心肺复苏后血浆组织因子和组织因子途径抑制物的变化及银杏达莫的干预研究

目的 探讨大鼠心肺复苏后血浆中组织因子(TF)和组织因子途径抑制物(TFPI)含量改变以及银杏达莫干预后对其影响.方法 成年雄性SD大鼠120只,随机分为对照组(A组)、复苏组(B组)、银杏达莫组(8 mL/kg)(C组),再分别按气管切开后(对照组)或自主循环恢复(Rose)后(复苏组和银杏达莫组)0.5、3、6、9和24 h分为五个亚组,每组8只.建立窒息型大鼠心肺复苏模型,分别于各时间点取血,使用ELISA法测定各组大鼠血浆中TF和,TFPI的含量.结果 B组心肺复苏后各时间点血浆TF较A组显著升高(P<0.01),9 h达到峰值;C组心肺复苏后各时间点血浆TF含量较A组显著升高(P<0.01),较B组分别在6、9、24 h显著下降(P<0.01).B组各时间点TFPI含量较A组均无显著变化(P>0.05),C组24 h TFFPI较A组升高(P<0.05).结论 心肺复苏后血浆TF含量显著升高,但同期TFPI并无明显变化,存在明显的凝血和抗凝作用失衡;银杏达莫注射液可降低心肺复苏后血浆TF含量,提高TFPI含量,恢复凝血和抗凝的平衡.     

不同治疗方法对急性心肌梗死患者血浆组织因子及组织因子途径抑制物的影响

目的 观察急性心肌梗死(AMI)患者血浆组织因子(TF)、组织因子途径抑制物(TFPI)水平的变化及不同治疗方法对血浆TF、TFPI的影响,探讨其意义.方法 将80例AMI患者依治疗方案不同分为介入治疗组(40例)和药物(低分子肝素)治疗组(40例),在两组患者入院时及治疗后6 h、24 h、1周采集外周静脉血,以ELISA法测定TF、TFPI水平,分析其动态变化,并以20名健康人作为对照组.结果 AMI患者血浆TF和TFPI水平均高于正常对照组(P<0.01),介入治疗组术后6 h血浆TF水平略有升高,之后出现下降,至术后1周仍高于治疗前(P<0.05);药物治疗组用药后TF 水平呈明显逐渐下降趋势;AMI患者血浆TFPI水平于治疗后均出现升高(P<0.05,P<0.01),且以药物治疗组更显著.结论 AMI发生时TF途径被启动,TFPI随之激活,抑制TF诱发的凝血过程,低分子肝素抗凝治疗较单纯急诊介入治疗促进TFPI发挥抗外源性凝血效果更明显.     

心肺复苏患者凝血功能和血管性血友病因子动态变化及其与预后的关系

目的 探讨心肺复苏(CPR)不同预后患者凝血功能、血管性血友病因子(vWF)动态变化及意义.方法 选择50例心搏骤停后CPR患者,依复苏最终结果分为3组.复苏失败组25例,患者初期复苏成功、自主循环恢复(ROSC)≥72 h,但最终死亡;存活组10例,患者复苏成功,康复出院;死亡组15例, CPR 30 min后无效死亡,或虽复苏成功但ROSC<2 h.于CPR过程中及ROSC 24、48、72 h取血检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fg)、血小板计数(PLT)、D-二聚体、抗凝血酶Ⅲ(ATⅢ)、vWF水平的动态变化.结果 死亡组CPR过程中PT、APTT、TT、D-二聚体、vWF均高于复苏失败组和存活组,Fg、PLT、ATⅢ均低于复苏失败组和存活组(P均<0.01);而复苏失败组和存活组各指标比较差异均无统计学意义(P均>0.05).复苏失败组和存活组ROSC 24 h起PT、APTT、TT、D-二聚体、vWF水平升高,Fg、PLT、ATⅢ降低,均于ROSC 48 h达峰值或谷值(P<0.05或P<0.01);ROSC 72 h存活组各项指标较ROSC 48 h明显改善(P均<0.01),而复苏失败组则改善不明显(P均>0.05).复苏失败组ROSC 24、48、72 h PT、APTT、TT、D-二聚体、vWF水平显著高于存活组,Fg、PLT、ATⅢ显著低于存活组(P<0.05或P<0.01).结论 心搏骤停和随后CPR患者存在组织和血管内皮细胞损伤以及内/外源性凝血功能紊乱,纤溶功能紊乱;其变化对病情严重程度及预后有重要的判断价值.     

