1例急性心肌梗死反复心搏骤停患者联合应用ECMO+IABP+CRRT的护理

总结1例急性ST段抬高型心肌梗死患者反复心搏骤停经CPR后联合应用体外膜肺氧合器(ECMO)、主动脉内球囊反搏(IABP)、连续性肾脏替代疗法(CRRT)的护理救治经验。救治过程中，患者发生3次心搏骤停，经CPR抢救后及时、有效地予以IABP、ECMO等循环辅助装置的干预，经过严密监测生命体征、观察血流动力学变化等一系列规范化治疗与精心护理后，该患者康复出院。     

体外循环与辅助循环在心脏急症中的应用

目的：应用体外循环与辅助循环方法救治围术期心脏急症病人。方法：紧急应用体外循环支持5例，其中3例同时进行原发心脏疾病的手术治疗。主动脉内球囊反搏（IABP）4例，左心辅助循环1例。结果：治愈7例，死亡3例。结论：体外循环与辅助循环，对围术期心脏危重急症病人是一种非常有效的治疗辅助措施。     

主动脉内球囊反搏在急诊冠状动脉介入治疗中的护理

目的探讨主动脉内球囊反搏（IABP）在急诊经皮冠状动脉介入治疗（PCI）中的护理。方法对36例急诊PCI病人应用主动脉内球囊反搏治疗及护理进行回顾性分析。结果36例急诊PCI病人动脉收缩压、舒张压及平均动脉压有不同程度升高，尿量增加、心率减慢、血管活性药物用量明显减少。结论急诊PCI病人一旦发生血流动力学不稳定，可立即使用主动脉内球囊反搏辅助循环治疗，不仅能有效降低心脏后负荷，而且能有效增加心脏搏出量，改善心功能，提高抢救成功率。     

主动脉内球囊反搏的监测与护理

主动脉球囊反搏(IABP)是一种以左心辅助功能为主的机械性循环装置[1].是利用IABP球囊在心脏舒张期充气,加大主动脉舒张压,从而改善冠状动脉的供血和心肌供氧;在心肌收缩前气囊放气,主动脉压力下降,心脏后负荷下降,从而降低氧耗,增加心排量,达到改善心功能的目的.2005年以来,我们采用IABP治疗8例重度心力衰竭患者,现将护理体会报告如下.     

急性重症心肌炎合并心源性休克1例临床护理

正急性重症心肌炎是由病毒感染所致心肌严重炎性损害,主要表现为猝死、严重心律失常、心源性休克、充血性心力衰竭、心肌炎或心包炎等[1]。临床上往往发病急,病情进展快,如不及时治疗,患者可在数小时或数日内死亡,及时诊断并采取综合性治疗措施可改善预后,降低病死率。主动脉内球囊反搏(IABP)是一种以左心辅助功能为主的机械性循环装置,是将一特定的球囊装置置入降主动脉内,利用IABP球囊在心     

体外心肺复苏技术在成人心搏骤停抢救中的应用

目的 回顾性总结应用体外心肺复苏(E-CPR)技术救治成人心搏骤停患者的临床经验.方法 2005年7月至2009年7月,有11例心源性心搏骤停成人患者(男7例,女4例,年龄24～71岁)经常规心肺复苏(CPR)抢救10～15 min无法有效恢复自主循环,而采用E-CPR技术抢救.7例心脏手术后患者在CPR抢救同时自原胸骨切口先建立升主动脉-右心房常规体外循环辅助,再转为体外膜肺氧合(ECMO)辅助;4例患者在CPR抢救同时直接经股动、静脉置管建立ECMO辅助.结果 11例患者CPR时间30～90 min,平均(51±14)min,10例患者可恢复自主心律.11例患者ECMO辅助时间2～223 h,中位时间126 h.6例患者成功撤离ECMO辅助,但存活出院率为36.4%(4/11).2例患者在ECMO辅助的同时加用主动脉内球囊反搏术(IABP),1例存活.3例患者因合并肾功能衰竭而需血液滤过治疗.结论 E-CPR为抢救危重的心搏骤停患者提供了一个新的手段.如何有效评估和选择病例,及时开始救治以提高成功率,值得进一步研究.     

