初级心肺复苏44例分析

目的:分析本院两年来急诊初级心肺复苏情况,为进一步提高心肺复苏成功率提供依据。方法:回顾性分析本科2004年1月～2005年12月间44例心肺复苏病例。观察其心跳骤停发生地点、骤停时间、病因、肾上腺素用量、有无电除颤及机械通气等指标。结果:成功组复苏前骤停时间比失败组短(P<0.05);在院内发生骤停的复苏成功率比院外要高(P<0.01);成功组需要的胸外按压时间和肾上腺素总量均低于失败组(P<0.05)。结论:影响心肺复苏成功的基础因素包括心肺复苏前骤停的时间、地点、基础病,在心肺复苏过程中是否及时开放气道、进行胸外按压的时间、肾上腺素的用量等可预测复苏的成功率。     

心肺复苏与线粒体功能的研究进展

正心跳骤停是临床常见的急危重症,心跳骤停后心肺复苏(CPR)初期自主循环恢复成功的病人存活率低,病死率高。研究表明自主循环恢复患者中,约66.7%的院外心跳骤停患者和22.9%院内心跳骤停患者死于脑损伤,存活患者中40%-50%出现永久性的认知功能障碍[1]。因此,心肺脑复苏领域的研究任重而道远。近年来调节线粒体功能作     

影响院前心跳呼吸骤停存活出院率的部分因素分析

目的:探讨影响院前心跳呼吸骤停存活出院率的因素。方法:采用回顾性研究方法,以广东省佛山市第一人民医院急诊科2015年10月至2017年6月诊治的院前心跳呼吸骤停患者98例为研究对象,分析影响院前心跳呼吸骤停患者存活出院率的因素。结果:影响院前心跳呼吸骤停患者存活出院率的因素较多,包括有无第一目击者、是否专业急救人员、心跳骤停时的心电图类型(心室颤动、心电静止及无脉性电活动)等主要因素,且存活组与死亡组间存在明显差异(P0.05)。结论:院前心跳呼吸骤停患者存活率的影响因素较多,其中目击者、专业急救人员、心跳骤停时的心电图类型(心室颤动、心电静止及无脉性电活动)对院前心跳呼吸骤停患者存活率的影响较大,应加强此方面的培训与识别。     

心肺复苏75例临床分析

目的：探讨心跳呼吸骧停患者心肺复苏的程序及影响因素,以提高心肺复苏成功率。方法：回顾75例心跳呼吸骤停心肺复苏患者的临床资料,分析病因、开始复苏时间、复苏程序及方法对心肺复苏结果的影响。结果：早期组复苏有效率和成功率都明显高于晚期组（P〈0．05）,除急性内科疾病患者心肺复苏成功率较高外（60％）,其它疾病复苏成功率均较低（约20％）。结论：心肺复苏抢救成功与否与开始复苏时间、骤停前重要脏器功能密切相关,当心跳呼吸骤停发生时要强调实施早期现场心肺复苏,加强及时电除颤、气管插管使用,大剂量肾上腺素可增加自主循环恢复率,同时注重原发病和脑复苏处理。     

急性心跳呼吸骤停救治临床分析

目的探讨急性心跳呼吸骤停的临床救治效果,进一步提高心肺复苏的救治成功率。方法选取南方医科大学第五附属医院2012年1月至2014年11月收治的66例心跳呼吸骤停患者的临床资料,记录患者的复苏时间、病因、复苏场所及成功率数据资料之间的关系。结果心血管和呼吸系统疾病是心跳呼吸骤停的主要病因,且抢救治疗成功率较其他病因偏低,复苏地点与复苏开始时间对临床抢救成功结局具有一定的影响,66例患者经过心肺复苏的救治,共有28例患者成功,其余失败,成功率为42.4%。结论患有心血管呼吸系统疾病的患者易发生心跳呼吸骤停,及早采取措施进行救治可以提高心肺复苏的成功率。     