乌司他丁对大鼠心肺复苏后早期血清S-100B蛋白和NSE的影响

目的 探讨乌司他丁(UTI)对大鼠心肺复苏(CPR)后早期血清S-100B蛋白、神经元特异性烯醇化酶(NSE)及海马病理改变的影响及作用.方法 成年雄性SD大鼠随机分为假手术对照组、复苏组和UTI组,每组10只.采用窒息法致复苏组和UTI组大鼠心脏骤停(CA),继而进行心肺复苏(CPR).UTI组于自主循环恢复(ROSC)后2 min内经颈动脉推注注射用UTI 100 000 U/kg,与生理盐水配伍成2 mL溶液.对照组仅行麻醉、气管切开和血管穿刺.复苏组和UTI组于ROSC后1 h,对照组于气管切开后1 h经颈动脉取血和快速断头取左侧脑海马组织.采用双抗体夹心酶联免疫吸附法(ELISA)分别检测血清S-100B蛋白与NSE水平;光镜下观察海马的病理改变.结果 与假手术对照组比较,复苏组和UTI组大鼠血清S-100B蛋白与NSE浓度在ROSC后1 h均明显升高(P<0.01);与复苏组比较,UTI组大鼠血清S-100B蛋白浓度显著降低(P<0.01),而NSE的浓度降低不明显(P>0.05).UTI组病理损害轻于复苏组.结论 UTI能降低大鼠CPR后早期(1 h)血清S-100B蛋白和NSE水平,减轻病理损伤,对CPR过程中的脑组织具有保护作用.     

心肺复苏后大鼠血清神经元特异性烯醇化酶、S100β蛋白对脑损伤诊断的价值

目的观察大鼠心肺复苏后血清神经元特异性烯醇化酶(NSE)和S100β蛋白水平变化,确立CPR后脑损伤具有早期诊断价值的生化指标。方法选择成年雄性Sprague-Dawley大鼠50只,采用窒息合并冰氯化钾停跳液制备大鼠心跳骤停-心肺复苏模型。随机分为5组:对照组即假手术组10只,自主循环恢复(ROSC)后6、12、24、48h组各10只。停跳5min后开始心肺复苏,采用双抗体夹心酶联免疫分析法为对照组及ROSC后6、12、24、48h组进行动态观测血清中NSE、S100β蛋白水平变化。结果在ROSC后6、12、24、48h组的血液中NSE、S100β蛋白水平与对照组比较都有显著升高(P<0.05),但指标升高的时间和幅度并不一致。与对照组比较,血清NSE在24h时点、S100β蛋白在6h时点升高水平差异有极其显著性(P<0.01)。结论血清NSE、S100β蛋白水平可作为评价CPR后脑损伤具有早期诊断价值的指标。     

