心肺复苏犬脑组织神经元特异性烯醇化酶表达及纳络酮的干预

目的：通过检测心肺复苏后脑组织神经元特异性烯醇化酶（NSE）表达及纳络酮（NXL）的干预后的改变．探讨NXL对脑复苏的作用。方法：18只健康杂种犬,随机分成三组,空白组（n=6）：不诱发室颤,6h后取脑组织．对照组（n=6）：心跳骤停后予常规心肺复苏术,实验组（n=6）：心跳骤停后予常规心肺复苏术＋NXL。于复苏后6h取脑组织行NSE表达的测定以及脑形态学检查。结果：实验组、对照组、空白组NSE表达的差别均有统计学意义（P〈0．05）,其中对照组NSE表达明显高于空白组（P〈0．01）,实验组NSE表达低于对照组（P〈0．05）。实验组脑组织的病理损害低于对照组。结论：NSE参与了心肺复苏后再灌注损伤发生发展的过程,使用NXL可减轻心跳骤停后脑组织NSE的表达,从而减轻心肺复苏后脑的再灌注损伤。     

纳络酮用于心肺脑复苏21例疗效观察

为了观察β EP拮抗剂纳络酮对心肺复苏的作用 ,我们设对照组 ,前瞻性观察了纳络酮在心肺脑复苏 ( CPCR)中的作用 ,报告如下。1　病例与方法1.1　病例选择 :急诊抢救和住院、留观的心跳骤停患者 42例 ,其绝对心跳骤停时间 2～ 7分钟 ;年龄 2 8～ 74岁 ,平均5 1岁。随机划分纳络酮组与常规复苏组2组 (各 2 1例 )。 2组患者一般情况见表1,有可比性。1.2　治疗方法 :纳络酮组在常规复苏基础上给予纳络酮 2 .0 mg加生理盐水2 0 ml静推 ,此量可间隔半小时重复使用。常规复苏组行正规 CPCR,其中用标准剂量肾上腺素 ,第 1次无效时重复使用 ;有室…     

提高心肺复苏后的脑复苏率

随着心肺复苏术的普及和进展,心跳呼吸骤停的复苏率大有提高,但仍有相当的存活患者并发神经系统损害,不能恢复正常生活,致使心肺脑复苏的成功率仍较低.故心肺复苏中及复苏后脑复苏就成为复苏成功的关键之一.     

犬心肺复苏后心肌凋亡的变化及纳洛酮的干预作用

目的：观察犬心跳骤停复苏后心肌细胞凋亡的变化以及纳洛酮(NLX)的干预作用。方法：体外电击诱发犬室颤，3min后复苏，18只犬随机分为3组，CPR组，NLX组，空白对照组，每组6只，6小时后取心肌组织，TUNEL法检测心肌组织凋亡的形态学改变。结果：CPR组心肌细胞凋亡指数高于空白对照组，使用NLX后心肌细胞凋亡指数下降。结论：犬室颤复苏后心肌细胞凋亡增加，纳洛酮可以减少心肌细胞凋亡，对复苏后心肌具有保护作用。     

纳洛酮对心肺复苏犬脑组织S100蛋白表达的影响

目的　通过检测心搏骤停犬复苏后及给予纳洛酮干预后脑组织中S1 0 0蛋白表达情况 ,了解纳洛酮对脑复苏的影响。方法　 1 8只健康杂种犬 ,随机分成 3组 ,每组 6只 ,予体外电击诱发室颤 ,对照组 :心搏停后予标准心肺复苏术 ;实验组 :心搏骤停后予标准心肺复苏术 +纳洛酮 ;空白组 :不诱发室颤 ,于复苏后 6h取脑海马组织行脑形态学检查 ,及S1 0 0蛋白表达的测定。结果　实验组S1 0 0蛋白表达明显低于对照组 (P <0 0 1 ) ,实验组脑组织的病理损害低于对照组。结论　使用纳洛酮后心肺复苏犬脑组织的病理损害有所减轻 ,脑组织S1 0 0蛋白的生成也显著减少 ,纳洛酮可能通过减少S1 0 0蛋白的表达而减轻心肺复苏后脑的再灌流损伤     