心跳骤停41例抢救体会

我们自 1989～ 1999年共抢救心跳骤停 41例 ,其中心肺复苏成功 2 6例 ,脑复苏成功 10例。现对影响心肺脑复苏的各种因素作一回顾性分析。1　临床资料1 1　一般资料　本组 41例 ,其中男 2 4例 ,女 17例 ,年龄 15～ 71岁。病因 :电击伤 5例 ,溺水 3例 ,药物中毒 6例 ,脑血管疾病 4例 ,心脏病 2 3例。心跳骤停时间 :心跳骤停时间 1～ 4ｍｉｎ 2 8例 ,～ 8ｍｉｎ 9例 ,～ 12ｍｉｎ 4例。骤停时室颤 2 7例 ,停搏 9例 ,心电机械分离 5例。1 2　复苏药　确诊心跳骤停时 ,即行心肺复苏术 (ＣＰＲ) ,ＣＰＲ用药 :肾上腺素每次 1ｍｇ ,最大剂量为每次 …     

23例重度有机磷农药中毒致心跳骤停23例抢救体会

[目的]总结23例重度有机磷农药中毒致心跳骤停的治疗经验.[方法]对23例有机磷农药中毒致心跳骤停患者的治疗情况进行回顾性分析.[结果]23例患者抢救治疗2小时至14天,心肺脑复苏成功12例;心肺复苏成功6例,3例患者遗留有智力障碍,2例最终因MODS而死亡,1例放弃抢救;5例心肺复苏失败;心肺复苏成功总计18例,成功率78.3%,存活15例,存活率65.2%,死亡8例,病死率34.8%.其中一例分别于中毒后2h、d3心跳骤停2次,抢救成功.[结论]心脏骤停后立即实施心肺复苏CPR和尽早电除颤,积极的脑复苏,同时有效的毒物清除措施和解毒药物的正确使用防止了毒物对机体的继续损害和心跳骤停的再次发生.     

电话指导现场心肺复苏临床效果观察

目的急救队员在接到呼吸心跳骤停的求救电话后,在赶往现场的途中给予目击人电话指导如何立即心肺复苏抢救,分析其对急救效果的影响。方法回顾性分析2008年12月-2010年12月,经120呼救的呼吸心跳骤停患者108例,按目击者是否接受电话指导分为未指导组(n=61)和指导组(n=47),观察两组在复苏成功率及出院(患者)存活率等方面的差异。结果指导组47例患者中,呼吸心跳恢复12例,复苏成功率25.5%,其中7例存活,5例未留任何后遗症;而未指导组61例中,呼吸心跳恢复4例,成功率6.6%,1例植物状态出院;两组在复苏成功率及出院存活率上有明显差异,且是否参加过心肺复苏术培训也有差异。结论现场第一目击者在等待专业救护人员到来之前,接受电话指导后,能完成初级生命支持,为后续复苏赢得宝贵时间,大大提高了复苏成功率。     

ICU内心肺复苏的执行与结果分析

目的:探讨ICU内心肺复苏的执行与结果。方法:以队列研究的方式,前瞻性观察我院经培训的ICU医生实施心肺复苏的具体情况。结果:(1)心跳呼吸骤停有三种形式,以心跳骤停为主,且以室性逸搏最多。(2)均能给予人工通气,首次除颤成功率88.5%。(3)呼吸骤停组及室速 室颤组复苏成功率高(23.8%比2.9%,P<0.01;42.9%比14.5%,P<0.05),室性逸搏 等电位线组复苏成功率低(15.5比70.5%,P<0.01)。结论:ICU内心跳呼吸骤停的最多形式是室性逸搏。呼吸骤停及室速、室颤的复苏成功率高,而室性逸搏的复苏成功率低。     

急诊心肺复苏140例临床分析

目的分析因心跳骤停（CA）来院急救的140例患者行心肺复苏后的结果及影响心肺复苏的相关因素,为有效的心肺复苏提供临床参考资料。方法选择2009年1月至2010年1月四川省人民医院城东病区急救的140例心跳骤停患者,分析患者复苏的方式、急救时间及复苏的结果等,为临床心肺复苏提供有价值的参考材料。结果复苏失败122例,成功18例,其中3例痊愈出院。复苏的方式、时间等对心肺复苏结果有重要影响。结论心跳骤停是急诊医学中的常见情况,急诊工作者要在尽可能短的时间内进行正确的心肺复苏才能提高患者的存活率。     