乌司他丁对大鼠心肺复苏后血清与海马CA1 区S100β蛋白变化的作用

目的 探讨乌司他丁对大鼠心肺复苏(CPR)后脑含水含量、血清S100β蛋白及海马CA1区S100β蛋白表达变化的影响.方法 成年雄性SD大鼠120只,随机分为假手术对照组(n=40)、复苏组(n=40)、乌司他丁组(n=40),每组按气管切开后(对照组)或自主循环恢复(ROSC)后(复苏组、乌司他丁组)0.5 h,3 h,6 h,12 h和24 h分为5个亚组(n=8).复苏组和乌司他丁组采用窒息致大鼠心脏骤停(CA)和心肺复苏(CPR)模型,乌司他丁组于ROSC后2 min内经颈动脉推注注射用乌司他丁(10万u/k).对照组仅行麻醉、气管切开和血管穿刺.分别于各时间点取血和组织标本,以干湿比质量法测定脑组织含水量;ELISA法检测血清S100β蛋白质量浓度,免疫组化测定海马S100β蛋白的表达.数据处理应用SPSS 10.0软件,多组比较采用方差分析.方差齐性检验采用用Levene's 法,方差齐性时采用LSD法,方差不齐时采用Tamhane's检验,相关分析采用Person's法.结果 与对照组比较,复苏组Rose后各亚组脑含水量显著升高(P<0.05或P<0.01),与复苏组比较,乌司他丁组12 h,24 h脑含水量显著降低(P<0.05).与对照组比较,复苏组血清S100β蛋白ROSC后0.5 h起即明显升高,并持续上升至12 h达峰值,24 h有所回落,差异具有统计学意义(P<0.01);与复苏组比较,乌司他丁组ROSC后6 h、12 h、24 h显著降低(P<0.01).免疫组化显示对照组海马CA1区S100β蛋白阳性细胞均维持在较低水平,复苏组ROSC后各时相海马CA1区S100β蛋白阳性细胞数均显著高于对照组(P<0.05或P<0.01);与复苏组比较,乌司他丁组从ROSC后6 h起S100β蛋白阳性细胞表达显著降低(P<0.05).且复苏后各时相海马CA1区S100β蛋白与脑含水量密切相关(r=0.862,P:0.015).结论 乌司他丁能降低大鼠心肺复苏后血清S100β蛋白、海马CA1区星形胶质细胞S100β蛋白表达和脑水肿程度,从而减轻脑损伤.     

创伤弧菌脓毒症血浆组织因子和组织因子途径抑制物的改变及抗菌药物的影响

目的探讨大鼠创伤弧菌(VV)脓毒症血浆中组织因子(TF)和组织因子途径抑制物(TFPI)的改变以及头孢哌酮钠与乳酸左氧氟沙星联用对其的影响。方法制作大鼠VV脓毒症模型(VV组)和VV脓毒症药物干预模型(AA组),使用ELISA法测定各组大鼠血浆中TF和TFPI的含量。结果与正常对照组(NC组)相比,VV组在染菌后9 h、12 h血浆TF显著升高(P＜0．05),各时间点血浆TFPI含量无显著改变(P＞0．05);9 h、12 h的TFPI/TF比值有显著性下降(P＜0．05)。AA组染菌后9 h、12 h血浆TF明显高于NC组(P＜0．05),TFPI/TF比值在抗菌药物干预后逐渐上升,16 h时点该比值明显高于NC组(P＜0．05)。与相同时间点的VV组比较,AA组染菌后12 h血浆TF明显减低(P＜0．05),12 h、16 h血浆TFPI明显升高(P＜0．05),9 h、12 h、16 h的TFPI/TF比值亦明显升高(P＜0．05)。结论创伤弧菌脓毒症时血浆TF含量显著升高,但同期TFPI并无明显减低或升高,TFPI/TF比值减低;头孢哌酮钠联用乳酸左氧氟沙星可减低血浆TF含量,提高TFPI/TF比值。创伤弧菌脓毒症时存在明显的促凝和抗凝作用的失衡,抗菌药物干预后可使促凝和抗凝平衡被逐渐恢复。     