急性心肌梗死致反复心搏骤停应用ECPR联合IABP技术的急救和监护

总结1例急性心肌梗死致反复心搏骤停行体外循环心肺复苏后,联合主动脉内球囊反搏的护理。护理重点为体外循环心肺复苏实施时做好团队配合及体外膜肺氧合的护理,围复苏期重视主动脉内球囊反搏的护理、亚低温治疗的监护、神经系统监护、抗凝管理及机械通气监护,密切观察病情警惕并发症发生,同时做好渐进式早期肺康复训练。患者在急诊重症监护室治疗16 d后转入心内科普通病房继续治疗,入院50 d后病情稳定出院。     

主动脉内球囊反搏的监测与护理进展

<正>主动脉内球囊反搏(IABP)是一种以左心室辅助功能为主的机械性循环装置,利用IABP球囊在心脏舒张期充气,加大主动脉舒张压,从而改善冠状     

心脏瓣膜手术患者围术期应用主动脉内球囊反搏辅助循环的临床护理

本文总结了93例围术期应用主动脉内球囊反搏装置辅助循环的心脏瓣膜手术患者的护理及其要点,包括置管前的准备与护理以及IABP置入术后的护理.58例患者成功撤机,35例因低心排综合征、感染性休克或迟发性心包填塞死亡.认为围术期使用IABP辅助循环的心脏瓣膜手术患者病情危重,在护理工作中了解IABP的基本工作原理,并在此基础上对此类患者的护理要点加以落实有助于提高IABP的辅助效果.     

18例应用主动脉内球囊反搏患者的监测与护理

主动脉内球囊反搏(Intra-Aortic Balloon Pump,IABP)是一种以左心室辅助功能为主的机械性循环装置。我院2010年4月至2012年3月应用IABP治疗急性心肌梗塞行PTCA及支架植入术患者,取得良好效果,现将护理体会报告如下。1临床资料     

急诊体外循环动脉灌注管位置对心肺复苏效果的影响

目的 探讨急诊体外循环（ECPB）动脉灌注管位置对肺门部火器伤后心脏骤停犬心肺复苏（CPR）的影响。方法 杂种犬14只随机均分为两组,麻醉后用小口径步枪射击犬右肺门区,心脏骤停后10min开始复苏。A、B两组分别采用股动脉、颈动脉插管建立ECPB,同时给予人工呼吸、胸内心脏按压、静注肾上腺素治疗。观察动物CPR情况。结果 A、B两组动物均全部复苏成功,B组恢复自主循环时间明显短于A组（P＜0．05）;复苏1min时B组平均动脉压（MAP）显著高于A组（P＜0．05）,PaO2显著高于A组（P＜0．01）,PaO2显著低于A组（P＜0．05）;复苏3min时B组PaO2显著高于A组（P＜0．05）,PaCO2显著低于A组（P＜0．05）。自主循环恢复后10min两组间MAP、PaO2、PaCO2均无统计学差异。辅助循环停止后,两组动物自主循环基本保持稳定。结论 ECPB能有效地应用于心脏骤停的CPR,动脉灌注管靠近升主动脉根部有助于提高急诊体外循环心肺复苏的治疗效果。     

Beneficial effects of terlipressin in prolonged pediatric cardiopulmonary resuscitation: a case series

OBJECTIVE: Arginine vasopressin was found in experimental and clinical studies to have a beneficial effect in cardiopulmonary resuscitation. The American Heart Association 2000 guidelines recommended its use for adult ventricular fibrillation arrest, and the American Heart Association 2005 guidelines noted that it may replace the first or second epinephrine dose. There is little reported experience with arginine vasopressin in cardiopulmonary resuscitation of children. Terlipressin, a long-acting analog of arginine vasopressin, has recently emerged as a treatment for vasodilatory shock in both adults and in children, but evidence of its effectiveness in the pediatric setting is sparse. The objective of this retrospective study is to describe our experience in adding terlipressin to the conventional protocol in children with cardiac arrest. DESIGN: Retrospective case series study. SETTING: An 18-bed pediatric critical care department at a university-affiliated tertiary care children's hospital. PATIENTS: Seven pediatric patients with asystole, aged 2 months to 5 yrs, who experienced eight episodes of refractory cardiac arrest and did not respond to conventional therapy. INTERVENTIONS: Addition of terlipressin to epinephrine during cardiopulmonary resuscitation of children. MEASUREMENTS AND MAIN RESULTS: Return of spontaneous circulation was monitored and achieved in six out of eight episodes of cardiac arrest. One patient died 12 hrs after return of spontaneous circulation, and four patients survived to discharge with no neurologic sequelae. CONCLUSIONS: The combination of terlipressin to epinephrine during cardiopulmonary resuscitation may have a beneficial effect in children with cardiac arrest. More studies on this drug's safety and efficacy in this setting are mandated.     