院前心脏停搏与院内心脏停搏复苏存活率的比较

目的：分析我院急诊中心心脏停搏患者心肺复苏（CPR）存活率及其影响因素,并比较院前发生心脏停搏与院内发生心脏停搏复苏存活率。方法：对我院急诊中心78例心搏骤停（cardiacarrest,CA）患者的资料进行回顾性分析,比较院前发生心搏骤停组和院内发生心搏骤停组的CPR开始时间（从心脏停搏至CPR开始时间）、气管插管时间、CPR持续时间、开始除颤时间、除颤次数、肾上腺素用量及存活率。结果：院前组复苏存活率2．86％,院内组复苏存活率11．62％。两组CPR开始时间、气管插管时间、存活率比较差异有统计学意义（P〈0．01）,CPR持续时间、除颤次数及肾上腺素用量比较差异无统计学意义。结论：院前心脏停搏较院内心脏停搏复苏存活率低,与“生命链”未彻底落实及急救水平低有关。普及全民急救知识,加强完善急救医疗体系建设,早期除颤及早期亚低温治疗,是提高CPR成功率及复苏存活率的重要措施。     

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.     

Characteristics of prehospital cardiac arrest patients in Japan and determinant factors for survival

Two hundred forty-seven consecutive patients who had prehospital cardiac arrest and were transferred to a municipal hospital were studied to elucidate the characteristics of these patients and to investigate factors for improving the survival rate among prehospital cardiac arrest patients. Detailed information on 130 patients with cardiac etiology was analyzed: 110 were confirmed dead in the emergency department (group A); 14 survived less than 1 week (group B); 6 survived longer than 1 week (group C). Only one patient received cardiopulmonary resuscitation (CPR) from a bystander, and none received electrical defibrillation before arriving at hospital because, at the time, emergency personnel were not allowed to perform advanced life support (ALS) in Japan. The three characteristics for better prognosis after prehospital cardiac arrest were found to be as follows: being witnessed on collapse, receiving prompt ALS, and ventricular fibrillation on arrival at hospital. The survival rate would have been higher if more lay people could have performed CPR and if emergency unit personnel had been allowed to perform ALS.     

两种不同复苏方法对院前心搏骤停患者初期复苏效果的随机对照研究

目的：比较主动加压减压心肺复苏(ACD—CPR)和标准心肺复苏(CPR)对于院前发生心搏骤停患者的初期复苏效果，探讨ACD—CPR对院前心搏骤停患者的疗效。方法：将在急诊重症监护室(EICU)发生心搏骤停的92例患者按照区组随机的方法分为ACD—CPR组和标准CPR组，比较两组在复苏开始后1、3、5、10、15和30min时的收缩压(SBP)、自主循环恢复率(ROSC)和入院率。结果：ACD—CPR组3、5、10和l5min时SBP均高于标准CPR组(P均＜0．05)。ACD—CPR组思者的ROSC(52．5％)高于标准CPR组(27．8％)，也具有显著的统计学差异(P＜0．05)。ACD—CPR组的收住院率(21．3％)也高于标准CPR组(15．3％)，但无统计学意义。结论：ACD—CPR在改善院前发生的非创伤性心搏骤停患者初期复苏效果方面，优于标准CPR。     

