胸外心脏按压相关因素与救援者疲劳的关系

目的 探讨胸外心脏按压相关因素与救援者疲劳的关系.方法 将5名技能小组护士每周集中1次,按照2010美国心脏协会心肺复苏及心血管急救指南的操作要求,每人每次在心肺复苏人体模型上连续实施心肺复苏3 min,操作完毕,打印包括胸外按压总数、满意按压数等测试结果.共实施心肺复苏50人次.结果 随着按压时间延长,按压总数与满意按压数显著降低,疲劳发生率显著增多;救援者客观疲劳发生时间上,女性短于男性,取站姿者短于取跪姿者(均P＜0.01);当总平均按压频率大于120次/min时,疲劳时间缩短(P＜0.01).结论 救援者疲劳的相关因素包括性别、操作姿势、按压频率、时间等,应1～2 min更换一次施救人员,以延长救援者疲劳时间,提高心肺复苏质量.     

四八拍胸外按压计数法在心肺复苏教学中的应用

目的探讨四八拍胸外按压计数法在实习护生心肺复苏教学中的应用效果。方法将急诊科200名实习护生按实习时间分为对照组和干预组各100名。对照组采用常规计数胸外按压急救方法进行教学,干预组采用四八拍计数胸外按压急救法进行教学。结果干预组心肺复苏考核中按压深度、按压频率、送气量错误次数显著低于对照组,施救体验满意度显著高于对照组(均P0.01)。结论应用四八拍胸外按压计数法进行心肺复苏教学可以提升心肺复苏模拟操作质量。     

对心肺脑复苏新进展的评介

自胸外心脏按压术在临床上应用成功之后(1957,1960),胸外直流电除颤和口对口人工呼吸亦先后得到推广,从此组成了一套可供普及推广的基础生命支持(BCLS)措施和进一步的生命支持(ACLS)措施,或统称为心肺复苏术(CPR)。两年多来,我国红十字会与急救学会等协作,在许多省市开办了CPR学习班,进行普及训练,取得了初步成效。在七十年代中,国外一些学者开始注意到在CPR后脑复苏的必要     

42例重度有机磷中毒心肺复苏一点体会

目的:探讨重度有机磷中毒致呼吸心跳骤停心肺复苏侧重点.方法:通过观察42例重度有机磷中毒致呼吸心跳骤停患者在心肺复苏初期,胸外按压和畅通气道辅助呼吸侧重不同对复苏效果的影响,比较其优缺点.结果:在心肺复苏初期优先畅通气道辅助通气组,复苏成功率59.1%,优先胸外按压组复苏成功率25%,两组复苏结果比较有显著性差异P＜0.05.结论:重度有机磷中毒引起呼吸心跳骤停,首先建立人工通气可提高复苏的成功率.     

谈口对口吹气法操作注意点

口对口吹气法是抢救心跳呼吸骤停一种简单、无创、快捷的方法,其正确操作与有效心肺复苏密切相关。笔者就口对口吹气法操作注意点浅谈如下。一、口对口人工呼吸开始后先吹气2口心跳呼吸停止后,脑组织和许多重要器官缺血缺氧,数分钟后组织将坏死。病人的肺处于半萎陷状态,因此,在开放气道下首先给病人吹气2口,以扩张肺组织,利于气体交换。用口向病人肺内吹入2口气量较多的新鲜空气(>800ml)供肺脏吸收20%的氧气,呼出80%氧气,基本上能保证病人肺内氧气量,将带氧血液维持循环,赢得心肺复苏成功的时机。二、口对口吹气时不要按压胸部     

基础生命支持技术研究进展

回顾2005年美国心脏病协会(AHA)和国际复苏联盟(ILCOR)修订的心肺复苏标准的同时,对2005国际标准颁布后基础生命支持技术的最新研究进展进行了探讨。综述了心前区叩击、单纯胸外按压、通气按压比、除颤时机、复苏时长等问题,旨在更新急救观念,探索提高基础生命支持效果的途径。     

基础生命支持技术研究进展

回顾2005年美国心脏病协会（AHA）和国际复苏联盟（ILCOR）修订的心肺复苏标准的同时,对2005国际标准颁布后基础生命支持技术的最新研究进展进行了探讨。综述了心前区叩击、单纯胸外按压、通气按压比、除颤时机、复苏时长等问题,旨在更新急救观念,探索提高基础生命支持效果的途径。     

高职护生对不同人群实施现场心肺复苏态度的调查分析

目的了解高职护生(下称护生)对院外发生心搏骤停的不同人群实施心肺复苏的态度以及影响护生实施现场心肺复苏的因素。方法采用问卷对127名护生进行不同人群实施心肺复苏态度的调查。结果分别有1.5%、14.1%、41.8%、41.8%、62.2%的护生表示不愿意对亲人或朋友、儿童、老年人、陌生男性、创伤患者实施现场心肺复苏。不愿意实施现场急救的诸多原因中位于第一位的是“担心由于自己急救知识、技术的局限而不能胜任现场急救任务”。与心肺复苏(人工呼吸加心脏按压)相比,护生更愿意单纯实施心脏按压(P<0.01)。结论护生实施院外现场心肺复苏意识较差,在急救护理教学过程中,应注重对护生急救意识及急救态度的培养,为护生提供有效的现场急救实践,帮助他们体验急救经历,增强角色意识,成为现场急救的积极参与者。     

心肺复苏操作考核结果分析

目的 通过训练考试,掌握有效的心肺复苏方法,提高心脏骤停患者的抢救成功率.方法 对全院117名护士进行心肺复苏操作训练及考试.结果 合格率为92.3%.在心脏骤停的判断、开放气道和人工呼吸及胸外心脏按压方面存在不少操作细节问题.结论 应认真对待心肺复苏操作训练,熟练掌握动作要领和细节,方能正确灵活运用于临床患者的抢救,提高抢救成功率.     

萨勃心肺复苏器在心跳骤停的临床应用

萨勃心肺复苏器是依照美国心脏学会所定心肺复苏指南标准而设计的机械心肺复苏设备,其巧妙而严谨的设计使心脏按压与机械通气同步,准确有效进行。2010年《心肺复苏指南》在2005年《心肺复苏指南》的基础上,着重强调了胸外按压,先按压后吹气,按压部位在双乳头连线与胸骨交界,     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.