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。     

209例中青年院前猝死及复苏状况回顾分析

目的分析广西南宁市中青年院外猝死度现场复苏成败的原因,以进一步提高现场复苏成功率。方法收集1999年1月至2004年12月经本院急诊科外出急救的209例猝死病历,参照Utstein模式进行资料收集并进行回顾性研究。结果猝死前有心血管病史者占首位,为93例,占44．49％;猝死高发年龄40～49岁,占37．32％,男性多于女性;家中猝死者约占50％;先由目击者进行心肺复苏（CPR）的18例中5例复苏有效,有效率27．78％,呼叫至到迭现场平均间期分别为16．4分钟;总复苏成功率为3．82％（8例）。结论南宁市中青年猝死者以心源性为主,现场复苏成功率低,亟待强化院外猝死发生率的急救干预,特别是在人群中普度以CPR为主的初级救护知识和努力缩短急救反应时间。     

镇区医院院前猝死49例临床分析

目的:总结镇区医院院外猝死发生的临床特点,提高院前急救的成功率.方法:回顾性分析2005年1月～2011年12月我院救治的院外猝死49例的临床资料.结果:猝死前有心血管病史者24例,有前驱症状者14例,猝死高发年龄为40～60岁,家中猝死者占71.4％;由目击者进行心肺复苏(CPR)的3例中复苏有效1例;呼叫至到达现场的平均时间为11.4分钟.结论:对已有心血管病基础病史的患者应关注其发生猝死的可能性,在人群中普及以CPR为主的初级救护知识和努力缩短急救反应时间可提高CPR的成功率.     

院前急救心肺复苏猝死患者分析

选取我院2011年1月～2013年1月我院急救中心出诊抢救的猝死患者70例作为临床研究对象,根据患者抢救结果将其分为心肺复苏（CPR）成功组和CPR失败组两组,CPR方法按照《国际心肺部复苏2010指南》操作。比较两组患者的异同。两组患者在猝死发生到胸外压开始时间、猝死前有无人呼叫120、早期除颤时间和急救人员配合情况的差异均有统计学意义（P〈0.05）,CPR成功组显著优于CPR失败组。而气管插管或人工呼吸开始时间两组比较差异则无统计学意义（P〉0.05）。在院前急救CPR猝死患者时,要及早到达现场,保持患者呼吸道畅通,坚持为患者进行心脏体外按压,同时进行除颤,急救人员应通力合作,可以大大提高猝死患者在院前CPR抢救的成功率。     

心肺复苏患者院内急救以及院外急救效果观察

资料选自2012年8月~2014年4月我院急诊科室接诊的院内和院外急救的心脏呼吸骤停患者80例,将院内急救的40例心脏骤停患者当作院内组,院外急救的40例心脏骤停患者当作院外组,给予所有患者进行胸外按压、开放气道、人工通气和静脉通道、心电除颤等心肺复苏的急救措施,观察比较两组的复苏效果。结果院内组的复苏到位时间为(3±0.6)min,院外组的复苏到位时间为(30±1.8)min。院内组的心电除颤、气管插管、复苏用药和快速建立静脉通道的比率明显比院外组高;院内组和院外组的心肺复苏总有效率分别为55%、15%,两组比较差异明显,有统计学意义(P0.05)。对心肺复苏患者及早进行胸外按压、开放气道、人工通气和静脉通道、心电除颤等心肺复苏的急救措施,可有效提高患者的心肺复苏成功率和有效率。     

院前急救心肺复苏中的护理配合

1临床资料我院2002-11～2004-11院前复苏98例,男58例,女40例,年龄10～95岁。根据是否有明确致呼吸、心跳骤停原因分为非猝死组和猝死组,猝死组52例,非猝死组46例。98例致病原因及构成比见表1。从呼救120到救护车到达现场时间最长30min,最短5min,平均(9.1±4.2)min。98例中行气管插管61例,有52例进行紧急除颤,仅有3例即3%获期复苏成功,转院内抢救。这3例中其中2例均是在转运途中突然发生呼吸、心跳停止,经采取人工呼吸、胸外心脏按压、气管插管、心电除颤等紧急救护措施,抢救成功;另外1例是呼吸、心跳骤停达10min之久,医护人员到达现场立即实…     

心肺复苏423例临床分析

目的了解我院院内发生心脏／呼吸骤停患者的心肺复苏（CPR）情况，规范操作，提高CPR水平。方法2006年1月至2008年1月我院收治心且匣／呼吸骤停患者423例，对CPR的开始时间、操作方法、电除颤的使用、气管插管等资料进行综合分析。结果CPR成功率为9．7％（41例），成活出院率3．3％（14例）；复苏开始时间（2．8&#177;0．9）分钟；电除颤22．9％（97例），复苏成功24．7％（24例）；气管插管15．4％（65例）。结论早期电除颤能提高CPR成功率，基层医院需要加强CPR的规范化培训，建立完善的急救体系，进一步提高心肺复苏成功率。     

插管、按压、除颤时机选择对心肺复苏成功率的影响

目的:研究气管插管、胸外按压及心脏电击除颤的时机选择对心肺复苏(CPR)成功率的影响.方法:将178例心脏骤停(CA)病人随机分为时机选择复苏组90例(A组)和常规复苏组88例(B组),比较两组复苏成功率.结果:A组CPR成功率48.9%明显高于B组成功率的19.3%,P<0.05.结论:气管插管、胸外按压及心脏电击除颤需根据CA的不同病因及现场情形进行选择.     

