关键词： 心脏停搏/治疗   肝/损伤   手术前护理/方法   破裂/病因学   人类   男(雄)性   中年人  

关键词： 心室纤颤   心脏骤停   药物影响   肾上腺素   利多卡因  

摘要： 于不少人的传统观念中,药物在抢救垂危病人时扮演着重要的角色,'灵丹妙药'一词就是明显的写照.自从现代CPR问世的40年来,尤其是'生命链'的观念正式提出的近10年来,药物在心室纤颤(VF)、心脏骤停中所发生的影响明显减弱.此次新指南专门涉及这个课题,开宗明义地列了一个小节'药物在VF、心脏骤停中的作用正在减弱'.认识、理解这一问题是重要的,有助于在抢救时的指导原则和实施应用,以免主次不分.

关键词： 心肺复苏   机械通气   胸外心脏按压  

摘要： 目的 :探讨与胸外心脏按压同时和非同时机械通气在心肺复苏中应用的效果。方法 :将 12例心跳呼吸骤停患者随机分为与胸外心脏按压同时控制机械通气组和与胸外按压非同时手控机械通气组。采用控制通气模式机械通气与持续徒手胸外心脏按压同时进行 ;后者采用手控通气模式机械通气 ( MAMV)与间断徒手胸外心脏按压非同时相配合进行心肺复苏 ,胸外心脏按压每 5次后暂停 1次 ,在暂停间期给予 MAMV 1次 ,之后通气与按压依此比例进行。 2组均进行无创动脉血压、心电、经皮氧饱和度 ( Sp O2 )、潮气量 ( VT)、气道峰压( Ppeak)等监测。结果 :与胸外心脏按压非同时手控机械通气组的 Sp O2 、VT 均明显高于与胸外心脏按压同时机械通气组的 Sp O2 和 VT,P均 <0 .0 5 ;而 Ppeak则明显低于后者 ,P<0 .0 5 ;2组的平均动脉压无显著差别。结论 :与胸外心脏按压非同时手控机械通气在提高 Sp O2 、VT,降低 Ppeak。

关键词： 心肺复苏   心脏按压   前向血流机制   CPR   循环支持  

摘要： 胸外按压是心跳骤停病人心肺复苏(CPR)的重要措施之一，1960年Kouwenboven[1]等提出的胸外按压心肺复苏术已得到普遍的接受，并挽救了许多心脏骤停患者的生命。但有关CPR的确切机理仍然存在争论。近年来，随着研究的进展，又出现了一些新方法、新理论，揭示了CPR的一些奥秘。现就其机制及进展作一概述。

关键词： cardiopulmonary resuscitation   ventricular fibrillation   defibrillation   fast Fourier transformation   VENTRICULAR-FIBRILLATION   PERFUSION-PRESSURE   CARBON-DIOXIDE   WAVE-FORM   RESUSCITATION   EXPERIENCE   FREQUENCY   SURVIVAL   PREDICTION   SHOCKS  

摘要： The frequency spectrum of the ECG in ventricular fibrillation (VF) correlates with myocardial perfusion and might predict defibrillation success defined as return of spontaneous circulation (ROSC). The predictive power increases when more spectral variables are combined, but the complex information can be difficult to handle during the intensity of CPR. We therefore developed a method for expressing this multidimensional information in a single reproducible variable reflecting the probability of defibrillation success. This is based on the highest performing predictor for ROSC after 883 shocks given to 156 patients with VF. This was a combination of two decorrelated spectral features based on a principal component analysis of an original feature set with information on centroid frequency, peak power frequency, spectral flatness and energy. The function 'Probability of defibrillation success' (P-ROSC(nu)) was developed by a 2-dimensional histogram technique. P-ROSC(nu) discriminated between shocks followed by ROSC and No-ROSC (P < 0.0001). The present methodology indicates a possible way to develop a CPR monitor. (C) 2001 Elsevier Science Ireland Ltd. Ail rights reserved.