Out-of-hospital thrombolytic therapy during cardiopulmonary resuscitation in refractory cardiac arrest due to acute myocardial infarction.

Out-of-hospital thrombolytic therapy was administrated to a 53-year-old woman with confirmed acute myocardial infarction and refractory cardiac arrest. Standard advanced cardiac life support measures were performed by an out-of-hospital critical care team but they were unsuccessful. Thrombolytic therapy was given as a rescue therapy after prolonged cardiopulmonary resuscitation. The patient recovered a sinus rhythm and circulation 20 minutes after a bolus infusion of tissue plasminogen activator and was fit to be transported to the hospital. Reversal of arterial occlusion was confirmed at the hospital. There was no sequelae related to thrombolytic therapy and the patient was finally discharged 21 days later. This is the first published report of out-of-hospital thrombolytic therapy during cardiopulmonary resuscitation for a patient with refractory cardiac arrest due to acute myocardial infarction.     

Keeping cool: a case for hypothermia after cardiopulmonary resuscitation.

Cessation of circulation during cardiac arrest causes critical end-organ ischemia. Although the neurological consequences of cardiopulmonary arrest can be catastrophic, an aggressive "push fast and push hard" resuscitation technique maintains blood flow until the return of spontaneous circulation. However, reperfusion to the cerebrum leads to cellular chaos and further neurological injury. Use of moderate hypothermia after cardiac arrest mediates these cellular and chemical processes, reducing the impact of the arrest and reperfusion phenomena. A 43-year-old man had 2 asystolic arrests with 20 minutes of cardiopulmonary resuscitation as a result of massive, multiple pulmonary emboli. After the cardiac arrest, the patient was comatose and posturing. The 2005 American Heart Association guidelines for cardiopulmonary resuscitation were used along with moderate hypothermia in an attempt to minimize the neurological consequences of the cardiopulmonary arrest and to optimize the patient's outcome.     

颅脑降温仪在心肺脑复苏中的应用时机及护理

目的:探讨颅脑降温监护治疗仪在心肺脑复苏(CPCR)中的应用时机及护理方法。方法:将确定心跳和呼吸停止时间在6 min内、经心肺复苏(CPR)术后自主循环恢复并能维持24 h以上的68名复苏患者随机分为A组和B组各34例,A组患者在实施常规CPR同时,2 min内即用颅脑降温监护仪进行亚低温治疗;B组患者经CPR、在自主循环恢复后再用颅脑降温监护治疗仪进行亚低温治疗。两组均在2～4 h内使体表温度降至32～34℃,持续12～24 h。比较两组自主呼吸恢复情况、意识恢复(GCS评分)情况。结果:两组患者自主呼吸恢复人数及恢复时间比较,差异有统计学意义(P<0.05);24 h、48 h时、72 h内意识恢复(GCS评分)情况比较,差异有统计学意义(P<0.05)。结论:颅脑降温监护治疗仪实施越早越好,最好在实施常规基础生命支持(BLS)和高级生命支持(ACLS)同时开始,并配合高质量CPCR技术及精心护理,可有效提高脑复苏成功率。     

心跳呼吸骤停与复苏效果

复习1987年以来国内期刊发表的有关复苏的文献,就资料完整的1521例及我院复苏成功的6例进行分析并指出:心肺复苏既要突破4 min急救极限,又要树立骤停时间20 min仍有可能复苏的信念,但骤停时间小于4 min仍是长期存活不留后遗症的主要因素,而有效的心肺复苏则是提高复苏成功率的关键。开胸心脏按压的血流机制明显优于胸外心脏按压。大剂量肾上腺素有利于自主循环的恢复。而复苏后,积极维持有效循环的稳定有利于提高复苏成功率。     

Successful resuscitation of a verapamil-intoxicated patient with percutaneous cardiopulmonary bypass

