自制多功能复苏套管通气效果研究

目的验证自制多功能复苏套管的通气效果,比较自制复苏套管和传统气管插管的置管时间。方法选择12只狗,在麻醉作用下自然呼吸后,检测动脉血气分析,所得数据为对照组。然后用常规插管置管,同时记录置管时间。待狗呼吸平稳后,再次检测动脉血气分析,所记录的置管时间和检测的血气结果做为第1组。然后取出气管插管,1h后再用复苏套管置管,同时记录置管时间。待狗呼吸平稳后,检测动脉血气分析。所记录的置管时间和检测的血气结果做为第2组。对两组置管时间、血气分析值进行比较。结果使用传统气管插管和使用多功能复苏套管协助实验动物呼吸,两组通气效果指标比较,差异无统计学意义(P0.05)。复苏套管置管时间显著小于传统气管插管时间,差异有统计学意义[(42.53±5.45)svs.(61.54±0.54)s,P0.05]。结论自制复苏套管在通气效果上不劣于传统气管插管,由于自制复苏套管结构简单紧凑,节省了抢救时间,有助于提高心肺脑复苏成功率。     

气管插管昏迷患者鼻胃管置管方法的改进

目的探讨更好的气管插管昏迷患者鼻胃管置管方法。方法将286例气管插管昏迷（GCS昏迷评分〈7分）需行鼻胃管置管的患者,按插管月份分为两组,单月为实验组,双月为对照组。实验组采用改进插管法（抬高床头15～30°后直接插入）,对照组采用传统插管法,比较两组插管首次成功率。结果实验组插管首次成功率为90.13%,对照组为60.19%,两组比较差异有统计学意义（P〈0.01）。结论气管插管昏迷患者鼻胃管置管采用抬高床头15～30°后直接插入首次成功率明显高于传统插管法,且操作方便,患者痛苦少。     

球囊与气管插管辅助呼吸在心脏骤停院前急救中的效果比较

目的比较球囊与气管插管辅助呼吸在心脏骤停院前急救中的应用效果。方法 78例心脏骤停院前急救患者随机分为两组,气管插管组(n=38例)采取气管插管辅助呼吸,球囊组(n=40例)采取球囊辅助呼吸,比较两组患者建立通气所需时间、复苏5min后血氧饱和度、复苏成功率、并发症发生率,以及院前急救前和后1 h血气指标(p H、Pa O2、Pa CO2、SO2)变化情况。结果球囊组患者建立通气所需时间明显低于气管插管组(P0.05);球囊组患者复苏5min后血氧饱和度、复苏成功率与气管插管组比较无显著差异性(P0.05);两组患者院前急救后1h血气指标(p H、Pa O2、Pa CO2、SO2)较院前急救前均明显好转(P0.05),两组院前急救后1h血气指标比较无显著差异性(P0.05);气管插管组院前急救中的并发症发生率明显高于球囊组(P0.05)。结论球囊与气管插管辅助呼吸在心脏骤停院前急救中的应用效果基本一致,但前者建立通气所需时间及并发症发生率均明显低于后者,适合院前急救应用。     

经鼻或口气管插管和气管切开在呼吸衰竭患者中的应用探讨

目的研究经鼻或口气管插管和气管切开在呼吸衰竭患者中的治疗效果。方法128例呼吸衰竭患者随机分为A（48例）、B（40例）、C（40例）三组,A组患者经鼻气管插管,B组患者经口气管插管,C组患者行气管切开,观察三组患者治疗前后血气变化、置管时间、肺部感染等情况。结果三组呼吸衰竭患者血气改善时间和血气变化无显著差异,但是A组具有置管时间短、肺部感染少和降低了死亡率等优点。结论经鼻气管插管对呼吸衰竭患者有更好的临床应用价值,安全有效,值得临床推广应用。     

多功能气管导管的设计与临床应用

在气管导管的基础上设计了一种多功能气管导管。由通气管、吸痰管、注药管 ,充、排气管 ,两组气囊组成 ,气管起搏电极及起搏电源线组成 ,使气管呼吸、给药、吸痰、起搏同步进行 ,初步临床应用 ,显示具有方便、实用的特点     

