关键词： 早期   气管插管   心脏电击除颤   院前抢救   心肺复苏   心跳骤停   呼吸骤停  

摘要： 心肺复苏（CPR）技术近10年来在国内外有了较快的发展。我院急诊科于1994年6月开始，对全体急诊医生实行气管及心脏电击除颤技术培训，要求每位急诊科医生要熟练掌握气管插管及心脏电击除颤，在院前CPR抢救中早期普及性应用气管插管及心脏电击除颤，并对插管及除颤随可能不同的病因而作出顺序选择电动机使呼吸、心跳骤停抢救的成功率大大提高。

关键词： anesthesia   cardiac arrest   brain ischemia   cardiopulmonary resuscitation   epinephrine (adrenaline)   pulmonary edema   BRAIN PROTEIN-SYNTHESIS   CEREBRAL-ISCHEMIA   CARDIOPULMONARY-RESUSCITATION   NEURONAL DAMAGE   GLOBAL-ISCHEMIA   CARBON-DIOXIDE   COMPRESSION   SEIZURES   REPERFUSION   RECOVERY  

摘要： We review 7 years experience with the chest compression model of cardiac arrest and resuscitation, comparing two different anesthetics. Ketamine stimulates cardiac function and only mildly depresses respiration; of the two it provides easier resuscitation. However, ketamine severely depresses brain protein synthesis; in studies using this measure ketamine is unsuitable and another agent must be used. Sodium pentobarbital mildly depresses brain protein synthesis, but depresses both cardiac and respiratory function, making resuscitation more difficult. Use of alternate chest/abdominal pumping (Babbs resuscitation technique), with judicious use of intra-cardiac epinephrine (adrenaline), made resuscitation reliable under sodium pentobarbital as well. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.

关键词： pediatric resuscitation   cardiac arrest   cardiopulmonary resuscitation   echocardiography   TROPONIN-I   PROGNOSTIC VALUE   SURGERY   INFARCTION   OPERATIONS   DIAGNOSIS   ISCHEMIA   RELEASE   AGE  

摘要： Background: Myocardial dysfunction occurs immediately after successful cardiac resuscitation. Our purpose was to determine whether measurement of cardiac troponin I in children with acute out-of-hospital cardiac arrest predicts the severity of myocardial injury. Methods and results: This prospective, observational study was performed in the Pediatric Intensive Care Unit (PICU) on 24 patients following arrest, ranging in age from 8 months to 17 years. Troponin measurements were obtained on admission, and at 12, 24, and 48 h. Transthoracic echocardiograms were performed within 24 h after admission. Survival to hospital discharge was 29% (7/24). The mean age was 5.9+/-4.6 years for survivors and 4.2+/-5.3 years for non-survivors. The median (range) duration of cardiac arrest times for survivors was 6 min (3 to 63 min) versus 34 min (4 to 70 min) for nonsurvivors (P = 0.02). Survivors received 1.3 +/- 2.2 doses of epinephrine (adrenaline) compared with 2.9 +/- 1.6 doses for non-survivors (P = 0.02). Only one patient had ventricular fibrillation and defibrillation was unsuccessful. The ejection fraction for survivors averaged 73.2 +/- 11.2%, but for nonsurvivors only 55.4 +/- 19.8% (P = 0.04). Ejection fraction correlated inversely with troponin at 12 h (r = -0.54, P = 0.01) and at 24 h (r = -0.59, P = 0.02). Circumferential fiber shortening for survivors was 37.5 +/- 7.8 and 25.5 +/- 10.7% for nonsurvivors (P=0.02). It also correlated inversely with troponin (r = -0.46, P = 0.03 for survivors and r = -0.65, P = 0.01, for nonsurvivors). Conclusion: After cardiac arrest and resuscitation in pediatric patients, the severity of myocardial dysfunction was reflected in troponin I levels. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.

关键词： POTENTIAL ORGAN DONORS   BRAIN-DEATH   THERAPY   VASOPRESSIN   REPLACEMENT   ACTIVATION   REJECTION   REVERSAL   RAT  

摘要： Background. Brain death results in cardiovascular instability and poor organ perfusion in many brain-dead donors. Hormonal resuscitation stabilizes certain brain-dead donors and is associated with significant increases in the numbers of organs transplanted per donor. The goal of this study was to examine the quality of hearts recovered from donors treated with hormonal resuscitation. Methods. A retrospective analysis of 4,543 recipients of hearts recovered from brain-dead donors, reported to the United Network for Organ Sharing/Organ Procurement and Transplantation Network database between November 1, 1999, and December 31, 2001, was conducted. Hormonal resuscitation consisted of a methylprednisolone bolus and infusions of vasopressin and either triiodothyronine or L-thyroxine. Univariate and multivariate analyses were used to evaluate the quality of hearts from donors who received three-drug hormonal resuscitation (3HR) treatment versus donors who did not receive all three drugs (non-3HR). Death within 30 days and early graft dysfunction were used as endpoints. Results. Hearts from 3HR donors demonstrated a 1-month survival rate of 96.2%, compared with a 92.1% survival rate for non-3HR donor hearts (P<0.01). Early graft dysfunction occurred in 5.6% of 3HR donor hearts and 11.6% of non-3HR donor hearts (P<0.01). Multivariate results demonstrated a 46% reduced odds of death within 30 days and a 48% reduced odds of early graft dysfunction. Steroids alone and steroids plus triiodothyronine/L-thyroxine also significantly reduced prolonged graft dysfunction. Conclusions. This study suggests that 3HR treatment of brain-dead donors results in increased numbers of transplanted hearts, with improved short-term graft function.