出诊医师参与电话指导目击者实施心肺复苏

目的 评估出诊医生参与电话指导目击者实施心肺复苏(CPR)的可行性和有效性,并探讨电话指导的方法及影响电话指导的相关因素.方法 回顾分析2008-01～2009-04 32例院前心脏骤停(CA)患者的救治方法,没有电话指导或指导不成功18例,目击者未实施CPR;出诊医生采用预先制定的电话指导方案成功给予了电话指导14例,目击者实施了CPR.比较两组的复苏结果,并计算通过电话指导方案正确识别CA的比率,目击者对出诊医师电话指导CPR的接受率及CPR正确率等.结果 电话指导目击者25例,接受指导19例(19/25,76%),不接受6例.经指导成功完成CPR 14例(14/19,73.7%),未完成5例.指导人员采用电话指导方案正确识别CA 17例(17/19,89.5%),目击者正确实施CPR 5例(5/14,35.7%).目击者行CPR 14例中院前成活5例(35.7%),目击者未行CPR 18例中院前成活1例(5.6%).院前成活率两组比较有统计学意义(P＜0.01).结论 出诊医生依据简化的电话指导CPR方案参与电话指导目击者实施CPR能提高CA院前复苏结果.但值得注意的是电话指导受诸多因素影响.     

Combination of active compression decompression cardiopulmonary resuscitation and the inspiratory impedance threshold device: state of the art

PURPOSE OF REVIEW: Over the past decade, the combination of active compression decompression (ACD) cardiopulmonary resuscitation (CPR) and an impedance threshold device (ITD) has been shown to significantly increase vital organ perfusion pressures and survival rates in animals and humans. The purpose of this review article is to summarize the recent advances with this new technology. RECENT FINDINGS: Building upon animal studies that demonstrated the benefit of the ITD used with either ACD CPR or standard CPR (S-CPR), four prospective, randomized clinical trials with ACD/ITD CPR have been recently completed. One blinded, out-of-hospital cardiac arrest trial (n = 21 patients) demonstrated that systemic blood pressures and coronary perfusion pressures were markedly higher when ACD/ITD CPR was used when compared directly with ACD CPR alone. The second blinded trial demonstrated that the combination of ACD/ITD CPR was effective with both a facemask and an endotracheal tube (n = 15 patients). A third randomized clinical trial (n = 210 patients) demonstrated that 24-hour survival rates for out-of-hospital cardiac arrest were more than 65% higher with ACD/ITD CPR than with S-CPR (P < 0.01). Neurologic function after cardiac arrest trended higher in patients with witnessed arrest who received ACD/ITD CPR than in those who received S-CPR(P < 0.07). In addition, when ACD/ITD CPR was applied later in the course of treatment, short-term survival rates were threefold higher in patients receiving ACD/ITD CPR (44%) than in those receiving S-CPR (14%)(P < 0.05). In that study, patients with the greatest chance for survival-those with witnessed cardiac arrest and an initial rhythm of ventricular fibrillation-had a 23% 24-hour survival rate with S-CPR versus a 58% 24-hour survival rate with ACD/ITD CPR (P < 0.01). It should be noted that this trial was performed in a city where an earlier study found no difference in outcomes between ACD CPR alone and S-CPR. The fourth clinical trial was a randomized, double-blinded study of 400 patients with out-of-hospital cardiac arrest treated by advanced life support personnel. All patients received ACD CPR: half were treated with a sham ITD and the other half were treated with an active ITD. Twenty-four hour survival, the primary endpoint, was 32% in the active ITD group versus 22% in the sham group (P < 0.05). SUMMARY: On the basis of the cumulative findings of these studies, it is concluded that ACD/ITD CPR provides superior vital organ blood flow and results in significantly higher short-term survival rates than do ACD CPR alone or S-CPR. Use of the ACD/ITD CPR technology optimizes perfusion of the heart and brain during cardiac arrest and results in the highest reported survival rates of any CPR device technology. Use of this technology should be encouraged while additional studies are under way to examine the potential long-term impact of this new technology.     