Glidoscope视频喉镜在心肺复苏患者的应用

目的观察Glidoscope视频喉镜气管插管和直接喉镜气管插管在心肺复苏中的应用及其对心肺复苏效果的影响。方法 48例心肺复苏患者按其就诊顺序分为视频喉镜组及直接喉镜组,记录每例患者插管所用时间、患者1次吃插管成功率、记录每例患者因配合气管插管胸外按压中断时间、插管成功2、5、10分钟呼气末二氧化碳分压数值及恢复自主循环例数并作统计学分析。结果两组患者使用视频喉镜组明显缩短平均插管时间、一次插管成功率明显提高、由插管所造成的按压中断明显减少、视频喉镜组插管成功2、5、10分钟呼气末二氧化碳分压平均数值明显高于直接喉镜组、恢复自主循环例数视频喉镜组明显多于直接喉镜组。结论视频喉镜在心肺复苏中有重要应用价值。     

经口、鼻气管插管在新生儿急救中的应用效果对比观察

目的 比较经口和经鼻两种气管插管方式在新生儿急救中的应用效果.方法 124例拟行气管插管患儿,院前急救中行气管插管患儿45例（院前急救组）,其中24例行经口气管插管（A1组）,21例行经鼻气管插管（B1组）.新生儿重症监护室（NICU）中行气管插管患儿79例（NICU组）,其中37例行经口气管插管（A2组）,42例行经鼻气管插管（B2组）.计算首次插管平均操作时间、平均留管时间、首次插管成功率、非计划性拔管发生率及黏膜损伤发生率.结果 院前急救组首次插管平均操作时间为（16.87±3.61）s,平均留管时间为（71.82±30.22）h,首次插管成功率为35％,非计划性拔管发生率为17.8％,黏膜损伤发生率为17.8％;NICU组分别为（11.81 ±2.99）s、（87.05±37.90）h、72％、13.9％、18.9％;两组首次插管平均操作时间、平均留管时间、首次插管成功率比较,P均＜0.05.院前急救环境下,A1、B1组首次插管平均操作时间分别为（14.62±3.12）、（17.33±2.69）s,平均留管时间（66.67±27.37）、（91.43±27.62）h,两组比较P＜0.05.NICU环境下,A2、B2组非计划性拔管发生率分别为24.3％、4.8％,黏膜损伤发生率分别为8.1％、28.6％,两组比较P均＜0.05.结论 新生儿院前急救时经口气管插管效果好于经鼻气管插管,NICU环境下需长时间上机时经鼻气管插管效果好于经口气管插管.     

老年气管切开置管并发气管食管瘘

目的探讨老年患者气管切开置管并发气管食管瘘的原因及诊治方法。方法对9例老年气管切开置管并发气管食管瘘的临床资料进行回顾性分析。结果本组病例从套管留置到确诊气管食管瘘的时间平均为30.2±17.9天;临床表现主要有发作性成人呼吸窘迫症(3例),吸入性肺炎(3例);经套管中吸出胃内容物确诊4例,经纤维支气管镜确诊2例,2例误诊为慢性支气管炎,后经胃镜确诊;6例胃管鼻饲饮食,1例行胃造瘘术,1例行胃造瘘 空肠造瘘术;随访3个月,6例死亡。结论老年患者气管切开置管并发气管食管瘘与老年生理特点及疾病因素有关,死亡率高,临床表现缺乏典型性,应积极预防,及时诊断,避免误诊,以适宜的治疗为主。     

207例气管切开/气管插管后良性气道狭窄的疗效分析

目的 分析良性气道狭窄气管切开/气管插管后发生再狭窄采用球囊导管扩张加冷冻等综合治疗措施的疗效及安全性.方法 回顾性分析2005年8月至2014年12月住煤炭总医院的207例良性气道再狭窄患者,其中气管插管83例,气管切开124例.采用球囊导管扩张、CO2冷冻等综合治疗方法.结果 83例气管插管置管时间为(12.7±1.3)d,拔管后(30.3±4.1)d发生再狭窄;124例气管切开患者分别为(100.0±23.8)d和(73.2±12.8)d.气管插管组累及气管1区(87.7％),气管切开组累及气管Ⅰ区和Ⅱ区分别为63.7％、44.4％.气管插管组以瘢痕为主(57.9％),而气管切开组发生瘢痕和肉芽肿的百分比相似.气管插管组的形态以圆形为主(57.9％),不规则形占10.5％,而气管切开组分别为29.8％和41.1％,还有6例(4.8％)完全闭塞.气管插管组的治疗次数为(8.7±1.0)次,治愈时间为(4.0±0.4)个月,治愈率为89.5％;气管切开组分别为(6.7±0.5)次、(4.7±0.4)个月和72.6％.硬质镜在气管切开组比气管插管组使用率高.冷冻在2组中使用频率最高,分别达56.9％和49.9％,球囊导管扩张在气管插管组使用率达47.2％.结论 气管镜介入治疗在气管切开/气管插管后再狭窄的治疗中可发挥重要作用,冷冻和球囊导管扩张治疗是2种重要的治疗方法.     