心脏骤停后心肺复苏和心肺脑复苏成功病例的对比分析

目的 探讨影响心脏骤停患者成功脑复苏的相关因素.方法 回顾对比分析心脏骤停后成功心肺脑复苏(A组,n=38)和仅心肺复苏成功(B组,n=42)患者之间的相关指标,包括性别、年龄、原发疾病、心脏骤停原因、心脏骤停环境、心脏骤停相关时间和心肺复苏后相关治疗持续时间.结果 两组性别比和平均年龄比较差异无统计学意义(P＞0.05).原发疾病:A组以外科为主(78.9%),B组以内科为主(61.9%),两组比较差异有统计学意义(P＜0.005).心脏骤停原因:A组31例(81.6%)为急性缺氧、低血压、内脏神经反射和单纯心脏疾患, B组30例(71.4%)为慢性缺氧和慢性心脏病,两组比较差异有统计学意义(P＜0.005).心脏骤停环境:A组24例(63.2%)发生在手术室和ICU,B组22例(52.4%)发生在普通病房,两组比较差异有统计学意义(P＜0.005).心脏骤停相关时间:A组心脏骤停持续时间(8.2±8.7)min,自主心跳恢复时间(6.7±8.4)min,脑缺血缺氧时间(1.5±1.3)min,均明显短于B组[分别为(30.8±26.2)min、(27.7±24.9)min和(3.1±3.1)min,P＜0.001或P＜0.005].心肺复苏后相关治疗持续时间:A组亚低温持续时间(4.0±2.6)d,呼吸机持续时间(11.1±19.7)d,与B组[(5.9±3.8)d和(15.4±29.3)d]比较差异无统计学意义(P＞0.05).Logistic多因素回归分析显示,原发疾病(OR=6.22,95%CI 1.64～23.46)、心脏骤停持续时间(OR=1.11,95%CI 1.04～1.19)和心脏骤停发生环境(OR=4.51,95%CI 1.22～16.61)与成功脑复苏的关系更密切,成为三个独立影响因素.结论 没有明显慢性疾病,在手术室和ICU以急性缺氧、低血压和单纯心脏原因发生的心脏骤停,抢救及时有效,复苏后处理恰当、合理,尽早实施全面脑保护是成功脑复苏的有利因素.     

心肺脑复苏及复苏后处理的若干问题探讨

大剂量肾上腺素的临床应用 ,使大多数心跳骤停患者得以复苏 ,然而心肺复苏 ( CPR)后的维持和后续处理 ,也是急待解决的实际问题。现将我们救治的2 2例患者情况分析如下。1　临床资料1.1　病例 :患者男 2 0例 ,女 2例 ;年龄12～ 79岁 ,平均 44 .3岁。晚期癌症 2例 ,出血性脑中风 1例 ,缺血性脑中风 2例 ,急性心肌梗死 2例 ,病毒性脑炎和心肌炎各 1例 ,白血病和再生障碍性贫血各1例 ,慢性阻塞性肺疾病 ( COPD) 2例 ,阿片类药物中毒 4例 ,一氧化碳中毒1例 ,麻醉意外和高压电击伤各 2例。1.2　抢救方法 :立即行胸外心脏按压 ,开通气道 ,气管…     

心肺转流行心肺复苏的实验研究

观察狗心脏停搏３０分钟后的心肺复苏效果，以１０％氯化钾溶液静脉注射使实验狗心脏停搏、呼吸停止３０分钟后，分两组进行心肺苏实验研究。实验狗每组５只，第一组采用常规法，第二组采用心肺转流法。实验期间，定时对心电图、动脉压、静脉压、动脉血气和瞳孔进行监测。心脏骤停后６０分钟检查最终复苏效果。结果第一组仅１只狗于１５分钟后恢复自主循环，瞳孔开始缩小，其余４只狗均未获复苏，第二组于２－３分钟后全部恢复自主循     

