疾病谱对心肺复苏急救患者生存状况影响的研究

目的：探究疾病谱对行心肺复苏术的急救患者的生存状况的影响。方法：随机选取2012年3月至2014年3月在我院急诊手术室因发生心脏骤停实施CPR 复苏成功患者100例和复苏失败患者100例,分析两组患者的临床基本资料和直接病因。结果：复苏成功组大多为20～40岁患者（51例／100例,51％）,复苏失败组患者年龄分布集中在60岁以上（45例／100例,45％）,且差异具有统计学意义（ P＜0．05）;成功组和失败组在心肺复苏起始时间（100例／100例,100％;17例／100例,17％）、是否气管插管（91例／100例,91％;32例／100例,32％）和心电监护（79例／100例,79％;56例／100例,56％）均具有统计学意义（χ2＝12．829,P＝0．000;χ2＝10．025,P＝0．000;χ2＝4．982,P＝0．000）;直接病因主要为脑出血和梗死（44例／200例,22％）、冠心病（33例／200例,16．5％）、呼吸衰竭（40例／200例,20％）和急性心肌梗死（47例／200例,23．5％）,且两组患者间原发性疾病差异均有统计学意义（ P＜0．05）。结论：心肺复苏患者自主循环的恢复与患者年龄、原发性病、是否进行气管插管、心电监护和复苏起始时间有关。     

芳香开窍药经鼻给药对脑损伤昏迷患者脑血流速度及脑血流量的影响

目的研究芳香开窍药经鼻给药对脑损伤后意识障碍患者脑血流速度及脑血流量的影响,并观察其促苏醒作用。方法 60例脑损伤后意识障碍患者随机分为治疗组、对照组,各30例,两组均给予常规促醒治疗,治疗组在常规治疗的基础上加用芳香开窍药经鼻给药治疗。两组治疗前后均行经颅多普勒脑血管超声检测患者大脑中动脉(MCA)、基底动脉(BA)平均血流速度,对脑损伤区进行CT灌注成像扫描(CTPI)。治疗前后行Glasgow昏迷评分(GCS)进行疗效评定。结果治疗1个月后,治疗组大脑中动脉(MCA)及基底动脉(BA)平均血流速度均快于对照组[(93.65±9.71)cm/s比(81.43±9.52)cm/s),P0.05;(37.23±5.42)cm/s比(31.52±4.12)cm/s,P0.05]。治疗后治疗组CTPI参数r CBF、r CBV、r MMF和GCS评分与对照组比较有明显改善[(43.7±13.4)m L/(100g.min)比(35.5±14.8)m L/(100g.min),(3.2±0.6)m L/100g比(2.3±0.7)m L/100g,(4.5±0.9)s比(6.1±0.7)s,(11.23±1.55)分比(8.96±1.41)分,P均0.05]。结论芳香开窍药经鼻给药能提高脑损伤后昏迷患者的脑血流速度,改善脑损伤区脑血流量,有较好的促醒作用。     

ICU 常规与优化治疗对心脏骤停后综合征患者心肺、脑复苏情况的影响分析

目的：分析ICU 常规与优化治疗对心脏骤停后综合征患者心肺、脑复苏情况的影响。方法：选取90 例心脏骤停后综合征患者作为本次的研究对象,患者就诊时间段为2018 年7 月到2019 年11 月,按照数字表达法将其分为两组,其中接受ICU 常规治疗的45 例患者设为对照组,将另外45 例接受ICU 优化治疗的患者纳入观察组。将两组心脏骤停后综合征患者的神经功能评分、全心舒张末期容积指数、心脏指数、意识恢复时间以及并发症发生率进行对比。结果：经过治疗后,观察组患者的神经功能以及临床指标改善情况明显优于对照组;观察组的并发症发生率为4.4%;对照组的并发症发生率为17.8%,两组心脏骤停后综合征患者的神经功能评分、临床指标以及并发症发生率结果差异存在统计学意义（P<0.05）。结论：与ICU 常规治疗相比,ICU 优化治疗对心脏骤停后综合征患者的临床疗效更为显著,能够促进患者脑复苏情况的改善,提高神经功能恢复效率,改善心功能指标,减少并发症的产生,提升综合征患者的生存质量,具有积极的推广价值。     

