心肺复苏后大鼠延髓心血管中枢NMDA受体的表达变化

目的 研究心肺复苏后大鼠延髓心血管中枢NMDA受体的表达变化。方法 以水封瓶密闭法制作大鼠心搏骤停模型，迅速进行心肺复苏，复苏后20min制备脑组织石蜡切片，行光镜观察，并应用原位杂交、免疫组化技术检测延髓心血管中枢迷走神经背核、孤束核内NMDA受体2A／2B两个亚型的表达变化。结果 实验组大鼠延髓心血管中枢迷走神经背核、孤束核内NMDA受体NMDA-2A、NMDA-2B两个亚型的mRNA表达与对照组相比明显增高，差异有显著性（P〈0．05）。结论 心肺复苏后大鼠延髓心血管中枢NMDA-2A、NMDA-2B两型受体在mRNA及蛋白质水平上发生了显著上调，心肺复苏后大鼠脑水肿形成可能与NMDA受体上调有关。     

萨勃心肺复苏器与徒手心肺复苏加强复苏461例效果比较

心搏骤停抢救成功的关键在于及时有效的心肺复苏(CPR),而CPR患者生存率和自主循环恢复(R()SC)与冠状动脉(冠脉)再灌注有关,其中胸外按压是再灌注压改善的重要决定因素.传统的CPR因医务人员的技术、体力等因素可影响按压的效果,而萨勃复苏器、复苏床、复苏背心等多种机械CPR装置的使用能明显增加心排血量及通气量,提高脑灌注.大规模的临床研究显示,机械CPR装置能提高CPR的成功率[1].     

干细胞动员促进心肺复苏后大鼠脑损伤的修复

目的 观察粒细胞集落刺激因子(granulocyte colony-stimulating factor,G-CSF)与AMD3100动员自身骨髓干细胞治疗复苏后脑缺血损伤的效果,并探讨其作用机制.方法 在中山大学心肺脑复苏研究所建立窒息法心肺复苏大鼠动物模型.56只SD大鼠随机(随机数字法)分4组:G-CSF单独动员组、G-CSF+ AMD3100联合动员组、单纯复苏组和假手术组.通过NDS评分、纸带移除实验、头颅MR扫描影像分析等方法评价干细胞自体动员对复苏后神经功能的影响;采用ELISA法检测脑组织中血管内皮细胞生长因子(VEGF)含量、TUNEL法检测脑组织中神经细胞凋亡、免疫荧光法检测脑组织毛细血管密度变化.结果 复苏后3d时,G-CSF+ AMD3100组NDS评分(61.4±10.7)显著高于单纯复苏组(49.9±10.4) (P＜0.05),纸带移除时间为(85.5±28.9)s,显著短于单纯复苏组(148.1±23.8)s与G-CSF组(118.5 ±30.4)s (P＜0.05);脑MRI显示的脑损伤严重程度两个干细胞动员组低于单纯复苏组;G-CSF+ AMD3100组的神经细胞凋亡率(0.23±0.06)显著低于G-CSF组(0.34 ±0.08) (P＜0.05),而两者均显著低于单纯复苏组(0.44±0.09)(P＜0.05).在复苏后3d与6d,G-CSF+ AMD3100组脑组织中VEGF质量浓度(pg/mL)分别为(106.2±23.3)与(79.9±18.4),G-CSF组脑组织VEGF质量浓度(pg/mL)分别为(50.6±13.7)与(73.9±16.6),均显著高于单纯复苏组(23.1±10.2)与(36.2±12.8)(P＜0.05).G-CSF+ AMD3100组在复苏后3d时的脑毛细血管密度(351.8 ±67.9)个/高倍视野,显著高于G-CSF组(301.4 ±77.3)个/高倍视野与单纯复苏组(250.4 ±48.0)个/高倍视野(P＜0.05).在复苏后6d时,G-CSF组的脑毛细血管密度较3d时明显升高,为(348.4 ±76.7)个/高倍视野(P＜0.05),G-CSF+ AMD3100组为(344.1±65.7)个/高倍视野,与3d时比较无明显变化.结论 干细胞动员显著改善了复苏后大鼠神经功能状况,联合动员后神经功能恢复更加显著且恢复时间早于单独动员.干细胞动员对脑损伤的修复作用机制可能与抑制神经细胞凋亡、促进VEGF分泌及损伤区新生血管生成有关.     

准确把握心肺复苏程序

迄今 ,对心搏骤停患者通过变更传统心肺复苏(ＣＰＲ )程序 ,即ＡＢＣ程序 (Ａ ａｉｒｗａｙ气道、Ｂ ｂｒｅａｔｈ呼吸、Ｃ—ｃｉｒｃｕｌａｔｉｏｎ循环 ) ,而采用ＣＡＢ程序进行ＣＰＲ已引起人们极大关注。在ＣＰＲ历史上 ,ＡＢＣ程序发挥了重要作用 ,但随着时间的推移 ,渐露     

心肺复苏质量的影响指标分析

心肺复苏质量是影响心搏骤停生存率的关键,除开始心肺复苏时间外,反映心肺复苏质量的指标还包括按压频率、按压深度、按压位置、胸廓充分回弹、避免按压中断以及通气过度等,通过综合分析反映心肺复苏质量的指标参数,以期促进心肺复苏的质量的提高。     

肾上腺素对心肺复苏后大鼠脑损伤研究的干扰作用

目的观察大鼠心肺复苏早期脑水肿与血脑屏障变化的特点以及肾上腺素对其的干扰作用。方法以SD大鼠建立心肺复苏模型，120只大鼠随机分成手术对照组（分气管切开后即刻，1／2、3、6、9h），肾上腺组（给药后即刻，1／2、3、6、9h），复苏组（分复苏后即刻，1／2、3、6、9h），检测各组脑组织水含量及EB含量，观察心肺复苏后各时点脑水肿及血脑屏障通透性的变化情况。结果大鼠注射肾上腺素后3min内均出现心率加快，同时并发心律失常。肾上腺素组1／2h开始出现脑组织水含量的升高，6h已下降，9h已基本降至基线.肾上腺素组9h内均未出现EB含量升高.心肺复苏组于复苏后1／2h起就出现脑组织水含量的持续增加，与手术对照组同时间点比较均P〈0．01，和肾上腺素组比较6h开始才有显著差别，同时，心肺复苏纽6h后EB含量升高，与手术对照组比较均P〈0．01，与肾上腺素组比较6hP〈0．05，9hP〈0．01、相关分析发现，6h后EB舍量和脑水肿明显相关（r=0．832，P〈0．01）。结论应用肾上腺素的心肺复苏早期就出现脑水肿，开始以细胞毒性脑水肿为主，而后血脑屏障开放，促使血管源性脑水肿形成，肾上腺素能一过性地促进细胞性脑水肿的形成，可能是心肺复苏早期细胞毒性脑水肿形成的主要因素，反复应用会干扰心肺复苏后早期脑水肿的研究。     

院前心肺复苏临床分析研究

目的：探讨提高院前心肺复苏成功率的途径。方法：对我院1999年10月至2003年12月救治的48例院前心搏骤停者，用Utstein模式进行回顾性统计和分析。结果：经复苏的45例心搏骤停者中，自主循环恢复（ROSC）有4例，复苏率为8，89％，其中1例存活至出院；对比呼救-到达现场间期（CRI）〉6min和〈6min两组的复苏率有显著性差异，P〈0．05；对比目击者是医务工作者和非医务工作者两组的复苏率有显著性差异，P〈0．05。结论：缩短CRI是提高院前心肺复苏成功率的关键途径；公民中普及CPR对提高复苏成功率有重要意义；提高医院急救技术和改善急救设备也不容忽视。     

1007型萨勃心肺复苏机在急诊心肺复苏应用中的前瞻性对照研究

近年来专家们更加意识到胸外按压的质量问题是提高心肺复苏(CPR)成功率的关健,<2005国际心肺复苏与心血管急救指南>强调了胸外按压的质量问题,强调用力按压,快速按压,使胸廓充分回弹和尽量减少中断按压的时间[1].     

急诊超长心肺复苏16例分析

近年来,超长心肺复苏(CPR)成功的报道增多,针对特殊病因、特殊情况的超长CPR逐渐受到重视,我院急诊科2001-01以来对16例病人进行了超过30 min的CPR,最终出院5例,死亡11例。现报道如下。1 资料与方法     

Public Expectations of Survival Following Cardiopulmonary Resuscitation

Previous studies have demonstrated that the public maintains unrealistic expectations of the potential for successful recovery following administration of cardiopulmonary resuscitation (CPR). Others have attributed this phenomenon to misrepresentation of CPR outcomes on television and other sources of public information. OBJECTIVES: To determine public expectations of CPR and correlate these expectations with various sources of information regarding CPR, including age, television, personal medical training, public programs, friends/family with medical training, and personal experience with CPR. METHODS: A written survey was randomly distributed to local church congregations and completed on a voluntary basis. RESULTS: Ninety-six percent of the respondents expected CPR to be unrealistically effective. Those factors found to increase predicted CPR survival rate were as follows: 1) being under 50 years of age, 2) use of television as a source of information regarding CPR, 3) personal medical training, and 4) use of public programs about CPR. Neither exposure to friends or family with medical training nor personal experience with CPR resulted in increased CPR survival predictions. CONCLUSIONS: Regardless of the source, the public is not accurately informed about the effectiveness of CPR. This creates a situation in which people may elect CPR for themselves or for family members when survival, not to mention recovery, is unlikely. Without dissemination of realistic statistics regarding survival and recovery following CPR, the public will maintain unrealistic expectations of CPR, and be unable to make well-informed decisions concerning its use.     

Thrombolysis in Acute Myocardial Infarction Following Prolonged Cardiopulmonary Resuscitation

ABSTRACT
Thrombolytic therapy was administered to a 64-year-old man with an acute anterolateral myocardial infarction who had received cardiopulmonary resuscitation (CPR) for 24 minutes. At the time of thrombolytic therapy, the patient was alert and without clinical or radiographic evidence of injury. The patient developed a retroperitoneal hematoma related to femoral line placement, as well as subcutaneous bruising of the anterior chest wall; both were self-limited. No long-term morbidity developed, and the myocardial infarction was aborted. The use of thrombolytic therapy for patients with acute myocardial infarction who have received CPR is reviewed. In the absence of clinical or radiographic evidence of trauma from CPR, patients with acute myocardial infarction should not be excluded from receiving thrombolytic therapy solely because of having had CPR or the duration of CPR.     

心肺复苏仪胸外心脏按压对心肺复苏成功的影响

目的:探讨心肺复苏仪胸外心脏按压对心肺复苏成功的影响。方法:将42例心跳呼吸骤停患者随机分为徒手胸外心脏按压组(A组)和心肺复苏仪胸外心脏按压组(B组)。二组均进行无创动脉血压、心电、经皮氧饱和度sPO2等监测。结果:B组的自主循环恢复率和24小时存活率均明显高于A组(P<0.05和P<0.01),但二组的出院存活率无显著性差异。B组的经皮氧饱和度明显高于A组(P<0.05),而自主循环恢复时间则明显短于后者(P<0.01);二组的平均动脉压无显著性差异。结论:心肺复苏仪胸外心脏按压在提高自主循环率,缩短自主循环恢复时间,改善患者生存机会等方面明显优于徒手胸外心脏按压。     

Electroencephalography during Out-of-hospital Cardiopulmonary Resuscitation

Background

At the present time there is no parameter that can estimate the quality of cerebral perfusion and possible success of cerebral resuscitation during advanced cardiac life support (ACLS) efforts. In recent years, various attempts have been made to use electroencephalography (EEG)-based cerebral neuromonitoring to assess the effectiveness of cardiopulmonary resuscitation (CPR).

Objectives

The Cerebral State Monitor M3 (Danmeter A/S, Odense, Denmark) is a portable, single-channel EEG monitor that provides the user with different EEG-based parameters and the raw waveform EEG to measure cerebral activity.

Case Report

We report two cases of out-of-hospital CPR with single-channel EEG monitoring conducted parallel to ACLS with external chest compressions. We demonstrate an artifact in waveform EEG recordings that is caused by the external chest compressions, and that leads to a miscalculation of the Burst Suppression Ratio and Cerebral State Index.

Conclusion

These cases suggest that digitally processed EEG-monitoring is not a useful tool during CPR.