银杏达莫注射液对大鼠心肺复苏后血清低氧诱导因子-1α水平变化的影响

目的 观察大鼠心肺复苏(CPR)后血清低氧诱导因子-1α(HIF-1α)含量及大脑皮质的病理变化,探讨银杏达莫注射液对大鼠CPR后脑损伤的干预作用.方法 将160只成年雄性SD大鼠随机分为对照组、模型组、银杏达莫组低剂量组(0.8 ml/kg)、银杏达莫高剂量组(1.6 ml/kg),每组再分别按气管切开后(对照组)或自主循环恢复(ROSC)后(其余各组)0.5、3、6、9和24 h分为5个亚组,每个亚组8只大鼠.建立大鼠窒息型心脏停搏(CA)与CPR模型.以酶联免疫吸附法(ELISA)测定血清HIF-1α含量,光镜下观察大脑皮质病理改变.结果 对照组血清HIF-1α含量复苏后一直维持在较低水平;与对照组比较,模型组和银杏达莫高、低剂量组从ROSC后3 h起即显著升高,并持续至24 h,差异均有统计学意义(P均<0.01);与模型组比较,银杏达莫高、低剂量组血清HIF-1α含量于ROSC 3～24 h显著降低,且高剂量组降低幅度更为显著(P<0.05或P<0.01).银杏达莫高、低剂量组大脑皮质病理改变较模型组明显减轻.结论 大鼠CPR早期存在明显的脑损伤;银杏达莫注射液能明显减轻复苏后脑损伤,且该作用可能具有量效关系.     

山莨菪碱对心肺复苏后患者血清NSE和S100蛋白水平及神经功能的影响

目的 探讨山莨菪碱对心肺复苏(CPR)后患者血清神经元特异性烯醇酶(NSE)、S100蛋白水平及神经功能的影响.方法 53例心搏骤停后经心肺复苏心搏恢复≥72h、需要进一步生命支持的患者,随机分为山莨菪碱组27例(山莨菪碱+常规综合治疗)和常规组26例(单纯常规综合治疗).分别于治疗后不同时间点检测血清NSE、S100蛋白水平,并以格拉斯哥昏迷评分(GCS)和神经功能缺损评分(NFI)判断临床疗效.结果 与常规组比较,山莨菪碱组治疗后血清NSE、S100蛋白水平显著降低(P<0.05或P<0.01),GCS评分显著增高(P<0.05或P<0.01),NFI评分显著降低(P<0.05或P<0.01).结论 山莨菪碱通过降低血清NSE、S100蛋白水平对心肺复苏后脑损伤起到一定保护作用.     

子痫前期患者组织因子、组织因子途径抑制物与血清可溶性血管内皮生长因子受体1的相关性

目的探讨子痫前期患者外周血组织因子(TF)、组织因子途径抑制物(TFPI)与及可溶性血管内皮生长因子受体1(s Flt-1)水平的相关性。方法酶联免疫吸附试验(ELISA)检测健康孕妇、非重度子痫前期孕妇、重度子痫前期孕妇血浆TF、TFPI水平以及血清s Flt-1水平;免疫组化检测各组胎盘TF抗原的表达。结果 3组患者血浆及胎盘TF、血清s Flt-1水平均有显著差异,且随病变程度的增加逐渐升高。3组TF/TFPI比值有显著差异,随病变程度的增加亦逐渐升高。与非重度PE组相比,重度PE组血清s Flt-1水平显著升高(P0.05)。在子痫前期患者中,血浆TF、TF/TFPI比值与血清s Flt-1水平呈正相关。3组中胎盘TF表达与血清s Flt-1水平无相关性。在TF165.9 pg/m L组中,血浆、胎盘TF、血浆TFPI与血清s Flt-1水平呈正相关。结论子痫前期患者血浆TF、TF/TFPI比值与血清s Flt-1水平存在正相关关系。     

生脉注射液对家兔心搏骤停模型自主循环恢复和复苏早期血流动力学的影响

目的 探索生脉注射液对心搏骤停动物模型的自主循环恢复和复苏后早期血流动力学的影响,为心搏骤停复苏后动物的后续研究提供稳定循环的辅助支持.方法 将家兔30只随机(随机数字法)分成两组各15只,采用窒息法建立心搏骤停动物模型;生脉组在复苏开始即刻给予2mL/kg生脉注射液静注,自主循环恢复后10 min再次给予相同剂量一次;盐水组给药时间和盐水剂量与生脉组相同.记录家兔心搏骤停时间、自主循环恢复时间和自主呼吸恢复时间,分别记录窒息前和自主循环恢复即刻、ROSC后30 min,60 min和120 min的左室收缩压(LVSP)、左室等容收缩期最大上升速率(+dp/dtmax)和等容舒张期最大下降速率(-dp/dtmax)、左室舒张末压(LVEDP)等血流动力学指标的变化.计算自主循环恢复率与6 h存活率.结果 生脉组和盐水组家兔在心搏骤停时间、自主呼吸恢复时间、自主循环恢复率以及6 h存活率等指标之间的比较,差异无统计学意义(P＞0.05),但生脉组家兔自主循环恢复时间要明显早于盐水组;两组家兔在自主循环恢复30 min,60min和120 min的左室收缩压(LVSP)、左室等容收缩期最大上升速率(+dp/dtmax)和等容舒张期最大下降速率(-dp/dtmax)与窒息前相比明显降低,但左室舒张末压(LVEDP)升高(P＜0.05);生脉组在相应时间点的左室收缩压(LVSP)、左室等容收缩期最大上升速率(+dp/dtmax)和等容舒张期最大下降速率(-dp/dtmax)高于盐水组,左室舒张末压(LVEDP)低于盐水组(P＜0.05).结论 生脉注射液辅助用于心搏骤停家兔心肺复苏,可缩短家兔自主循环恢复时间,并且可改善其自主循环恢复后心肌舒缩功能,有利于复苏后血流动力学的稳定.     

海南省多中心心肺复苏Utstien模式注册研究

目的 本研究以心肺复苏乌斯坦因(Utstein)评估模式评价海南省13家医院心搏骤停患者流行病学特征、心肺复苏结果及其影响因素。方法 在Utstein指南基础上设计“海南省心肺复苏Utstein注册登记表”,在2007年1月1日至2010年12月31日期间对海南省13家医院急诊科心搏骤停心肺复苏患者实施注册登记。通过方差分析等统计学方法,对心肺复苏患者实施前瞻性描述性研究。结果 1125例心搏骤停患者男性占73.8％,女性26.2％,年龄为(53.9±13.1)岁,既往病史以冠心病最为多见,其次为高血压病;自主循环恢复率为23.8％,成活出院为7.4％。自主循环恢复和成活出院的患者中发病l min内获得心肺复苏患者所占比例分别为41.8％和49.4％。院内心搏骤停(IHCA)患者和院外心搏骤停(OHCA)患者ROSC率分别为36.3％,11.6％,成活出院率分别为11.5％,3.3％。心室纤颤/无脉性室性心动过速患者188例(16.7％),其自主循环恢复率及成活出院率分别为58.0％,21.8％。心源性心搏骤停448例(39.8％);其中院内与院外心搏骤停患者自主循环恢复率分别为36.3％,11.6％,成活出院率分别为11.5％,3.3％。非心源性心搏骤停677例(60.2％)。三级医院和二级医院自主循环恢复率分别为69.8％和30.2％,成活出院率分别为7.4％和7.3％。结论 心搏骤停更常见于男性。慢性疾病在本组患者中普遍存在,其中以冠心病和高血压病最为多见。院内心搏骤停患者自主循环恢复和成活出院率均明显高于院外心搏骤停患者。心室纤颤/无脉室性心动过速患者心肺复苏自主循环恢复及成活出院率高于其他类型初始心律的患者。缩短心肺复苏启动时间有助于提高自主循环恢复率及成活出院率。     