球囊漂浮电极与普通电极床旁心脏临时起搏对比观察

目的对经静脉球囊漂浮电极与普通电极进行心脏临时起搏进行对比观察。方法54例床旁临时心脏起搏中,31例选择普通电极,23例选择球囊漂浮电极。观察两组间置管操作时间、起搏阈值、并发症等。结果两组间均有较高成功率,但球囊漂浮电极组置管时间明显小于普通电极组(2.1±2.3minvs9.3±5.3min,P<0.01),而起搏阈值等指标无明显差异,普通电极组发生并发症2例,1例为心肌穿孔,另1例为RonT诱发室性心动过速。结论与普通电极相比,球囊漂浮电极有操作简便、时间短、并发症少的优点。     

不同通气方法对心肺脑复苏患者的影响

目的:比较不同通气方法在心肺脑复苏(CPCR)中的临床应用效果。方法:,回顾性分析抢救的87例心跳骤停患者的临床资料,根据所用通气方法的不同分为3组:一次插管组、气囊面罩组和多次插管组。比较3组患者的心脏复苏(CR)成功率、心肺复苏(CPR)成功率、CPCR成功率以及复苏后多器官功能障碍综合征(PR-MODS)的发生率。结果:与一次插管组比较,气囊面罩组的复苏成功率及PR-MODS的发生率无显著差异(P>0.05),而多次插管组则显示复苏成功率明显降低,PR-MODS的发生率明显升高(P<0.05)。结论:CPCR抢救中,紧急气管插管失败后,气囊面罩加压给氧可作为过渡时期简单有效的通气方法。     

兔模型心脏骤停标准的探讨

目的：比较心肺复苏动物模型的2种心脏骤停判断标准,以确立适合于心脏骤停后综合征研究的心脏骤停判断标准。方法：大耳白兔30只,随机分为心电图标准组（A组）、动脉压标准组（B组）。采用夹闭气管建立心脏骤停模型,分别使用2种不同的心脏骤停判断标准,心脏骤停5min时立即复苏,观察复苏成功率和兔存活时间,监测心脏骤停前、复苏后24、48、72、96、120h6个时间点兔血神经元特异性烯醇化酶（NSE）、谷丙转氨酶（ALT）、血肌酐及肌钙蛋白I水平,分析复苏后多器官功能障碍综合征（MODS）发生情况。结果：心肺复苏即刻成功率A组为33%,B组为86%,2组比较有显著差异（P〈0.05）。兔存活时间A组为（1.38±1.04）h,B组存活时间为（58.0±41.5）h,2组比较有显著差异（P〈0.01）。B组兔复苏后24、48、72h时间点血NSE、ALT、肌酐及肌钙蛋白I水平明显升高,与心脏骤停前比较有显著差异（P〈0.01）。复苏后24～72h,兔出现多器官功能障碍综合征（MODS）表现。结论：以平均动脉压为标准判断心脏骤停优于心电图标准,适用于标准化心脏骤停后综合征的兔模型的建立。     

Analysis of clinical outcomes following in-hospital adult cardiac arrest

AIMS: The outcome of in-hospital resuscitation following cardiac arrest depends on many factors related to the patient, the environment and the extent of resuscitation efforts. The aim of the present study was to determine predictors of successful resuscitation and survival to -hospital discharge following in-hospital cardiac arrest and to assess functional outcomes of survivors (cerebral performance scores). METHODS: Medical records of adult patients sustaining in-hospital cardiac arrest between June 2001 and January 2003 were reviewed. Successful resuscitation was defined as the return of spontaneous circulation at the completion of resuscitative efforts, irrespective of degree of inotropic/vasopressor support. Thirty demographic and clinical variables were analysed to determine predictors of successful resuscitation and in-hospital survival. RESULTS: In 105 patients with cardiac arrest, 46 patients (44%) were successfully resuscitated and 22 (21%) survived to hospital discharge. Predictors of successful resuscitation included a primary cardiac admission diagnosis, monitoring at the time of the arrest, a longer duration of resuscitation and the absence of the need for endotracheal intubation. Patients with ventricular tachycardia/fibrillation were more likely to survive to hospital discharge than those with asystolic or pulseless electrical activity (45 vs 12 vs 20%, P = 0.01). The sole independent predictor of survival to hospital discharge was the absence of the need for endotracheal intubation (odds ratio 0.14, 95% confidence interval 0.02-0.88, P < 0.01). The majority of survivors (73%) had normal cerebral performance scores. CONCLUSIONS: Identification of predictors of successful resuscitation following cardiac arrest is important for risk stratification. Ongoing appraisal of in-hospital cardiac arrests through a multicentre registry could improve clinical outcomes.     

