心肺复苏机与徒手心肺复苏抢救心脏骤停的临床效果比较

目的：比较心肺复苏机与徒手心肺复苏抢救心脏骤停患者的临床疗效,寻求有效的心脏骤停的抢救方法。方法回顾性分析100例心脏骤停患者临床资料。2011年1月至2012年1月收治的50例心脏骤停患者作为对照组,采取徒手心肺复苏进行抢救;2012年1月至2013年1月收治的50例心脏骤停患者作为观察组,采取心肺复苏机进行抢救。观察并比较两组患者术后的疗效。结果观察组心肺复苏后收缩压、SpO2及心率分别为（95．2±10．4） mmHg、（93．1±8．2）％、（89．6±5．7）次/min,均明显高于对照组的（71．8±6．7）mmHg、（78．7±5．5）％、（70．8±5．2）次/min,组间差异有统计学意义（t＝8．456、8．246、9．625,均P＜0．05）;两组呼吸频率差异无统计学意义（t＝0．955,P＞0．05）;观察组复苏成功率及存活率分别为72％、46％,均明显高于对照组（44％、22％）,观察组不良反应发生率为2％,低于对照组（18％）,组间差异均有统计学意义（χ2＝8．05、6．42、10．15,均P＜0．05）。心肺复苏后5 min两组患者动脉血气分析指标PaO2、PaCO2、SaO2差异均无统计学意义（ t＝0．868、0．922、0．747,均P＞0．05）;15 min、30 min后两组患者PaO2、PaCO2、SaO2等动脉血气分析指标差异均有统计学意义（ t＝5．984、4．673、4．685、9．647、8．356、5．534,均P＜0．05）。结论心肺复苏机较徒手心肺复苏在抢救心脏骤停患者中具有明显优势,可明显缩短自主循环时间,提高心肺复苏成功率,疗效确切,且不良反应较少,是一种简单、安全和有效的抢救方法,值得在临床广泛推广应用。     

Pralidoxime administered during cardiopulmonary resuscitation facilitates successful resuscitation in a pig model of cardiac arrest

Pralidoxime is a common antidote for organophosphate poisoning; however, studies have also reported pralidoxime's pressor effect, which may facilitate the restoration of spontaneous circulation (ROSC) after cardiac arrest by improving coronary perfusion pressure (CPP). We investigated the immediate cardiovascular effects of pralidoxime in anaesthetised normal rats and the effects of pralidoxime administration during cardiopulmonary resuscitation (CPR) in a pig model of cardiac arrest. To evaluate the immediate cardiovascular effects of pralidoxime, seven anaesthetised normal rats received saline or pralidoxime (20 mg/kg) in a randomised crossover design, and the responses were determined using the conductance catheter technique. To evaluate the effects of pralidoxime administration during CPR, 22 pigs randomly received either 80 mg/kg of pralidoxime or an equivalent volume of saline during CPR. In the rats, pralidoxime significantly increased arterial pressure than saline (P = .044). The peak effect on arterial pressure was observed in the first minute. In a pig model of cardiac arrest, CPP during CPR was higher in the pralidoxime group than in the control group (P = .002). ROSC was attained in three animals (27.3%) in the control group and nine animals (81.8%) in the pralidoxime group (P = .010). Three animals (27.3%) in the control group and eight animals (72.2%) in the pralidoxime group survived the 6-hour period (P = .033). In conclusion, pralidoxime had a rapid onset of pressor effect. Pralidoxime administered during CPR led to significantly higher rates of ROSC and 6-hour survival by improving CPP in a pig model.     

主动加压减压心肺复苏术在心脏骤停患者初期复苏中的临床研究

目的比较主动加压减压心肺复苏术（ACD-CPR）和标准心肺复苏术（STD-CPR）对于发生心脏骤停患者的初期复苏效果,探讨ACD-CPR对心脏骤停患者的疗效。方法根据复苏的方法不同,186例心脏骤停患者被分为ACD-CPR和STD-CPR组;比较两组在复苏开始后10、20和30min时的收缩压（SBP）、自主循环恢复率（ROSC）、24 h存活率及心电图（ECG）按压波形变化。结果ACD-CPR组10、20 min时SBP显著高于STD-CPR组（85.32±39.85 mmHgvs62.15±30.14 mmHg at 10 min,t=5.648,P〈0.001;73.56±36.58 mmHgvs2.39±25.73 mmHg at 20 min,t′=5.350,P〈0.001,respectively）;自主循环恢复率（19[23.75%]of 80 vs 10[11.63%]of86,χ^2=4.224,P〈0.05）、24 h存活率（17[21.25%]of80vs8[9.30%]of86,χ^2=4.625,P〈0.05）亦显著高于STD-CPR组;另外,ECG按压波形变化方面,ACD-CPR自动按压ECG按压波形变化较规律,STD-CPR人工徒手按压按压波形变化不规则。结论ACD-CPR在改善心脏骤停患者初期复苏效果方面,优于STD-CPR。     

对心跳骤停病例心肺复苏的分析研究

目的 分析研究心跳骤停复苏抢救成功的各种影响因素.方法 对36例心肺复苏成功患者临床资料开展分析.结果 16例有效心搏和自主呼吸得到恢复,20例心肺复苏成功之后进入ICU 病房监护治疗.结论 实施早期规范的胸外按压、及时除颤、气管插管治疗,科学用药,是复苏成功的重要促进因素.     