中晚期肿瘤患者围术期血浆TF和TFPI水平变化及意义

目的　观察中、晚期肿瘤患者围术期血浆组织因子 (TF) ,组织途径抑制物 (TFPI)水平的变化 ,旨在了解患者在围术期机体的凝血活性状态 .方法　采集 58例恶性肿瘤患者作为观察组I,1 6例良性肿瘤患者作为观察组II及 2 0例非肿瘤手术患者作为正常对照组 ,运用ELISA法检测血浆TF和TFPI的水平。结果　恶性肿瘤患者血浆TF水平较正常对照组术前明显升高 (P <0 .0 5) ,术中继续有轻微升高 (P <0 .0 1 )的现象 ,肺癌患者术中升高较明显 (自身术前 ,术后比较P <0 .0 5〉。术后除肺癌患者仍高于对照组外 ,其他基本恢复正常 .良性肿瘤患者在整个围术期无明显变化。而血浆TFPI水平术中有轻微升高 ,术前、术后及良性肿瘤患者与正常对照组比较没有明显的差异。结论　恶性肿瘤患者术前血浆具有较高表达的TF水平较对照组 ,术中继续有轻微升高 ,肺癌患者升高更明显 ,且术后仍处于较高的水平。TFPI术中有轻微的升高。这也许能解释为什么肺癌等恶性肿瘤患者围术期尤其术后易发生深部静脉血栓栓塞及肿瘤转移和复发。     

Periodic acceleration (pGz) CPR in a swine model of asphyxia induced cardiac arrest. Short-term hemodynamic comparisons

BACKGROUND: Asphyxia is one of the most common causes of pediatric cardiac arrest, and becoming a more frequently recognized cause in adults. Periodic acceleration (pGz) is a novel method of cardiopulmonary resuscitation (CPR). pGz is achieved by rapid motion of the supine body headward-footward that generates adequate perfusion and ventilation during cardiac arrest. In a swine ventricular fibrillation cardiac arrest model, pGz produced a higher return of spontaneous circulation (ROSC), superior neurological outcome, less echocardiography evidence of post resuscitation myocardial stunning, and decreased indices of tissue injury. In contrast to standard chest compression CPR, pGz does not produce rib fractures. We investigated the feasibility of pGz in severe asphyxia cardiac arrest and assessed whether beneficial effects seen in the VF model of cardiac arrest could be realized. METHODS AND RESULTS: Sixteen swine weight 4+/-1 kg were anesthetized, tracheally intubated, and instrumented to measure, hemodynamics and echocardiography. Asphyxia was induced by occlusion of the tracheal tube. After loss of aortic pulsations (median time 10 min) animals were observed for three additional minutes following which all were in cardiac arrest. The animals were then randomized to receive 10 min of pGz or standard chest compression ventilation performed with a commercial device (Thumper). A single dose of epinephrine (adrenaline) and sodium bicarbonate were given and defibrillation attempted if appropriate for a maximum of 10 min. Both groups received fractional inspired O2 concentration of 100% during CPR and after resuscitation. Four animals in each group (50%) had an initial ROSC, however only two of the four initial survivors remained alive 3h after ROSC. There were no significant differences in blood pressure, coronary perfusion pressure during CPR and after early ROSC between groups. pGz treated animals had significantly lower pulmonary artery pressure; 20+/-4 mmHg compared to Thumper 46+/-5 mmHg, 30 min after ROSC (p<0.01). Surviving animals in both groups had severe myocardial dysfunction at 30 min after ROSC. At necropsy, 25% of the Thumper treated animals had rib fractures, while none occurred in the pGz group. CONCLUSIONS: In a lethal model of asphyxia cardiac arrest, pGz is equivalent to standard CPR, with respect to acute outcomes and resuscitation survival rates but is associated with significantly lower pulmonary artery pressures and does not produce traumatic rib fractures.     

