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： 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，79kg。3a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2.5h后突然出现血压下降，心率减慢，分2次静推麻黄素20mg、多巴胺3mg、阿托品1mg无效，继而出现室颤，立即静注肾上腺素1mg、气管插管、行胸外按压后心跳未恢复。继给肾上腺素每4 ～ 5min 2mg静推（共4次），并从气管插管内给肾上腺素（1mg/次）2次，静推利多卡因50mg（共2次），先后给5%碳酸氢钠共200mL，心跳仍未恢复，因除颤器出现故障无法使用，立即采用开胸心脏按压，30min心脏复跳，心率50 ～ 130次/min，血压低，给于5%葡萄糖500mL + 多巴胺200mg + 阿拉明20mg静滴，先后输血压1400mL，血压逐渐回升。同时头部置冰帽，静推地塞米松30mg，应用度非合剂4mL，控制呼吸。术毕送ICU病房，继续头部降温（32.8 ～ 35 ℃，4d），应用冬眠合剂2mL，Q6h静推，异丙酚0.5 ～ 3mg/(kg·h)微量泵泵入，4d后停。同时应用甘露醇250mL、速尿20mg，Q12h，地塞米松（前3d 60mg/d，以后逐渐减量，10d后停用），同时应用大剂量抗生素等药物。多巴胺维持血压至正常。呼吸机控制呼吸4d。复苏后第6天开始高压氧治疗（共30次）。患者心脏复跳后30min内呼吸恢复，6h后瞳孔缩小并出现对光反射，4d后神志恢复，能用形体语言应答简单的问题（如点头、摇头），肢体能活动。复苏后第17天语言表达能力恢复。20d后脑干和网状内皮系统功能恢复完善，大部分皮层功能恢复，记忆力、思维能力恢复。60d后患者能下床活动。

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   INFLAMMATORY RESPONSE SYNDROME   HUMAN SEPTIC SHOCK   CYTOKINE PRODUCTION   ORGAN FAILURE   FIBRINOLYSIS   NEUTROPHILS   ACTIVATION   MONOCYTES   SYSTEM   CARE  

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： 新生儿窒息   急救   监护   病因   心脏复苏  

关键词： external cardiac compression (ECC)   cardiac arrest   out-of-hospital CPR   cardiopulmonary resuscitation (CPR)   RESUSCITATION  

摘要： Prompt and effective cardiopulmonary resuscitation (CPR) is the first link in the chain of survival following cardiac arrest. We assessed a new device, the CPR-Ezy(TM) (Medteq Innovations Pty Ltd., Brisbane, Australia), to aid timing and effectiveness of external cardiac compressions (ECC), by 32 subjects who had prior community-based training in CPR. ECC was performed on a manikin for 4 min by all subjects without and with the device. There was a statistically significant improvement in timing of ECC. Effectiveness of compressions was also improved over the whole time period, especially so in the last minute. We conclude that the CPR-Ezy can improve timing and effectiveness of ECC, and reduce the effects of resuscitator fatigue, in community-trained subjects. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

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: