亚低温治疗对心肺复苏后幸存者神经功能和预后的影响

目的：研究亚低温治疗对心肺复苏后幸存者神经功能和预后的影响。方法118例心肺复苏幸存患者随机分入实验组和对照组,给予亚低温治疗和常规治疗,统计治疗数据,评价不同治疗方法对患者神经功能和预后效果的影响。结果实验组复苏后第1天、第2天、第4天和第6天的格拉斯哥昏迷指数及综合评分分别为2.31±0.24、3.09±0.32、3.75±0.52、4.62±0.65和3.76±0.45;对照组对应得分分别为0.87±0.13、1.54±0.42、2.46±0.63、2.96±0.58和2.74±0.52。结论亚低温疗法能够有效缓解患者心肺复苏后高灌注造成的二次伤害,促进患者神经功能的恢复,提高患者生活质量。     

亚低温对心肺复苏术后缺血缺氧性脑病的影响

目的探讨亚低温治疗对院内心脏停搏心肺复苏(CPR)后缺血缺氧性脑病者神经功能和预后的影响。方法收集惠州市第一人民医院ICU的心肺复苏术后50例患者的临床资料,在心肺复苏成功自主循环恢复后,30例(亚低温组)接受亚低温治疗(中心体温降至32～34℃,并维持24h),20例(对照组)常规治疗,7d后比较2组患者复苏后神经功能良好率和病死率。结果在心肺复苏后第7天,亚低温组患者神经系统转归率23%(7/30)明显高于常规组15%(3/20,P<0.05);亚低温组病死率50%(15/30),常规组为55%(11/20,P>0.05)。结论亚低温对心肺复苏术后缺血缺氧性脑病患者的病死率无明显影响,但可提高神经系统转归率。     

37例心肺复苏后昏迷病人的脑电图分析

目的：探讨心肺复苏后错迷病人的脑电图诊断对估计预后的价值。方法：回顾性分析３７例心肺复苏后昏迷病人ＥＥＧ。结果：表现以θ波为主者５例,３例痊愈,２例部分恢复;ＥＥＧ表现为暴发抑制波或平坦波异常者１３例,均死亡;ＥＥＧ呈现β活动者１例,完全恢复;δ为主者１８例,７例死亡,８例部分恢复,３例完全恢复。结论：在脑缺氧复苏后昏迷病例,进行ＥＥＧ检查,可以检测脑功能,而且对脑复苏最终预后作出一定评价。     

亚低温对心肺复苏术后缺血缺氧性脑病的影响

目的：分析亚低温对心肺复苏术后缺血缺氧性脑病患者的影响。方法收集我院收治的60例行心肺复苏术患者的临床资料,在心肺复苏术成功且自主循环恢复后,随机分为观察组和对照组,每组30例,对照组进行常规治疗,观察组进行亚低温治疗,即将中心体温降至33℃左右,并维持24 h。7 d后对2组复苏后神经功能良好率和病死率进行分析和比较。结果对照组良好转归3例（10.0％）,中度残疾6例（20.0％）;不良转归6例（20.0％）;死亡15例（50.0％）。观察组13例良好转归（43.3％）,中度残疾3例（10.0％）,不良转归2例（6.7％）,死亡12例（40.0％）。结论亚低温治疗心肺复苏术后缺血缺氧性脑病操作简单、安全可靠、无痛苦,结合抗感染、防止电解质紊乱等治疗心肺复苏术后缺血缺氧性脑病效果显著,值得临床推广使用。     

心肺复苏后缺氧性脑病的脑电图和预后的关系

目的　探讨心肺复苏后缺氧性脑病的脑电图 (EEG)表现和预后的关系。方法　回顾性分析 4 8例成功心肺复苏患者的 2 4h内记录的EEG结果 ,并与临床预后作对照。结果　心脏停搏时间 <5min者 6 9%EEG为Ⅰ、Ⅱ级 ,31%为Ⅲ、Ⅳ、Ⅴ级 ,停搏时间 >5min者全数均为Ⅲ、Ⅳ、Ⅴ级。EEGⅠ、Ⅱ级者均完全恢复 ,Ⅲ级少数恢复 ,而Ⅳ、Ⅴ级者均呈去皮质状态或死亡。结论　分析心肺复苏后缺氧性脑病患者的EEG构型对判断预后有一定意义。     

亚低温对戊四氮诱导癫痫发作的影响

目的观察戊四氮诱导癫痫发作的形式变化及不同温度下癫痫大鼠海马组织病理学的变化和计数CA3区残存的神经元数量.方法雄性SD大鼠分为上述不同温度的四组,用冰袋降温、白炽灯泡升温的方法来控制温度.将控制好温度的大鼠用戊四氮诱导癫痫发作,在相同的时间内观察大鼠发作形式的变化.HE染色后观察海马区组织病理学的改变,并选择组织学损害最明显的区域在高倍镜(40×10)下计数神经元的丢失.结果高温状态下癫痫发作程度最重,神经元丢失最严重,低温下癫痫发作程度较轻,神经元丢失也较少,亚低温下癫痫发作程度最轻,持续时间也最短,神经元丢失最少.结论亚低温对癫痫大鼠有脑保护作用.     

亚低温治疗对重型颅脑损伤的预后影响

目的 探讨亚低温治疗和常温方法对重型颅脑损伤患者的预后比较.方法 对本院ICU收治的68例患者随机分为亚低温治疗组和常温对照组,在治疗后3个月进行格拉斯哥预后评分(GOS).结果 亚低温治疗组的病死率及恢复良好率明显好于对照组.结论 亚低温治疗可降低重型颅脑损伤患者的病死率,改善预后.     

心肺复苏后患者的脑电图分析

目的探讨脑电图检查对心肺复苏后患者的应用价值。方法对10例心肺复苏后患者的脑电图和临床资料进行分析。结果首次脑电图检查广泛重度异常7例(其中5例死亡,2例呈去大脑皮质综合征),广泛中度异常3例(均不完全恢复)。结论早期应用脑电图检测心肺复苏病人可以评估病人的脑功能状况,为脑复苏治疗及预后提供重要依据。     

不同方式亚低温对兔心肺复苏后脑保护作用的比较

目的 评估和比较体外血液冷却和体表降温形成亚低温对兔心肺复苏后的脑保护作用。方法 20只兔随机分为两组，电击室颤致心搏骤停5min再复苏，一组采用体表亚低温，另一组采用体外血液冷却法形成亚低温，24小时后评定OPC(overall periormance category，总体情况分类)和NDS(neurological deficit score，神经功能缺损评分)。第72小时处死，取脑病检，评定HDS(histopathologic damage score，组织病理学损害评分)。结果 体外血液冷却法形成亚低温的速度明显快于体表亚低温组，HDS优于体表降温亚低温组，OPC、NDS两组间无统计学差异。结论 心肺复苏后越早形成亚低温脑保护作用越好，体外血液冷却法比体表降温能更早形成亚低温，具有更好的脑保护作用。     

脑外伤病人亚低温冬眠的护理

亚低温人工冬眠治疗适应于重症脑挫伤而循环功能代偿良好者。躁动不安、高热、丘脑下部或脑干损伤者,以及严重脑水肿导致颅内压居高不降者。     

The prognostic significance of coma-rating, duration of anoxia and cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Early determination of outcome after successful prehospital cardiopulmonary resuscitation (CPR) is a common problem with great ethical, economic, social, and legal consequences. We prospectively investigated 112 adult patients who had been resuscitated after out-of-hospital cardiac arrest (CA). The aim of our study was to determine whether coma rating by the mobile intensive care unit (MICU) is a useful tool for outcome prediction. For neurological assessment the Innsbruck Coma Scale (ICS) was used initially and after return of spontaneous circulation (ROSC) or 20–30 min after the start of CPR, before any sedating drugs were given. The duration of anoxia and CPR were determined with the automatically recorded emergency call protocol of the dispatch centre and the protocol of the MICU. For estimation of cerebral outcome at the time of discharge from hospital we used the Glasgow-Pittsburgh Cerebral Performance Categories (CPC). Restoration of spontaneous circulation was achieved in 42 patients (37%), and 15 (13%) were discharged from hospital. The first coma rating performed immediately at the time of arrival on scene had no significant prognostic value for prediction of neurological outcome (P = 0.204) and survival (P = 0.103). The second coma rating (performed after ROSC or 20–30 min after the start of CPR), however, demonstrated a significant correlation with neurological outcome (P = 0.0000) and survival (P = 0.0000), a correlation which was comparable to both duration of anoxia and duration of CPR. In patients with out-of-hospital cardiac arrest prognostic information could be obtained with the ICS as early as 20– 30 min after the start of cardiopulmonary resuscitation. Received: 27 November 1996 Received in revised form: 10 July 1997 Accepted: 26 July 1997     