冠心病患者血浆TF、TFPI水平的变化及其临床意义

目的　观察冠心病患者血浆组织因子 (TF)、组织因子途径抑制物 (TFPI)水平的变化及其临床意义。方法　 79例临床确诊的冠心病患者 ,其中急性心肌梗死 (AMI组 ) 32例、不稳定型心绞痛 (UAP组 ) 2 7例、稳定型心绞痛 (SAP组 ) 2 0例 ,15例健康对照组作为对照组。采用发色底物法测定血浆TF、TFPI活性。结果　与对照组、SAP组比较 ,AMI组血浆TF、TFPI显著增高 ,三组差异具有显著性意义 (P<0 0 5 ) ;AMI组血浆TF活性与UAP组比较差异无统计学意义 (P >0 0 5 ) ,但TFPI活性较UAP组明显升高 ,两者差异具有显著性意义 (P <0 0 5 )。UAP组血浆TF活性较健康对照组及SAP组明显升高 ,三组间差异具有显著性意义 (P <0 0 5 ) ,UAP组血浆TFPI活性较健康对照组及SAP组差异无统计学意义 (P >0 0 5 ) ;SAP组血浆TF、TFPI活性较健康对照组差异无统计学意义 (P >0 0 5 )。结论　 (1)AMI、UAP患者存在异常激活的高凝状态 ,TF触发的外源性凝血途径在冠脉内血栓形成上发挥重要作用。 (2 )AMI、UAP患者体内TF、TFPI系统存在严重失衡     

Significant factors in predicting sustained ROSC in paediatric patients with traumatic out-of-hospital cardiac arrest admitted to the emergency department

BACKGROUND: Paediatric patients with out-of-hospital cardiac arrest (OHCA) due to trauma pose difficult challenges in resuscitation. Trauma is a major cause of OHCA in children. The aim of this study was to determine which factors were related to predicting a sustained return of spontaneous circulation (ROSC) in paediatric OHCA patients with trauma. METHOD: This retrospective study comprised 115 paediatric patients (56 traumatic and 59 non-traumatic OHCA patients) aged younger than 18 years who had been admitted to the emergency department (ED) from January 2000 to December 2004. We analysed the demographic data and the factors that may have influenced sustained ROSC in the group of OHCA paediatric patients with trauma. The non-trauma group was established as a control group. Survival analysis was used to compare differences in survival rate between trauma and non-trauma OHCA patients. Receiver operating characteristic (ROC) analysis was used to determine the significant in-hospital CPR duration related to sustained ROSC. RESULTS: Initial cardiac rhythm on arrival (P=0.005) and the duration of in-hospital CPR (P<0.001) were significant factors. Patients with PEA or VF had higher rate of sustained ROSC than those with asystole (PEA: P=0.003, VF: P=0.03). In the survival analysis, OHCA children with trauma had a lower chance of survival than non-trauma children as the interval from the scene to the ER increased (P=0.008). Based on the ROC analysis, the cut-off values of in-hospital CPR duration were 25min in OHCA paediatric patients with trauma. CONCLUSION: Several significant factors relating to sustained ROSC were determined in the OHCA paediatric patients with trauma; most importantly, we found that in-hospital CPR may have to be performed for at least 25min to enable a spontaneous circulation to return.     

山莨菪碱对心脏骤停患者氧化应激及心肺复苏效果的影响

目的:探讨山莨菪碱对心脏骤停患者氧化应激及心肺复苏效果的影响。方法:选择急诊科抢救的心脏骤停患者119例,骤停时间≤10min,随机分为对照组和干预组。两组均按照美国心脏学会心肺复苏指南进行标准的心肺复苏,干预组在标准心肺复苏基础上静脉注射山莨菪碱,比较两组患者自主循环恢复(ROSC)率及复苏后24h存活率;分别在自主循环恢复后和复苏24h后测定血清总超氧化物岐化酶(T-SOD)活力、总抗氧化力(T-AOC)和丙二醛(MDA)含量,比较两组间差别。结果:干预组患者自主循环恢复率与对照组比较差异无统计学意义(P>0.01);复苏24h后,干预组患者存活率显著高于对照组(P<0.01);自主循环恢复后及复苏24h后,干预组T-SOD活力和T-AOC显著高于对照组,MDA含量显著低于对照组(P<0.01)。结论:早期应用山莨菪碱可能会减轻心脏骤停患者体内氧化应激,可能有助于提高复苏后24h存活率,但对于短期自主循环的恢复可能没有明显改善。     