心跳骤停心肺复苏106例临床分析

目的通过回顾66例心脏骤停患者急诊科心肺复苏成功病例,分析成功因素。方法回顾本院2010～2011年急救心跳骤停106例患者心肺复苏抢救过程、结果等,进行统计分析。结果经过为时40min的急救,106例患者中复苏成功66例（62．26％）,死亡40例（37．74％）,其中,院内成功率为83．33％,院外成功率为16．67％。病因与复苏成功率关系不大,不同开始心肺复苏时间患者成功率差异明显（P〈0．05）。结论缩短检查确诊、评估时间,提早进入复苏时间．心肺复苏基础上,根据病情情况,适当配合联合运用血管活性药物和加压素,灵活掌握复苏技巧,可以有效提高复苏成功率。     

大鼠心脏骤停后行心肺复苏对海马脑组织的影响及机制

目的探讨大鼠心脏骤停后,实施心肺复苏术对大鼠海马脑组织的保护作用和机制。方法SD大鼠40只,随机均分为对照组、缺血组、心肺复苏组、依达拉奉治疗组,采取窒息法使大鼠心脏骤停造模,缺血组大鼠心脏停跳10 min;复苏组实施心脏骤停/心肺复苏(CA/CPR),即使大鼠心脏停跳3 min后,再行心肺复苏7 min。10 min后处死各组大鼠,留取静脉血检测氧化应激指标,HE染色和电镜观察海马脑组织结构改变,实时荧光定量PCR和Western blot检测大鼠海马中Nrf2、Keap1基因和蛋白表达。结果与对照组大鼠比较,缺血组大鼠血清氧化应激水平升高,海马内神经细胞尼氏体减少,线粒体嵴破坏,Nrf2、Keap1基因和蛋白表达增加;与缺血组比较,心肺复苏组大鼠血清氧化应激水平降低,海马内神经细胞尼氏体增多,线粒体嵴破坏减轻,Nrf2、Keap1基因和蛋白表达降低。结论心脏骤停后心肺复苏术对大鼠海马脑组织具有保护作用,其机制与改善氧化应激损伤Nrf2/Keap1通路有关。     

窒息大鼠心肺复苏后补体水平变化及血必净的干预

目的探讨血必净对复苏后补体水平变化的影响。方法建立心肺复苏大鼠模型,84只SD大鼠动物随机分为5组,A组：正常对照组;B组：假手术组（仅进行麻醉和气管切开插管、血管穿刺,不进行窒息及心肺复苏）;C组：常规复苏组（常规复苏＋生理盐水4mL/kg）;D组：血必净低剂量治疗组（血必净2mL/kg＋生理盐水2mL/kg）;E组：血必净高剂量治疗组（血必净4mL/kg）;动态观察血浆补体水平的变化。结果 （1）与A组比较,B、C、D、E组：复苏后即刻C4、C3水平显著升高,差异有显著意义（P〈0.05,P〈0.01）;（2）与B组比较,C组复苏后6hC3水平降低（P〈0.05）,D、E组差异无显著意义,各组间C4水平差异无显著意义;（3）与同组复苏后即刻比较,C组复苏后6hC3、C4水平分别下降45.24%、49.97%,且差异有显著意义（P〈0.01）;D、E组复苏后2h、4h、6h的C3、C4水平与同组复苏后即刻比较,差异无显著意义。结论心肺复苏早期存在补体的过度活化与消耗,血必净可减轻复苏后补体水平的大量消耗。     

心内膜临时心脏起搏在心跳骤停复苏抢救中的临床研究

目的：了解心内膜临时心脏起搏对心跳骤停抢救时应用的方法及疗效,探索提高心跳骤停抢救的成功率。方法：通过经左锁骨下静脉或右股静脉穿刺置入电极导管,在起搏心电图或电极孚管激惹室性早搏引导下,定位电极,紧急临时心脏起搏,抢救心脏停搏患者,统计复苏成功率。结果：试验组中,1例是创伤引起的心跳骤停、起搏成功;其余17例是随机选取心跳骤停的患者,其中1例起搏有效。结果该组心跳骤停的抢救心跳恢复7例;心跳复跳成功率为38．8％。研究结果显示本方法对非室颤性心脏停搏的患者心内膜起搏配合心肺复苏可取得较好的效果。结论：在心跳骤停患者抢救中使用心脏起搏术对复苏成功率并没有明显的提高,如何判断采用临时起搏器的时机和看待其意义应该得到临床工作者的重视。     

舒血宁辅助治疗对呼吸心跳骤停患者院前心肺复苏成功率影响的临床研究

目的探讨舒血宁辅助治疗对呼吸心跳骤停患者院前心肺复苏成功率的影响。方法选择本院2011年1月～2013年10月收治的院外呼吸心跳骤停患者100例进行研究并分为两组。对照组患者在常规抢救药物治疗的基础上进行常规心肺复苏,观察组在对照组基础上联合舒血宁静脉注射治疗。比较两组的心肺复苏成功率。结果观察组的心肺复苏成功率为67．31％,显著高于对照组的37．50％（P〈0．01）。结论舒血宁辅助治疗应用于呼吸心跳骤停患者院前心肺复苏中,能够有效提高其复苏成功率,降低死亡率,值得临床推广应用。     

心脏骤停急诊心肺复苏成功因素探究

目的对心脏骤停急诊心肺复苏成功的相关因素进行分析探讨,为今后的临床抢救工作提供可靠的参考依据。方法选取2010年1月～2012年12月本院收治的心脏骤停接受心肺复苏的患者82例,按照心肺复苏成功与否分成成功组和失败组,对比分析两组患者的相关资料,总结成功与失败因素。结果成功组急救反应时间较失败组显著缩短（P〈0．05）,成功组急救措施优于失败组（P〈0．05）。结论对心肺复苏工作给予重视,建立高效护理协助平台,配备优良先进设备,并注意其生物安全和卫生洁净度,从而提高心肺复苏成功率,改善患者预后。     

心肺脑复苏进展

<正>心跳骤停是指心跳及呼吸突然停止,血液循环终止。由于脑细胞对缺氧十分敏感,循环停止4～6min脑组织即可出现不可逆性损害。脑损害是心肺脑复苏后患者致残的主要原     

Pharmacotherapy of cardiopulmonary arrest.

The assessment and treatment of patients requiring cardiopulmonary resuscitation (CPR) is discussed. Cardiovascular pharmacotherapy is discussed as suppressive therapy, stimulant therapy and treatment of hypotension. Special situations covered include hyperkalemia, anaphylaxis and drug overdosages. It is concluded that the likelihood of success of CPR depends on the rapid initiation of ventilation and restoration of circulation, and is inversely dependent on the severity of the underlying disease or injury.     

The Brighton resuscitation ambulances: review of 40 consecutive survivors of out-of-hospital cardiac arrest

In three years 40 patients were resuscitated by ambulancemen after out-of-hospital cardiac arrest and survived to be discharged. Twenty-six of these had had circulatory arrest before an ambulance arrived and a further three had developed ventricular fibrillation before they were moved. Thirty-two patients were alive at the time of review six months to three and a half years later. Resuscitation by ambulancemen can be effective for patients with unheralded sudden cardiac arrest as well as for patients with recent myocardial infarction. Survivors of out-of-hospital ventricular fibrillation may have a favourable long-term prognosis.     

心脏骤停急诊心肺复苏成功相关因素分析

目的探讨心脏骤停患者心肺复苏成功相关因素,进一步提高急诊心肺复苏成功率。方法随机抽取近年来急诊科心脏骤停患者72例进行分组对比分析,甲组38例为心肺复苏成功,乙组34例为心肺复苏效果不佳。结果两组比较甲组复苏成功占76.3%(29/38),明显高于乙组的26.5%(9/34)。甲组胸外心脏按压开始时间(2.3±0.5)分,早于乙组(7.8±3.0)分,电除颤开始时间甲组(3.6±1.5)分,早于乙组(7.2±3.8)分,甲组心脏复苏成功78.9%(30/38)明显高于乙组32.4%(11/34)。结论(1)及早开展心肺复苏,早期电除颤在确保心肺复苏成功上赢得时间。(2)持续有效胸外心脏按压和有效的使用肾上腺素是心肺复苏成功的重要措施。(3)急救小组分工协作更能提高心肺复苏成功率。     

Endotracheal drug therapy in cardiopulmonary resuscitation

Use of endotracheal drug therapy during cardiopulmonary resuscitation (CPR) is reviewed. Endotracheal drug therapy--instillation of a drug solution directly into an endotracheal tube for absorption into the circulation via the alveoli--may be used during CPR when venous access is limited. Administration of drugs via a central vein is the most efficient route, but a central i.v. line may not be present and peripheral venous administration may not be possible because of vasoconstriction, trauma, other patient-related factors, or absence of personnel trained to insert i.v. catheters. An endotracheal tube is usually inserted during CPR; in most cases, this procedure can be performed outside the hospital by emergency medical personnel. Basic life-support measures are not interrupted during endotracheal administration as they are in intracardiac drug administration. Drugs that may be administered by the endotracheal route include epinephrine, atropine sulfate, lidocaine hydrochloride, naloxone hydrochloride, and metaraminol bitartrate. Endotracheal delivery of calcium salts, sodium bicarbonate, and bretylium tosylate is not recommended. Pharmacokinetic data for drugs administered endotracheally are lacking; therefore, dosage recommendations are empirical. Usually, the same dose is administered endotracheally as by the i.v. route. Little is known about choice and volume of diluent and the best anatomic site of application. Endotracheal drug administration may replace intracardiac injection as the second-line alternative to intravenous drug injection during CPR.