在院前心肺复苏中血管加压素的临床研究

目的：研究血管加压素在院前心肺复苏（CPR）中的疗效。方法：在103例心脏骤停患者中随机分为3组，标准肾上腺素组（A组）38例，血管加压素组（B组）34例，肾上腺素＋血管加压素组（C组）31例，各组分别观察自主循环恢复率、24h存活率、出院存活率、脑复苏率、自主循环恢复时间及复苏后心肌酶变化。结果：B组（44％）、C组（42％）自主循环恢复率明显高于A组（16％），B组（38％）、C组（39％）24h存活率也明显高于A组（13％），C组出院存活率（23％）高于A组（8％）、B组（12％）；脑复苏率3组无差异；B组、C组自主循环恢复时间明显短于A组；复苏后心肌酶变化3组无差异。结论：在心肺复苏期间应用血管加压素比用肾上腺素可明显提高自主循环恢复率、24h存活率，缩短自主循环恢复时间，与肾上腺素联合应用还可提高出院存活率。     

心脏骤停患者心肺复苏抢救中的影响因素分析

目的 探讨心脏骤停患者心肺复苏抢救中的影响因素。方法 回顾性收集2015年9月-2018年9月急救中心收治的304例成年心脏骤停患者的临床数据,包括患者基本人口学信息、现场心肺复苏(cardio-pulmonary resuscitaion,CPR)情况[包括是否有目击者、目击者是否实施CPR、胸部按压分数(chest compression fraction,CCF)、到达急救中心时间等],患者24 h的存活率,采用单因素分析和Logistic回归分析研究心脏骤停患者CPR后24 h存活率的影响因素。结果 单因素分析发现,目击者是否进行CPR及接受不同CCF的患者,其24 h存活率比较,差异有统计学意义(P＜0.05);Logistic回归分析显示,CCF≤80%为24 h存活率的危险因素(P＜0.05),目击者进行CPR为24 h存活率的保护因素(P＜0.05)。结论 对心脏骤停患者,目击者尽早实施CPR及增加有效持续胸部按压时间,能够提高心脏骤停患者心肺复苏后的24 h存活率。     

385例院前心肺复苏成败的原因及探讨

目的:通过分析院前死亡病因及现场复苏成败的原因,进一步提高院前急救复苏有效率。方法:回顾性分析我区急救中心2000年1月-2003年12月385例院前心肺复苏病例资料。结果:本组385例死亡原因以心血管疾病、外科创伤、脑血管疾病、不明原因为前4位;全部病例在急救人员到达前均未开展心肺复苏((CPR),其中有最初目击者155例(40.3％);急救中心接到呼救并派出救护车到达现场平均间期在复苏有效组与无效组中分别为8.32min和10.23 min;所有病例经现场复苏无效死亡360例(93.5％),现场复苏有效25例(6.5％),复苏成功1例(0.26％);由急救人员行除颤、气管内插管(或喉罩插管)现场复苏有效率分别为21.2％和33.3％,而未行除颤、气管内插管(或喉罩插管)现场复苏有效率分别为2.3％和0.6％,两者差别有显著意义(P<0.01)。结论:识别高危人群,在人群中普及以CPR为主的初级救护知识,由最初目击者及早开展CPR,尽可能缩短呼救-到达现场间期,早期除颤及气管内插管(或喉罩插管),可提高院前急救复苏有效率。     

Early mechanical cardiopulmonary resuscitation can improve outcomes in patients with non-traumatic cardiac arrest in the emergency department

ObjectiveTo compare the outcomes of patients with non-traumatic cardiac arrest (CA) who received early versus late mechanical cardiopulmonary resuscitation (CPR) with the Lund University Cardiac Assist System (LUCAS) device in the emergency department (ED).MethodsThis was a retrospective observational study in the ED of a single medical center performed from May 2018 to December 2019; 68 patients with CA were eligible. We grouped the patients according to the time to initiating LUCAS use after CA into an early group (≤4 minutes) and late group (>4 minutes).ResultsThe rate of return of spontaneous circulation (ROSC) was higher in the early group vs the late group (69.2% vs 52.4%, respectively). The 4-hour survival rate was significantly higher in the early group vs the late group (83.3% vs 45.5%, respectively), and CPR duration was significantly shorter in the early group (23.3 ± 12.5 vs 31.1 ± 14.8 minutes, respectively).ConclusionEarly mechanical CPR can improve the success of achieving ROSC and the 4-hour survival rate in patients with non-traumatic CA in the ED, considering that more benefits were observed in patients who received early vs late LUCAS device therapy.