the fraction of arrest time without chest compressions(no-flow fraction) were recorded. Main Outcome Measure: Adherence to American Heart Association and international CPR guidelines. Results: Analysis of the first 5 minutes of each resuscitation by 30-second segments revealed that chest compression rates were less than 90/min in 28.1%of segments. Compression depth was too shallow(defined as< 38 mm) for 37.4%of compressions. Ventilation rates were high, with 60.9%of segments containing a rate of more than 20/min. Additionally, the mean(SD) no-flow fraction was 0.24(0.18). A 10-second pause each minute of arrest would yield a no-flow fraction of 0.17. A total of 27 patients(40.3%) achieved return of spontaneous circulation and 7(10.4%) were discharged from the hospital. Conclusions: In this study of in-hospital cardiac arrest, the quality of multiple parameters of CPR was inconsistent and often did not meet published guideline recommendations, even when performed by well-trained hospital staff. The importance of high-quality CPR suggests the need for rescuer feedback and monitoring of CPR quality during resuscitation efforts.

关键词： 心脏骤停   心肺复苏   胸部按压   心电图分析   生命支持   工作循环   自主循环   胸垫   通气状况   护理人员  

摘要： Context: Cardiopulmonary resuscitation(CPR) guidelines recommend target values for compressions, ventilations, and CPR-free intervals allowed for rhythm analysis and defibrillation. There is little information on adherence to these guidelines during advanced cardiac life support in the field. Objective: To measure the quality of out-of-hospital CPR performed by ambulance personnel, as measured by adherence to CPR guidelines. Design and Setting: Case series of 176 adult patients with out-of-hospital cardiac arrest treated by paramedics and nurse anesthetists in Stockholm, Sweden, London, England, and Akershus, Norway, between March 2002 and October 2003. The defibrillators recorded chest compressions via a sternal pad fitted with an accelerometer and ventilations by changes in thoracic impedance between the defibrillator pads, in addition to standard event and electrocardiographic recordings. Main Outcome Measure: Adherence to international guidelines for CPR. Results: Chest compressions were not given 48%(95%CI, 45%-51%) of the time without spontaneous circulation; this percentage was 38%(95%CI, 36%-41%) when subtracting the time necessary for electrocardiographic analysis and defibrillation. Combining these data with a mean compression rate of 121/min(95%CI, 118-124/min) when compressions were given resulted in a mean compression rate of 64/min(95%CI, 61-67/min). Mean compression depth was 34mm(95%CI, 33-35 mm), 28%(95%CI, 24%-32%) of the compressions had a depth of 38 mm to 51 mm(guidelines recommendation), and the compression part of the duty cycle was 42%(95%CI, 41%-42%). A mean of 11(95%CI, 11-12) ventilations were given per minute. Sixty-one patients(35%) had return of spontaneous circulation, and 5 of 6 patients discharged alive from the hospital had normal neurological outcomes. Conclusions: In this study of CPR during outof-hospital cardiac arrest, chest compressions were not delivered half of the time, and most compressions were too shallow. Electrocardiographic analysis and defibrillation accounted for

关键词： 心脏骤停   心肺脑复苏   抢救   成功率  

摘要： 目的:探讨影响心脏骤停的若干因素,提高心脏骤停的复苏成功率。方法:回顾分析成功复苏且存活的心脏骤停患者26例的临床资料。结果:心脏骤停发生在院内者18例(占69.2%),发生在心电监护下者12例(占46.1%),复苏开始时间平均3.1±1.5min,电击除颤开始时间平均为3.8±1.2min,26例均成功复苏存活,无1例使用大剂量或超大剂量肾上腺素。结论:尽快、尽早及有效的心肺脑复苏(CPCR)是抢救成功的关键。同时重点处理脑复苏,有利于进一步提高存活率,减少致残率。

关键词： 卡维地洛   心肌缺血再灌注损伤   血流动力学   心脏复苏  

摘要： 目的研究卡维地洛对心脏瓣膜置换患者术后血流动力学和心脏复苏情况的影响。方法30例择期瓣膜置换术患者分为两组,每组15例。两组病人入院后均给予强心、利尿常规改善心功能药物,治疗组在此基础上加用卡维地洛。于入院时、麻醉前、切皮前、停CPB、术毕各时点记录平均动脉压(MAP)及心率(HR),并记录复跳方式、复跳后心律失常情况、术毕血流动力学稳定时多巴胺和硝普钠用量比。结果卡维地洛组各时点MAP、HR均低于对照组但无明显差别,自动复跳率明显高于对照组,复跳后心律失常发生率明显低于对照组,两组术毕血流动力学稳定时多巴胺和硝普钠用量比两组之间无明显差异。结论卡维地洛可安全应用于心脏瓣膜置换术患者围术期,有利于体外循环心脏手术心肌缺血再灌注后心脏复苏。

关键词： 急性心肌梗死   复苏成功   心脏骤停   急性广泛前壁心肌梗死   心前区疼痛   心肌酶谱检查   室性心动过速   溶栓治疗   呼吸停止   退休干部  

摘要： 患者陈某,男性,68岁,部队退休干部,因持续性心前区疼痛7小时于2004年4月28日早上7:00入院.经心电图和心肌酶谱检查确诊:急性广泛前壁心肌梗死.给予扩血管,止痛及抗凝,溶栓治疗,心前区疼痛消失,心电图显示溶栓成功.4月30日上午11:00病人突然出现四肢抽搐,牙关紧闭,眼球上翻,神志不清,随之呼吸减弱,心电监护示:室性心动过速,持续5分钟后转为心室颤动,呼吸停止,瞳孔散大,血压为零.

关键词： bystander CPR   cardiac arrest   cardiopulmonary resuscitation   education   out-of-hospital CPR   resuscitation   BYSTANDER CARDIOPULMONARY-RESUSCITATION   FAMILY-MEMBERS   RIGHT PEOPLE   ARREST   COMMUNITY   EMERGENCY   ATTITUDES   SURVIVAL   WILLINGNESS   PERFORMANCE  

摘要： Aim : To investigate the level of cardiopulmonary resuscitation (CPR) training among cardiac patients and their co-habitants and to describe the possibilities for, and obstacles to, CPR training among this group. Methods : All patients admitted to a coronary care unit during a four-month period were considered for participation in an interview study. Out of 401 patients, 268 were co-habiting. This study deals with these subjects. Results : According to the answers given by the patients, 46% of the patients and 33% of the co-habitants had attended a CPR course at some time. Among those who had not previously attended a course, 58% were willing to attend, and 60% of the patients whose co-habitant had not received CPR education, wanted him or her to attend a course. The major obstacle to CPR training was the patient's own medical status. The major obstacle to the co-habitant's participation was the patient's doubts concerning their partner's physical ability or willingness to participate. Younger persons were more often willing to undergo training than older persons (p < 0.0001). Of those patients who had previously attended a course or who were willing to undergo training, 72% were prepared to do so together with their co-habitant. A course specially designed for cardiac patients and their relatives was a possible alternative for 75% of those willing to participate together with their co-habitant. Conclusions :Two-thirds of the patients did not believe that their co-habitant had taken part in CPR training. More than half of these would like their co-habitant to attend such a course. Seventy-two percent were willing to participate in CPR instruction together with their co-habitant. Major obstacles to CPR training were doubts concerning the co-habitant's willingness or physical ability and their own medical status. (c) 2005 Elsevier Ireland Ltd. All rights reserved.