关键词： cardiopulmonary resuscitation   bystander   cardiac arrest   OPALS  

摘要： Aim To describe possible factors modifying the effect of bystander cardiopulmonary resuscitation on survival among patients suffering an out-of-hospital cardiac arrest. Patients A national survey in Sweden among patients suffering out-of-hospital cardiac arrest and in whom resuscitative efforts were attempted. Sixty per cent of ambulance organizations were included. Design Prospective evaluation. Survival was defined as survival 1 month after cardiac arrest. Results In all, 14 065 reports were included in the evaluation. Of these. resuscitation efforts were attempted in 10 966 cases, of which 1089 were witnessed by ambulance crews. The report deals with the remaining 9877 patients: of whom bystander cardiopulmonary resuscitation was attempted in 36%. Survival to 1 month was 8.2% among patients who received bystander cardiopulmonary resuscitation vs 2.5% among patients who did not receive it (odds ratio 3.5, 95% confidence interval 2.9-4.3). The effect of bystander cardiopulmonary resuscitation on survival was related to: (1) the interval between collapse and the start of bystander cardiopulmonary resuscitation (effect more marked in patients who experienced a short delay); (2) the quality of bystander cardiopulmonary resuscitation (effect more marked if both chest compressions and ventilation were performed than if either of them was performed alone); (3) the category of bystander (effect more marked if bystander cardiopulmonary resuscitation was performed by a non-layperson); (4) interval between collapse and arrival of the ambulance (effect more marked if this interval was prolonged); (5) age (effect more marked in bystander cardiopulmonary resuscitation among the elderly); and (6) the location of the arrest (effect more marked if the arrest took place outside the home). Conclusion The effect of bystander cardiopulmonary resuscitation on survival after an out-of-hospital cardiac arrest can be modified by various factors. Factors that were associated with the effect of bystander cardiopulmonary resuscitation wer

关键词： lactic acid   fatty acid metabolism   glucose oxidation   glycolysis   resuscitation   IMPROVES HEART FUNCTION   MYOCARDIAL-FUNCTION   RAT HEARTS   METABOLISM   OXIDATION   PYRUVATE   CARBOHYDRATE   NECROSIS   CANINES   MUSCLE  

摘要： This study tested the hypothesis that removal of fatty acids as a fuel source would improve cardiac efficiency at the expense of reduced cardiac contractile function in the isolated working heart after hemorrhageretransfusion. Non-heparinized male Sprague-Dawley rats were anesthetized with ketamine-xylazine and were hemorrhaged to a mean arterial blood pressure of 40 mmHg for 1 h. Two-thirds volume of shed blood was reinfused together with 0.9% NaCl in a volume equal to 2.3 times the shed blood volume, followed by continuous infusion of 0.9% NaCl at 10 mL/kg per h for 3 h. Hearts were removed and perfused in closed, recirculating working mode for 60 min to measure hydraulic work and cardiac efficiency. Rates of glycolysis and glucose oxidation were assessed with [5-H-3/U-C-14] glucose (11 mM) in the absence or presence of 0.4 mM palmitate. Compared to baseline measurements, hemorrhageretransfusion significantly reduced arterial blood glucose (228 +/- 7 versus 118 +/- 12 mg/dL) and non-esterified fatty acid concentrations (0.36 +/- 0.01 versus 0.30 +/- 0.02 mM), while elevating blood lactate (0.8 +/- 0.1 versus 2.5 +/- 0.4 mM). Perfusion of sham hearts with glucose-only did not alter cardiac work compared to shams perfused with glucose plus palmitate. However, shocked hearts perfused with glucose-only demonstrated a significant reduction in cardiac work compared to shocked hearts perfused with glucose plus palmitate and compared to sham hearts perfused with glucose only (P< 0.05, repeated measures ANOVA). Shocked hearts perfused with glucose plus palmitate showed no reduction in cardiac work compared to shams. Shocked hearts perfused with glucose-only had increased glucose oxidation rates compared to shams perfused with glucose plus palmitate. In sham hearts perfused with glucose-only, myocardial glycogen and triacylglycerol contents were significantly reduced compared to hearts freeze-clamped in situ. These endogenous fuels were not decreased in shocked hearts. These data indicate that hemorrhagic shock renders t