无血预充大鼠体外心肺复苏模型的建立及支持效果评价

目的 建立稳健的大鼠体外心肺复苏(ECPR)模型,为体外生命支持研究的发展提供思路.方法 12只成年雄性SD大鼠,随机分成常规心肺复苏(CCPR)组及体外心肺复苏(ECPR)组,各6只.两组均吸入七氟烷诱导麻醉,行气管切开术置入自制气管插管,经右股动脉监测血流动力学.C组仅行常规心肺复苏治疗,E组建立V-AECMO,C...     

Outcomes of cardiopulmonary resuscitation efforts in a Greek tertiary hospital

Abstract

Introduction: In-hospital cardiac arrest is a leading cause of death and despite recent advances in cardiopulmonary resuscitation, the survival to hospital discharge is poor. The aim of our study was to evaluate the success of resuscitation efforts in a tertiary hospital.

Patients and Methods: We retrospectively collected and analysed data on all patients in whom cardiopulmonary resuscitation was attempted after in-hospital cardiac arrest in one-year period.

Results: 96 cardiac arrest victims were studied. Sustained return of spontaneous circulation was achieved in 15 (15.6%) patients, while all of them survived for 24 h. Training in cardiopulmonary resuscitation, initiation of resuscitation efforts in less than 5 min, and intubation time < 1 min after team arrival were predictive factors associated with restoration of spontaneous circulation. Non-certified residents resuscitated 87 (90.6%) patients with 6 (6.8%) of them achieving return of spontaneous circulation and surviving for 24 h. On the contrary, certified ward residents resuscitated nine (9.3%) patients with 100% immediate and 24-h survival.

Conclusion: In our hospital, certified providers had remarkably higher successful resuscitation rates for in-hospital cardiac arrest than non-certified providers. This finding suggests that training in cardiopulmonary resuscitation, continuing medical education, and implementation of the existing legislation will result in increased survival.     

Advanced cardiac life support: Update on recent guidelines and a look at the future

The objectives of this article are to provide an update of the American Heart Association (AHA) 1992 National Conference guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care and to review the investigation and development of new methods of CPR which may be considered in future recommendations. Despite an organized approach to sudden cardiac arrest, survival in patients receiving CPR is in the range of 5–15%. The new AHA guidelines recommend standard manual CPR performed at a rate of 80–100 compressions/min and organized algorithms of advanced cardiac life support. These guidelines stress widespread community training and rapid response in the following sequence: (1) recognition of early warning signs, (2) activation of the emergency medical system (EMS), (3) basic CPR, (4) early defibrillation, (5) intubation, and (6) intravenous medication. Several new recommendations pertain specifically to in-hospital care and are, therefore, particularly relevant to physician management of cardiac arrest. The best predictor of survival in patients requiring circulatory support after cardiac arrest is attainable coronary and cerebral perfusion. Unfortunately, the minimal levels of end-organ perfusion required to sustain life are often difficult or impossible to achieve with standard manual cardiopulmonary resuscitation and several new techniques have therefore been introduced. The most promising of these techniques are (1) interposed abdominal compression, (2) pneumatic vest, and (3) active compression-decompression resuscitation. Each of these techniques offers unique advantages when compared with standard manual cardiopulmonary resuscitation. The 1992 National Conference recommendations provide a rational framework for the resuscitation of cardiac arrest victims. New methods of cardiopulmonary resuscitation are now available and investigation into these methods continues. In the future, these modalities may be incorporated in newer guidelines and be available on a widespread basis to supplement our current approach to cardiac arrest.     