去甲肾上腺素联合多巴胺在感染中毒性休克液体复苏中的作用

目的 探讨去甲肾上腺素联合多巴胺在感染中毒性休克液体复苏中的作用。方法 采用回顾性研究方法,选择2015年2月—2018年1月在榆林市星元医院ICU诊治的144例感染中毒性休克患者作为研究对象,根据治疗方法的不同分为观察组74例与对照组70例。两组都给予充分液体复苏,对照组给予多巴胺辅助治疗,观察组给予去甲肾上腺素联合多巴胺辅助治疗,记录两组6 h复苏率与28 d死亡率,记录两组治疗前与治疗3 d后的心率（HR）、混合静脉血氧饱和度（SvO₂）、尿量、内生肌酐清除率及白介素-4（IL-4）、白介素-10（IL-10）。结果 观察组的6 h复苏率与28 d死亡率分别为70.3%和24.3%,对照组分别为47.1%和47.1%,两组比较差异具有统计学意义（P<0.05）。两组治疗后的SvO₂都显著高于治疗前,且观察组高于对照组,差异均有统计学意义（P<0.05）;观察组治疗后的HR低于治疗前,也低于对照组,差异均有统计学意义（P<0.05）。治疗后,两组的尿量与内生肌酐清除率都显著高于治疗前,同组治疗前后比较差异有统计学意义（P<0.05）;且观察组高于对照组,差异有统计学意义（P<0.05）。治疗后,两组血清IL-4和IL-10水平都显著低于治疗前,同组治疗前后比较差异有统计学意义（P<0.05）;且观察组低于对照组,差异有统计学意义（P<0.05）。结论 去甲肾上腺素联合多巴胺在感染中毒性休克液体复苏中的应用能抑制炎症因子的释放,改善患者的肾功能与血气指标,从而提高复苏率与降低死亡率。     

Practical skills training influences knowledge and attitude of dental students towards emergency medical care

Background: Medical emergencies in dental practice are generally perceived as being rare. Nonetheless, recent studies have shown that incidents occur on a regular basis. Therefore, patients have the right to expect necessary skills to manage life‐threatening situations from every dentist. Objective: To observe students’ attitude and self‐assessment towards emergency medical care (EMC) and its practical appliance. Material and methods: Students of dentistry took part in small group sessions for adult and paediatric basic life support. Participants filled out pre–post questionnaires regarding knowledge and attitude towards EMC (6, respectively, 10‐point Likert scale). Additionally, feedback was asked for the quality of course and tutors. Results: Forty dental students in their last 2 years of study registered for the EMC courses. The majority had never attended any first‐aid course; the mean age was 25% and 75% were women. A comparison between pre‐ and post‐evaluation showed that the participation in practical training easily enhances the students’ awareness of EMC importance as well as self‐confidence in managing emergencies. After the course, 71% shared the opinion that retraining should be obligatory for all medical personnel. At the same time, students’ self‐assessment of confidence for specific tasks got significant upgrades in every aspect. Conclusion: The evaluation data clearly show the participants’ needs to deal with topics of EMC within the curriculum of dentistry. The proposed course is able to change participants’ attitudes towards EMC and its importance for their daily practice. The considerable enhancement of self‐confidence in performing EMC‐techniques might also lead to more willingness to manage emergency situations.     

Do we need cardiac arrest centres in Australia?

The mortality rate post admission to hospital after successful resuscitation from out‐of‐hospital cardiac arrest is high, with significant variation between regions and individual institutions. While prehospital factors such as age, bystander cardiopulmonary resuscitation and total cardiac arrest time are known to influence outcome, several aspects of post‐resuscitative care including therapeutic hypothermia, coronary intervention and goal‐directed therapy may also influence patient survival. Regional systems of care have improved provider experience and patient outcomes for those with ST elevation myocardial infarction and life‐threatening traumatic injury. In particular, hospital factors such as hospital size and interventional cardiac care capabilities have been found to influence patient mortality. This paper reviews the evidence supporting the possible development and implementation of Australian cardiac arrest centres.