心肺脑复苏成功后的康复护理干预

目的 探讨住院患者心脏骤停行心肺脑复苏（cardiac pulmonary cerebral resuscitation,CPCR）成功后进行康复护理干预治疗。以延续患者的生命和生存质量。方法 对1998年12月至2005年12月CPCR患者99例随机分为康复组48例和对照组51例,比较两组患者干预前后抽搐和烦躁不安、记忆力减退、反应迟钝、胸部疼痛、恐惧心理等不良反应的情况。结果康复组患者护理干预前后不良反应有明显改善;与对照组相比,不良反应也有明显缓解（P〈0．05）。结论 进行CPCR术后的康复护理干预,有利于提高护理心脏骤停后患者的健康,巩固CPCR术后患者的生存率。     

犬室颤心脏骤停模型的研究与改进

目的建立一种简单、有效、稳定的犬心脏骤停（CA）模型,为心肺脑复苏的实验研究奠定基础。方法选用健康成年犬30只,体质量（15±2）kg,雌雄不限,麻醉后经右颈外静脉置电极导管至右心室,以5mA电流诱发室颤的方法制作CA模型,根据CA时间不同随机分为CA3 min组、CA5 min组和CA8 min组,每组10只,随后进行电除颤及标准胸外心肺复苏术,比较各组的复苏成功率及存活情况。结果诱颤后所有犬心电图均显示室颤波,动脉血压下降并失去波动;各组自主循环恢复（ROSC）情况为CA 3min组：90％（9／10）、CA5min：80％（8／10）、CA8min：20％（2／10）;ROSC率CA3 min组和CA5 min组比较差异无统计学意义（P〉0.05）,CA8 min组与其他2组之间比较差异具有统计学意义（P〈0.05）;CA3rain组与CA5min、CA8 min组存活时间比较差异有统计学意义（P〈0.05）。结论犬经右心室导管诱发室颤制作的心脏骤停模型稳定且可靠,CA3 min后开始复苏具有较好的ROSC率和存活时间,能满足心肺脑复苏基础研究的需要。     

Hospital Variability of Out-of-Hospital Cardiac Arrest Survival

Background. Previous literature has identified patient andemergency medical services (EMS) system factors that are associated with survival of out-of-hospital cardiac arrest patients. Objective. To determine variability in rates of survival to discharge of resuscitated adult out-of-hospital cardiac arrest patients andto identify hospital-related factors associated with survival. Methods. This was a retrospective, observational study of all adult (21 years or older) out-of-hospital Utstein criteria cardiac-etiology arrests treated by Milwaukee County EMS during the period 1995–2005 andsurviving to hospital intensive care unit admission. The primary outcome measure was survival to hospital discharge. Logistic regression analysis was used to compare the odds of survival between hospitals, patient factors, andhospital factors. Results. 1,702 patients at eight receiving hospitals were included in the study analyses. Hospital survival rates ranged from 29% to 42%. Patient andcase factors associated with increased survival included younger age, male gender, nonwhite race, witnessed arrest in a public location, bystander cardiopulmonary resuscitation (CPR), a modest number of defibrillations, andinitial cardiac rhythm of ventricular tachycardia. The only hospital characteristic correlated with survival was the number of beds per nurse. Patients admitted to a hospital with a ratio of beds to nurse less than 1.0 were over 1.5 times more likely to survive. Conclusions. Survival to discharge of resuscitated adult out-of-hospital cardiac arrest patients may vary by receiving hospital. A hospital's ratio of beds to nurse andseveral patient/case f actors are correlated with survival. Further research is warranted to investigate how this may affect resuscitation care, EMS transport policy, andresearch design.     