关键词： 心脏停搏   急救   院前复苏  

摘要： 心搏骤停者院前复苏率是评估某地院前急救水平的重要标志之一，努力提高心搏骤停者院前复苏率在提高院前急救水平中起重要作用。本文回顾性地对上海市医疗救护中心所属市区11个分站在1998年急救的全部4564心搏骤停者，用Utstein模式进行资料报告方法进行统计并对成败进行分析，以求客观上反映上海市心搏骤停者的院前复苏率，通过分析成败原因，为寻找提高院前急救水平途径而努力。 一、材料和方法 回顾性地对上海市医疗救护中心所属市区11个分站在1998年急救的全部4564心搏骤停者病历，用Utstein模式进行资料报告方法进行统计［1］，其中有91例由外伤引起不列入统计、98例因已出现僵硬等体症不可能复苏也不列入统计，符合统计要求的共4375例，统计性别、年龄、心搏骤停者有否目击者、救护车到时是否在作CPR、心搏骤停者心电图表现、现场复苏成功人数、现场复苏成功者入院人数及出院人数、呼救-到达现场间期的测定，复苏成功者与未成功者比较。 心搏骤停的判断依据为意识丧失、大动脉脉搏消失、心电图表现为心室纤维颤动（VF）、无脉搏心电活动（PEA）或直线。现场复苏成功的判断依据为自主循环恢复、心电图表现为窦性心律或心室率基本正常的其他心律。 心搏骤停病员中男2238例，女2137例，平均年龄63岁，病因为心血管疾病3018例、其他疾病1357例。 二、结果 需要复苏的4375例，心电图表现为VF的有402例，占9.2％；表现为PEA的有626例，占14.3％；表现为直线的有3445例，占76.5％，平均呼救-到达现场间期为11.3min，46例复苏成功者心电图表现为VF的有8例，占17.4％；表现为PEA的有6例，占13.0％；表现为直线的有32例，占69.6％；平均呼救-到达现场间期为8.3min，现场复苏成功组和未成功组有显著差别（见表1）。需要复苏的4375例心搏骤停者，最后有46例恢复自主循环，现场均有目击者，现场复苏率为1.05％，其中1例恢复健康出院。1．本组心脏停搏病例心电图表现VF的较少，不到10％，多数表现为PEA或心电静止与美国洛杉矶医学院近期报导相似［2］。这与呼救-到达现场间期较长有关，平均为11.3min。因为随着时间的延迟，很多VF将演变为心电静止。然而从本组院前急救自主循环恢复的46例，分析中可以看出自主循环恢复前大多数心电图表现为PEA或心电静止，这也说明心脏停搏，尤其是虽然心电图出现PEA或心电静止，复苏还是有可能，决不能轻易放弃积极的抢救，这点也与洛杉矶医学院报导相一致。

关键词： 脑复苏   心肺复苏   成功率   电击伤   胸骨   心肌梗塞   冠心病   心脏骤停   心跳骤停   心脏复苏  

摘要： 现代复苏学的发展,认为心肺复苏是复苏成功的基础,而脑复苏的成败则是衡量心肺复苏成败的标志.本文分析52例心脏骤停心肺复苏成功及其中21例脑复苏成功病例,以探讨心脏骤停复苏抢救中脑复苏成败的原因.

关键词： 心脏复苏   肾上腺素   剂量  

摘要： 肾上腺素是心脏复苏的首选药物.多年来,在心脏复苏中肾上腺素的用量一直以1mg为标准剂量.重复应用不超过3次.近年来,有人主张应用大剂量肾上腺素进行心脏复苏,能提高复苏成功率.我院自1998年以来,用大剂量肾上腺素进行心脏复苏的病例30例,与以往用标准剂量进行心脏复苏的病例30例作比较.结果大剂量组较标准剂量组复苏成功率要高.现报道如下.