31例心脏性猝死病例院外复苏成功分析

目的:通过对天津市急救中心31例心脏性猝死病例院外现场复苏(CPR)成功原因分析说。方法:回顾性分析31例心脏猝死患者的临床资料及现场处置过程。结果:本组病例,其中10例一次除颤成功,21例两次除颤成功。除颤后患者出现室上性心动过速心电图型,心率110～150次/min,BP80/40mmHg(1mmHg=0.133kPa),经进一步人工呼吸支持、可拉明、洛贝林静脉注入后,恢复自主呼吸,心电图亦转为窦性心律。其中2例患者现场即恢复神志。结论:现场复苏成功不仅仅取决于复苏开始时间,急救半径,急救反应时间等时间因素,还取决于投入的急救资源、急救设备的质量、所采用的急救手段、急救药品等因素。并认为,进一步提高院前急救成功率必须关注患者的原发疾病控制,关注第一目击者培训及政府对急救事业的投入。     

急性海洛因中毒致呼吸心搏骤停25min院外除颤16次复苏成功1例

大量的临床实践表明,猝死的现场急救对挽救患者的生命起到至关重要的作用。我市12 0急救中心曾对1例急性海洛因中毒致呼吸、心搏骤停2 5 min患者实施院外综合抢救加电击除颤16次,而最终获得复苏成功,报告如下。1　病历简介患者男性,4 7岁,2 0 0 3年3月16日因静脉注射海洛因加饮酒10 0 ml后昏迷而呼叫12 0。医护人员到达现场后诊断为急性海洛因中毒伴急性肺水肿、严重心律失常、心源性休克。在院外抢救约1h而获得成功。患者苏醒后拒绝入院,并自行拔掉液体,驱逐医护人员。在急救人员离开几分钟后,患者又突发呼吸、心搏骤停,于16 :2 1再次呼叫1…     

Evaluation of the use of automatic external defibrillation in out-of-hospital cardiac arrest in Hong Kong.

A retrospective 6-month audit of out-of-hospital cardiac arrests in Hong Kong following the introduction of automatic external defibrillators is presented. During the 6-month period from 1 July 1995 to 31 December 1995, resuscitation was attempted on 754 patients. Of the 744 patients with cardiac arrest whose records were available, 53.6% had a witnessed arrest. Few cardiac arrest patients (8.9%) received bystander cardiopulmonary resuscitation (CPR) and the majority (80%) of arrests occurred at home. Six hundred and forty-three (86.4%) patients were declared dead on arrival at hospital or in the Accident and Emergency department; 89 (12%) died in hospital and only 12 (1.6%) were discharged alive. The average ambulance response interval (call receipt to arrival of ambulance at scene) was 6.42 min. The average arrest-to-first-shock interval was 23.77 min. Factors predicting survival included initial rhythm and arrest-to-first-shock interval. The survival rate of 1.6% is low by world standards. To improve the survival rates of people with out-of-hospital cardiac arrest, the arrest-to-call interval must be reduced and the frequency of bystander CPR assistance increased. Once these changes are in place, a beneficial effect from the use of pre-hospital defibrillation might be seen.     

Resuscitation for patients with out-of-hospital cardiac arrest: Singapore

AIM: To evaluate characteristics and outcome of out-of-hospital cardiac arrest (OHCA) patients presenting to the Emergency Department (ED), and to examine factors that could be used to determine to prolong or abort resuscitation for these patients. METHOD: All OHCA patients presenting to the ED were studied over a three-month period from November 2001 through January 2002. Patient with traumatic cardiac arrest were excluded. Data were collected from the ambulance case records, ED resuscitation charts, and the ED Very High Frequency (VHF) radio case-log sheet. Information collected included the patient's demographic characteristics, timings (time from call to ambulance arrival on scene, time from arrival at scene to departure from scene, time from scene to arrival in the ED) recorded in the pre-hospital setting, the outcome of the resuscitation, and the final outcome for patients who survived ED resuscitation. RESULTS: Ninety-three non-traumatic patients with an OHCA were studied during the three-month period. Of the 93 patients, 15 (16.1%) survived ED resuscitation, and one survived to hospital discharge. There were no statistically significant differences for age, race, or gender with regards to the outcome of the resuscitation. The initial cardiac rhythms were asystole (65), pulseless electrical activity (21), and ventricular fibrillation (7). Fourteen (15%) received bystander cardiopulmonary resuscitation (CPR). All seven patients with return of spontaneous circulation (ROSC) on arrival in the ED survived ED resuscitation. The ambulance took an average of 11.80 +/- 3.36 minutes for the survivors and 11.8 +/- 4.22 minutes for the non-survivors from the time of call to get to these patients. The average of the scene times was 12.5 +/- 4.61 minutes for the survivors and 12.0 +/- 4.02 minutes for the non-survivors. Transport time from the scene to the ED took an average of 39.1 +/- 8.32 minutes for the survivors and 37.2 +/- 9.00 minutes for the non-survivors. CONCLUSION: The survival rate for patients with OHCA after ED resuscitation is similar to the results from other studies. There is a need to increase the awareness and delivery of basic life support by public education. Automatic External Defibrillators (AED) should be available widely to ensure that the chance of early defibrillation is increased. Prolonged resuscitation efforts appear to be futile for OHCA patients if the time from cardiac arrest until arrival in the ED is > or = 30 minutes coupled with no ROSC, and if continuous asystole has been documented for > 10 minutes.     