Neuroprotective mechanisms and translational potential of therapeutic hypothermia in the treatment of ischemic stroke

Stroke is a leading cause of disability and death,yet effective treatments for acute stroke has been very limited.Thus far,tissue plasminogen activator has been the only FDA-approved drug for thrombolytic treatment of ischemic stroke patients,yet its application is only applicable to less than 4–5% of stroke patients due to the narrow therapeutic window( 4.5 hours after the onset of stroke) and the high risk of hemorrhagic transformation.Emerging evidence from basic and clinical studies has shown that therapeutic hypothermia,also known as targeted temperature management,can be a promising therapy for patients with different types of stroke.Moreover,the success in animal models using pharmacologically induced hypothermia(PIH) has gained increasing momentum for clinical translation of hypothermic therapy.This review provides an updated overview of the mechanisms and protective effects of therapeutic hypothermia,as well as the recent development and findings behind PIH treatment.It is expected that a safe and effective hypothermic therapy has a high translational potential for clinical treatment of patients with stroke and other CNS injuries.     

Views of elderly patients on cardiopulmonary resuscitation before and after treatment for depression

OBJECTIVE: To investigate elderly patients decision to accept cardiopulmonary resuscitation (CPR) before and after treatment for depression. METHODS: A Prospective cohort study set within a specialist psychiatrist hospital for the elderly. The subjects were 50 consecutively admitted day and in-patients with depression. Changes in the acceptability of CPR between baseline and end of treatment for depression together with patient characteristics were measured and compared. RESULTS: 49 patients completed the study; all but one of the 17 patients who initially declined CPR accepted once recovered and none who initially accepted later changed their minds (p=0.0001. CONCLUSIONS: The study demonstrates that depressed elderly people frequently decline CPR but accept after recovery from depression. The presence of depression should be specifically considered if an elderly person unexpectedly declines CPR.     

中药蝶脉灵注射液在心肺复苏中脑保护作用的实验研究

目的 探讨中药蝶脉灵注射在心脏骤停时对脑复苏的作用。方法 用电刺激导致室颤制备家兔心脏骤停模型，在光镜和电镜下观察大剂量肾上腺素治疗时，蝶脉灵注射液对脑组织的影响。结果 蝶脉灵注射液对脑细胞有明显的保护作用。结论 蝶脉灵注射液能明显改善心脏骤停时脑缺血性损害，因而有利于脑复苏。     

亚低温对重型颅脑创伤患者血清抗脑抗体含量的影响

目的 研究重型颅脑创伤(sTBI)后患者血清抗脑抗体(ABAb)浓度变化及亚低温治疗对血清ABAb浓度的影响,探讨亚低温脑保护机制.方法 选择80例sTBI住院患者,随机分成常温治疗(NT)组和亚低温治疗(HT)组各40例,分别予以常温治疗和亚低温治疗,于伤后第1、3、5、7、14天采血.用酶联免疫吸附(ELISA)法测定血清ABAb浓度,观察各时间点血清ABAb浓度的变化,分析各时间点两组血清ABAb浓度与格拉斯哥预后评分(GOS)的相关性.另取20例健康体检者作为对照组.结果 (1)所有sTBI患者在伤后各时间点血清ABAb浓度高于正常对照组(P＜0.01).(2)HT组于伤后各时间点血清ABAb浓度低于NT组,且差异有统计学意义(P＜0.01).(3)NT组于伤后各时间点血清ABAb浓度与GOS评分呈负相关,出院时HT组预后也较NT组为佳.结论 HT能够降低sTBI患者血清ABAb含量,具有脑保护作用,其脑保护机制可能与HT能减轻血清ABAb介导的损伤性脑细胞炎性反应有关.