关键词： editorials   resuscitation   death, sudden   defibrillation   AUTOMATED EXTERNAL DEFIBRILLATORS   TASK-FORCE   SURVIVAL   INFARCTION   COMMUNITY   IMPACT   DEATH   TIME   CARE   HOME  

关键词： 心脏穿通伤   心搏骤停   急救   复苏   病例报告  

摘要： 心脏穿通伤因急性失血、心脏压塞、张力性气胸,随时可发生心搏骤停,抢救成功的关键在于迅速进行手术治疗.而麻醉医师对呼吸、循环系统复苏措施是否得当是抢救能否成功的关键.我院曾对2例心脏穿通伤致心搏骤停的病人进行了成功的抢救,现将急救与复苏体会报告如下.

关键词： pulmonary embolism   cardiac arrest   cardiopulmonary resuscitation   thrombolysis   haemorrhage   outcome   ACUTE MYOCARDIAL-INFARCTION   TISSUE-PLASMINOGEN ACTIVATOR   GUIDELINES   STATEMENT   EFFICACY   COUNCIL   SAFETY  

摘要： Objective: Thrombolytic therapy in patients with massive pulmonary embolism (MPE) and prolonged cardiopulmonary resuscitation (CPR) is subject to debate. This study was performed to determine whether (1) thrombolytic treatment increases the risk of bleeding complications, (2) if the risk of bleeding is influenced by the duration of CPR and if (3) thrombolytic therapy improves outcome. Design: Retrospective cohort study. Setting: Emergency department of a tertiary care university hospital. Patients and methods. Sixty-six patients with cardiac arrest (CA) due to MPE admitted between July 1993 and December 2001. Thirty-six patients received thrombolysis (TL) and were compared with 30 patients without thrombolytic therapy. Bleeding complications were assessed by clinical evidence or autopsy. Results: Major bleeding complications appear to occur more frequently in patients treated with thrombolytics (9/36 (25%) vs. 3/30 (10%)) even though the difference was statistically not significant (P = 0.15). It appears that CPR duration > 10 min has no adverse impact on major bleeding complications. No difference in the rate of major bleeding complications between thrombolyzed patients who had a CPR duration of less than or equal to 10 or > 10 min could be observed (2/8 (25%) vs. 7/28 (25%), P = 0.99). In thrombolyzed patients a return of spontaneous circulation could be achieved more frequently (24/36 (67%) vs. 13/30 (43%) in controls, P = 0.06) and survival after 24 h was higher (19/36 (53%) vs. 7/30 (23%), P = 0.01). Survival to discharge was also higher in the TL group (7/36 (19%) vs. 2/30 (7%)), but not statistically significant (P = 0.15). Conclusion: Although severe bleeding complications tend to occur more frequently in patients undergoing TL, the benefit of this treatment might outweigh the risk of bleeding. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.

关键词： epinephrine   vasopressin   alpha(2)-adrenergic agonist   cardiopulmonary resuscitation (CPR)   post-resuscitation myocardial dysfunction   ventricular fibrillation   PROLONGED CARDIOPULMONARY-RESUSCITATION   ORGAN BLOOD-FLOW   CORONARY VASOCONSTRICTION   MYOCARDIAL-ISCHEMIA   PERFUSION   CIRCULATION   RECEPTORS   INCREASES   RECOVERY   ARREST  

摘要： The objective of this research was to compare the effects of an alpha- and beta-adrenergic agonist, epinephrine, a selective alpha(2)-adrenergic agonist, alpha-methylnorepinephrine (alpha-MNE), and a non-adrenergic vasopressin on post-resuscitation myocardial function and duration of survival. Epinephrine continues to be the primary adrenergic agent for advanced cardiac life support. However, its major inotropic actions and especially its beta-adrenergic and, to a lesser extent, its alpha(1)-actions increase the severity of global ischemia during cardiac arrest and adversely affect post-resuscitation myocardial function and survival. We had previously observed significantly better outcomes with a selective alpha2-adrenergic agonist when compared with epinephrine. Non-adrenergic vasopressin also has promise of more favorable actions. The present study was, therefore, undertaken to compare a selective alpha(2)-adrenergic vasopressor drug with vasopressin, epinephrine, and saline placebo. Ventricular fibrillation (VF) was induced in 20 Sprague-Dawley rats. Mechanical ventilation and precordial compression were initiated after 8 min of untreated VF. About 2 min later, alpha-MNE in a dose of 100 mug/kg, vasopressin in a dose of 0.4 U/kg, epinephrine in a dose of 30 mug/kg, or saline control was administered. Defibrillation was attempted after 6 min of CPR. Left ventricular pressure, dP/dt(40), -dP/dt, and cardiac index were measured for an interval of 240 min after resuscitation. Except for saline controls, comparable increases in coronary perfusion pressure (CPP) were observed after each drug intervention. All animals were successfully resuscitated. Post-resuscitation myocardial function and survival were significantly better in animals treated with alpha-MNE. Both post-resuscitation myocardial function and survival were most improved after administration of the selective alpha(2)-adrenergic agonist, intermediate after vasopressin and least after epinephrine and saline placebo. (C) 2002 Elsevier Science Ireland Ltd.

关键词： 抢救   心跳呼吸骤停   心脏复苏   临床病例  

摘要： 心跳呼吸骤停是急诊室经常遇到的一种极为紧急的危重症.1999年3月至2000年12月本院急诊内科共抢救心跳呼吸骤停12例,其中心跳呼吸骤停6例抢救成功.

关键词： 心脏直视术   复苏   温血灌注  

摘要： 心脏直视术发生心脏复苏困难时有可见,但多见于心脏瓣膜病及部分先心病合并重度肺动脉高压者.心脏扩大,心肌肥厚,心功能不全,是它们共同的病理、生理改变特点,特别是以左心室肥厚扩大者,更为严重.