对心源性猝死高危患者家属进行心肺复苏术培训的效果评价

目的 探讨对心源性猝死高危患者家属进行心肺复苏术(CPR)培训的效果.方法 将未接受系统的家属CPR培训的心源性猝死患者35例作为对照组,将接受过家属CPR培训的心源性猝死患者35例作为实验组,比较2组患者现场复苏效果及应急反应时间.进行t检验.结果实验组复苏效果及应急反应时间显著优于对照组.结论 对心源性猝死高危患者家属进行第一目击者培训,可显著提高心源性猝死院前抢救成功率.     

连续胸外按压结合除颤对室颤患者的疗效观察

目的 观察连续胸外按压结合除颤对室颤猝死患者的复苏效果.方法 2005-02～2009-02室颤患者行除颤加连续胸外按压,而2001-06～2005-01收治的室颤患者行连续电除颤治疗,比较两组患者的抢救效果.结果 与连续除颤者相比,连续性胸外按压加除颤组自主循环恢复率较高;除颤次数少;入院率增加;自主循环恢复所需时间缩短.结论 连续性胸外按压结合除颤可提高室颤猝死患者的复苏成功率.     

188例院前心肺复苏临床分析

目的:分析院前心肺复苏(CPR)病例的抢救经过,总结其中的经验和教训,探讨提高院前心肺脑复苏成功率的途径。方法:回顾分析188例院前CPR病列的复苏开始时间,临床急救措施,心肺脑复苏的成功率等方面的资料。结果:188例患者中,31例心肺复苏成功,4例心肺脑复苏成功,心肺复苏成功率16.49%,心肺脑复苏成功率2.13%。CPR开始时间越早,除颤时间越早,心肺脑复苏的成功率越高。结论:良好齐全的急救设备,专业的院前急救水平,普及急救知识,加快CPR及除颤开始时间,及时给予基础和高级生命支持是提高院前心肺脑复苏成功率的重要途径。     

Prompt Advanced Life Support Improves Survival from Ventricular Fibrillation

Objective. To determine whether the interval between the arrival of basic life support (BLS) providers and the arrival of advanced life support (ALS) providers is associated with patient outcome after cardiac arrest. Methods. We conducted a retrospective cohort study of all witnessed, out-of-hospital ventricular fibrillation (VF) cardiac arrests between January 1, 1991, and December 31, 2007. Eligible patients (n = 1,781) received full resuscitation efforts from both BLS and ALS providers. Results. The BLS-to-ALS arrival interval was a significant predictor of survival to hospital discharge (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93–0.99); the likelihood of survival decreased by 4% for every minute that ALS arrival was delayed following BLS arrival. Other significant predictors of survival were whether the arrest occurred in public (OR 1.48, 95% CI 1.19–1.85), whether a bystander administered cardiopulmonary resuscitation (CPR) (OR 1.34, 95% CI 1.07–1.68), and the interval between the 9-1-1 call and BLS arrival (OR 0.78, 95% CI 0.73–0.83). Conclusions. We found that a shorter BLS-to-ALS arrival interval increased the likelihood of survival to hospital discharge after a witnessed, out-of-hospital VF cardiac arrest. We conclude that ALS interventions may provide additional benefits over BLS interventions alone when utilized in a well-established, two-tiered emergency medical services (EMS) system already optimized for rapid defibrillation. The highest priorities in any EMS system should still be early CPR and early defibrillation, but timely ALS services can supplement these crucial interventions.     

福建省急救中心116例院前猝死的流行病学研究

目的 回顾性调查分析我中心116例院前猝死的流行病学资料,探讨有效提高本地区猝死综合防治能力的策略.方法 回顾性分析我中心2007-01～2009-01间院前猝死116例流行病学资料,分析患者发病的年龄、性别、时间、地点、死因、现场心电图表现、反应时间.结果 本组116例猝死患者中男女比例为1.7∶1;平均年龄66.6岁;每日多发时段为8∶00～11∶00(28.45%)及16∶00～19∶00时(20.7%);且约3/4的患者发生在家中(74.14%),现场无一例目击者行心肺复苏术;死因主要为心脑血管疾病(68.98%);现场心电图多为室颤(42.24%)、心室停搏(46.55%);我中心平均反应时间为8.34 min.结论 通过本研究分析,我们提出"四早",即早期预防、早期监测、早期复苏、早期除颤,这对于提高本地区院前猝死的综合防治能力有重要意义.