不同方式在心跳呼吸骤停进行心肺复苏时的应用效果对比评价

目的 探析心跳呼吸骤停患者应用不同心肺复苏方式的临床效果.方法 将79例2018年10月-2020年1月在我院治疗的心跳呼吸骤停患者选为研究对象,依据心肺复苏方式不同分成两组,对照组与实验组.对照组39例患者予以人工心肺复苏治疗,实验组40例患者予以心肺复苏机治疗,对比两组患者按压有效率、并发症发生率及临床相关指标水平.结果 在按压有效率上,实验组数据为97.50%,对照组数据为82.05%,组间比较有统计学差异(P<0.05).在并发症发生率上,实验组数据为5.00%,对照组数据为7.69%,组间比较无统计学差异(P>0.05).在临床相关指标上,两组PaO2(氧分压)、SaO2(血氧饱和度)比较无统计学差异(P>0.05);实验组PaCO2(二氧化碳分压)、SP(收缩压)均高于对照组,组间比较有统计学差异(P<0.05).结论 相较于人工心肺复苏治疗而言,心肺复苏机治疗心跳呼吸骤停患者的效果更加显著,按压有效率更高,且不会增加并发症的发生,值得临床借鉴应用.     

甲泼尼龙琥珀酸钠对窒息型大鼠复苏后早期的心功能影响

目的:探讨甲泼尼龙琥珀酸钠(甲强龙)对窒息大鼠模型心肺复苏后早期心功能的影响及机制。方法:45只SD大鼠,雌雄不拘,分为对照组、常规复苏组(常规复苏+肾上腺素10μg/kg)和甲强龙组(常规复苏+肾上腺素10μg/kg+甲强龙1.8 mg/kg)。对窒息大鼠模型进行心肺复苏,记录平均动脉压(MAP)、左心室收缩压(LVSP)和左心室舒张末压(LVEDP)的变化,ELISA法检测大鼠心脏组织中肾上腺素能α1受体和β1受体水平。结果:在心肺复苏自主循环恢复(ROSC)30 min后,与对照组比较,常规复苏组及甲强龙组大鼠的MAP和LVSP均有明显下降(P均0.05);在ROSE后0、15 min时,常规复苏组及甲强龙组LVEDP与对照组相比有显著性差异(P均0.05)。甲强龙组MAP在ROSC后60、120 min时,LVSP在ROSC后30、60、120 min时均显著高于常规复苏组(P均0.05)。心肺复苏后,甲强龙组与对照组、常规复苏组比较,心脏组织中肾上腺素能α1受体和β1受体水平均明显升高(P均0.05)。结论:甲强龙可提高心肺复苏后心脏组织内肾上腺素能α1受体和β1受体含量,有利于心肺复苏后MAP和LVSP的稳定。     

Prolonged cardiac arrest and resuscitation in dogs: brain mitochondrial function with different artificial perfusion methods

Clinical techniques for artificial perfusion have not previously been examined directly for their effects on brain high-energy metabolism. Our study involved 24 large mongrel dogs that were anesthetized, instrumented for central venous intravenous access, and subjected to craniotomy to expose the dura and underlying parietal cortex. The animals were divided into the following six experimental groups of four animals each: nonischemic controls; 15-minute cardiac arrest without resuscitation; 45-minute cardiac arrest without resuscitation; 15-minute cardiac arrest plus 30 minutes resuscitation with conventional cardiopulmonary resuscitation (CPR); 15-minute cardiac arrest plus 30 minutes resuscitation with interposed abdominal compression (IAC) CPR; and 15-minute cardiac arrest plus 30 minutes resuscitation with internal cardiac massage. Cardiac arrest was induced by central venous injection of KCl 0.6 mEq/kg, and it was confirmed by continuous ECG monitoring. The three active resuscitation models included administration of NaHCO3 and epinephrine, but no attempt was made to restart the heart by defibrillation during resuscitation. At the indicated time in each group, a 4- to 5-g sample of brain was removed through the craniotomy, immediately cooled to 0 C and processed for isolation of mitochondria. The mitochondria were studied for their content of superoxide dismutase and for quantitative oxygen consumption with glutamate/malate substrate during resting and ADP-stimulated respiration. Our results show a significant drop in brain mitochondrial superoxide dismutase activity during the first 15 minutes of cardiac arrest. There is minimal injury to brain mitochondrial oxygen consumption during both 15 and 45 minutes of complete ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)