Abstract：

Objective To disclose the Probably protective mechanism of mild hypothermia protecting brain through investigating the contents charges of Antibrain-Antibody(ABAb)in serum in patients with severe traumatic brain injury(sTBI) and the influence of mild hypothermia on serum levels of ABAb.Methods A total of 80 cases with sTBI were treated with normothennia - treated (NT) (NT group, re =40)and mild hypothermia( HT) (HT group, n =40) respectively. ELISA was used to measure serum levels of ABAb. Groups at 1、3、5、7 and 14 days after injury to observe the contents changes of ABAb in serum and the influence of mild hypothermia. Simultaneous analysis two groups at each time point of serum ABAb concentration and Glasgow outcome scale (GOS) of relevance was performed Contrast analysis of clinical prognosis for patients in the two groups was carried out to reveal the protective mechanism of mild hypothermia protecting on patients with sTBL 20 serum specimens of normal persons were used as control group. Results (1) All sTBI patients at each time point after injury, serum ABAb levels were higher than the normal control group ( P ＜0.01). (2) Concentration of antibodies in the serum ABAb levels in HT group at each time point was lower than in NT group( P＜0.01). (3) Concentration of serum ABAb levels in NT group at each time point of injury was negatively correlated with the GOS score; prognosis at discharge in HT group was better than in NT group. Conclusions HT can reduce the serum ABAb levels in sTBI patients, improve the prognosis, have brain protective effect The brain protective mechanisms may be related to the mild hypothermia which reduce the serum ABAb - mediated inflammatory damage on brain cells.     

Mild hypothermia inhibits systemic and cerebral complement activation in a swine model of cardiac arrest

Complement activation has been implicated in ischemia/reperfusion injury. This study aimed to determine whether mild hypothermia (HT) inhibits systemic and cerebral complement activation after resuscitation from cardiac arrest. Sixteen minipigs resuscitated from 8 minutes of untreated ventricular fibrillation were randomized into two groups: HT group (n=8), treated with HT (33°C) for 12 hours; and normothermia group (n=8), treated similarly as HT group except for cooling. Blood samples were collected at baseline and 0.5, 6, 12, and 24 hours after return of spontaneous circulation (ROSC). The brain cortex was harvested 24 hours after ROSC. Complement and pro-inflammatory markers were detected using enzyme-linked immunosorbent assay. Neurologic deficit scores were evaluated 24 hours after ROSC. C1q, Bb, mannose-binding lectin (MBL), C3b, C3a, C5a, interleukin-6, and tumor necrosis factor-α levels were significantly increased under normothermia within 24 hours after ROSC. However, these increases were significantly reduced by HT. Hypothermia decreased brain C1q, MBL, C3b, and C5a contents 24 hours after ROSC. Hypothermic pigs had a better neurologic outcome than normothermic pigs. In conclusion, complement is activated through classic, alternative, and MBL pathways after ROSC. Hypothermia inhibits systemic and cerebral complement activation, which may provide an additional mechanism of cerebral protection.     

尿激酶溶栓辅助亚低温疗法对脑梗死患者预后的改善作用

目的观察尿激酶溶栓辅助亚低温疗法对脑梗死患者预后的改善作用。方法选取我院2010-06—2011-06收治的68例脑梗死患者为研究对象,抽签随机分为观察组与对照组,每组34例。对照组给予尿激酶150万U溶栓治疗,观察组在对照组的基础上同时加亚低温疗法干预。采用美国国立卫生研究院卒中量表(NIHSS)评定神经功能缺损程度,观察2组发病3h内与发病3~6h内给予治疗的神经功能缺损程度,比较2组血管再通率、并发症发生率。结果发病3h内给予治疗,观察组治疗后1、7、30、90dNIHSS评分(7.96±3.52)分、(6.85±3.35)分、(4.52±2.85)分、(2.32±2.56)分均低于对照组,差异有统计学意义(P0.05);发病3~6h内给予治疗,观察组治疗后1、7、30、90dNIHSS评分均低于对照组,差异有统计学意义(P0.05)。观察组血管再通率73.53%显著高于对照组47.06%,差异有统计学意义(P0.05)。2组并发症发生率比较差异无统计学意义(P0.05)。结论尿激酶溶栓辅助亚低温疗法可提高患者血管再通率,具有较好的神经保护作用,可有效改善预后。