Association of delay to first intervention with return of spontaneous circulation in a swine model of cardiac arrest

OBJECTIVE: No single drug improves survival after cardiac arrest, despite success in animal studies. We sought to determine the duration of circulatory arrest after which maximal drug treatment and a rescue shock would fail to achieve return of spontaneous circulation (ROSC). DESIGN/SUBJECTS: Retrospective analysis of 271 swine (20-30 kg) resuscitation attempts during ventricular fibrillation. Protocols were divided into five categories: immediate countershock, cardiopulmonary resuscitation (CPR) with standard-dose drugs, CPR alone, CPR and high-dose epinephrine (CPR+HDE) (0.1 mg/kg), and CPR with a drug cocktail (CPR+DC) of propanolol (1 mg), epinephrine (adrenaline) (0.1 mg/kg) and vasopressin (40IU). Time to first CPR, time to first drug administration, time to first shock, and protocol were examined as predictors of ROSC using logistic regression with Hosmer-Lemeshow test of fit. Probability of ROSC was calculated from logistic curves. MAIN RESULTS: ROSC occurred in 119 of the 271 swine (44%). Time to first drug and the CPR+DC group were predictors of ROSC. Time to first CPR, the CPR+DC group, and the CPR+HDE group were also predictors of ROSC. Time to first rescue shock, the CPR+DC group, and the CPR+HDE groups were predictors of ROSC. In the CPR+DC group, 50% ROSC occurred at a first CPR time of 13.4 min, first drug time of 14.1 min and first rescue shock time of 17.5 min. CONCLUSIONS: Pre-shock delivery of CPR+DC increases the likelihood of ROSC, and reaches 50% with a time of drug delivery of 14.1 min. ROSC rates of 50% may be achievable using an optimized resuscitation in experimental CPR.     

Comparing the survival between extracorporeal rescue and conventional resuscitation in adult in-hospital cardiac arrests: Propensity analysis of three-year data

Aim

Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to have survival benefit over conventional CPR (CCPR) in patients with in-hospital cardiac arrest of cardiac origin. We compared the survival of patients who had return of spontaneous beating (ROSB) after ECPR with the survival of those who had return of spontaneous circulation (ROSC) after conventional CPR.

Methods

Propensity score-matched cohort of adults with in-hospital prolonged CPR (>10 min) of cardiac origin in a university-affiliated tertiary extracorporeal resuscitation center were included in this study. Fifty-nine patients with ROSB after ECPR and 63 patients with sustained ROSC by CCPR were analyzed. Main outcome measures were survival at hospital discharge, 30 days, 6 months, and one year, and neurological outcome.

Results

There was no statistical difference in survival to discharge (29.1% of ECPR responders vs. 22.2% of CCPR responders, p = 0.394) and neurological outcome at discharge and one year later. In the propensity score-matched groups, 9 out of 27 ECPR patients survived to one month (33.3%) and 7 out of 27 CCPR patients survived (25.9%). Survival analysis showed no survival difference (HR: 0.856, p = 0.634, 95% CI: 0.453-1.620) between the groups, either at 30 days or at the end of one year (HR: 0.602, p = 0.093, 95% CI: 0.333-1.088).

Conclusions

This study failed to demonstrate a survival difference between patients who had ROSB after institution of ECMO and those who had ROSC after conventional CPR. Further studies evaluating the role of ECMO in conventional CPR rescued patients are warranted.