OBJECTIVE: To describe our experience with the use of percutaneous cardiopulmonary bypass as a therapy for cardiac arrest in an adult patient intoxicated with verapamil. DESIGN: Case report. SETTING: Emergency department of a university hospital. PATIENT: A patient with cardiac arrest after severe verapamil intoxication. INTERVENTIONS: Percutaneous cardiopulmonary bypass and theophylline therapy. CASE REPORT: A 41-yr-old white male had taken 4800-6400 mg of verapamil in a suicide attempt. On arrival of the ambulance physician, the patient was conscious with weak palpable pulses and was transported to a nearby hospital. The patient developed a pulseless electrical activity, and cardiopulmonary resuscitation was started. Despite all advanced life support efforts, the patient remained in cardiac arrest. Therefore, he was transferred under ongoing cardiopulmonary resuscitation to our department, where percutaneous cardiopulmonary bypass was initiated immediately (2.5 hrs after cardiac arrest). The first verapamil serum concentration obtained at admittance to our institution was 630 ng/mL. After several ineffective intravenous epinephrine applications, the administration of 0.48 g of theophylline as an intravenous bolus 6 hrs and 18 mins after cardiac arrest led to the return of spontaneous circulation. The patient remained stable and was transferred to an intensive care unit the same day. He woke up on the 12th day and was extubated on the 18th day. After transfer to a neuropsychiatric rehabilitation hospital, he recovered totally. CONCLUSION: In patients with cardiac arrest attributable to massive verapamil overdose, percutaneous extracorporeal cardiopulmonary bypass can provide adequate tissue perfusion and sufficient cerebral oxygen supply until the drug level is reduced and restoration of spontaneous circulation can be achieved.     

经皮氧饱和度监测在院外心脏骤停患者心肺脑复苏中的应用

目的探讨经皮氧饱和度(SpO2)监测在院外心脏骤停患者心肺脑复苏中的意义。方法 394例院外心脏骤停患者分成两组,监测组221例患者入院后立即进行心肺脑复苏,同时予以SpO2监测并观察波形为指导持续胸外按压;未监测组173例患者入院后立即进行心肺脑复苏,但未予以SpO2监测;两组比较心、脑肺复苏成功率及心跳骤停持续时间、自主心跳恢复时间和脑缺血缺氧时间。结果监测组心肺复苏成功117例(52.94%)与未监测组心肺复苏成功72例(41.62%)比较,差异有统计学意义(χ2=4.98,P<0.05),监测组脑复苏成功14例(6.33%)与未监测组脑复苏成功6例(3.47%)比较,差异无统计学意义(χ2=1.66,P>0.05)。监测组的心跳骤停持续时间(43.93±23.33)min短于未监测组(52.92±26.28)min,自主心跳恢复时间(22.13±18.72)min亦短于未监测组(29.09±21.40)min,差异均有统计学意义(t分别=2.45、2.35,P均<0.05);而两组脑缺血缺氧时间比较,差异无统计学意义(t=1.16,P>0.05)。结论在经皮SpO2监测指导下进行胸外按压有助于提高胸外按压的有效性,从而提高心肺复苏的成功率。     

L’arrêt cardiaque inattendu en réanimation : état des lieux et perspectives

Unexpected cardiac arrest is a rare event in the Intensive Care Unit (ICU). Despite immediate availability of advanced life support and trained staff, patients suffer from chronic diseases and organ failures that worsen the prognosis for cardiac arrest victims. Although the initial success rate of cardiopulmonary resuscitation may be high, most of the resuscitated patients die soon after restoration of spontaneous circulation. Studies report the percentage of patients surviving to hospital discharge to be about 15%. Factors associated with prognosis are divided into three groups: pre-arrest, intra-arrest, and post-arrest. Preexisting conditions associated with poor outcome are pneumonia, trauma, malignancy, renal insufficiency, organ failures, and comorbidities. Hypotension, sepsis and worsening of Acute Physiology Scores before arrest are more common among the non-survivors. Patients with ventricular tachycardia or fibrillation compared to non-shockable rhythms are more likely to survive. Even though spontaneous circulation is initially restored, the rate of patients discharged alive from hospital declines with the duration of cardiopulmonary resuscitation. However, cardiac arrest is frequently preceded by warning signs of clinical deterioration (hypoxia, hypovolemia, acidosis for instance) that can be identified and treated. Cautious anticipation, regular training, timely initiation of rescue, and selection of patients most likely to benefit from resuscitation are key steps to enhance prognosis and quality of life for cardiac arrest patients in the ICU.