Extracorporeal Resuscitation of Cardiac Arrest

OBJECTIVE: Extracorporeal support of heart and lung function (venoarterial perfusion) during cardiac arrest (ECPR) has been advocated as a means of improving survival following cardiac arrest. The authors retrospectively reviewed their institution's seven-year experience with this intervention. METHODS: Emergency department patients and inpatients in cardiac arrest or immediately postarrest were considered candidates. ECPR was instituted using venoarterial bypass and was continued until patients regained sufficient cardiopulmonary function to allow weaning from the device or until their condition was deemed irrecoverable. RESULTS: ECPR was attempted in 25 patients and successfully instituted in 21. Four patients (16%) were converted from ECPR to ventricular assist devices, two of whom survived and await transplantation. Seven additional patients were discharged from the hospital, resulting in an overall survival of 36%. Because none of the children treated survived, there was a trend toward higher age among survivors (survivors 40 +/- 14 yr, nonsurvivors 33 +/- 15 yr, p = 0.29). The duration of conventional CPR was shorter among survivors (survivors 21 +/- 16 min, nonsurvivors 43 +/- 32 min, p = 0.04), as was the duration of extracorporeal support (survivors 44 +/- 21 hr, nonsurvivors 87 +/- 96 hr, p = 0.18). Survival was seen only in patients whose conditions were amenable to a definitive therapeutic intervention, particularly cardiac arrest due to respiratory or pulmonary embolic disease. While four of the five patients treated in the ED were successfully supported, none survived to discharge. CONCLUSION: In select patients with reversible disease, extracorporeal CPR can be used to successfully treat cardiac arrest. Further investigation into its most appropriate application is warranted.     

126例心跳骤停心肺复苏临床分析

目的：探讨急诊抢救心跳骤停的程序及方法，以便提高心肺复苏成功率。方法：回顾性分析126例在急诊抢救心跳骤停患者的临床资料，分析抢救程序及方法对心肺复苏的影响。结果：126例患者中31例复苏成功，63例复苏有效，32例复苏无效。结论：心肺复苏抢救成功与开始抢救时间、胸外按压方法、抢救药物及仪器的合理应用有密切关系。     

干细胞自体动员对心肺复苏后大鼠心功能的影响

目的：观察干细胞动员剂粒细胞集落刺激因子（G—CSF）与AMD3100对复苏后大鼠心功能的影响。方法：建立窒息法心肺复苏动物模型,56只sD大鼠随机分为单纯复苏组、G—CSF组、AMD3100＋G—CSF组和假手术组。观察恢复自主循环（ROSC）大鼠的复苏后生存率,复苏后3d与6d取材,通过CK—MB、dp／dt40与-dp／dt40测定评估心功能,采用WesternBlot法检测心肌组织SDF一1蛋白的表达。结果：G—CSF组与单纯复苏组大鼠在复苏后24h、3d、6d的存活率无显著差异,在复苏后3d,AMD3100＋G—CSF组、G—CSF组及单纯复苏组大鼠的血清CK—MB显著高于假手术组,而dp／dt40与-dp／dt40则均低于假手术组,但三组间无显著性差异。在复苏后6d时,各组CK—MB,ap／dt40与-dp／dt40之间无统计学差异。G—CSF组、单纯复苏组大鼠心肌组织SDF-1蛋白表达与假手术组比较无显著差异。结论：干细胞自体动员未能显著提高心肺复苏后ROSC大鼠的存活率,对复苏后大鼠的心功能无明显影响。     

血清中一氧化氮浓度与精子活动度关系的分析

目的探讨个体血清一氧化氮浓度对精子运动能力的影响。方法用721分光光度计测定血清中一氧化氮浓度,用OLYMPUS显微摄影系统等自动分析精子的运动情况。结果一氧化氮浓度在60~93μmol／L之间时显著促进精子的运动,一氧化氮浓度过高(>93μmol／L)和过低(≤59μmol／L)都会抑制精子的运动。结论精子运动能力与个体血清中一氧化氮浓度有关。     

脑梗死患者一氧化氮合酶基因多态性及其对一氧化氮的影响

目的观察脑梗死患者内皮型一氧化氮合酶(eNOS)基因多态性及一氧化氮(NO)变化情况。方法采用前瞻性病例对照研究,脑梗死组193例,均为发病2周内经头颅CT或MRI证实存在颈内动脉分布区梗死灶者,对照组103例为正常体检者。对两组eNOS基因4号内含子多态性进行测定,并采用Griess重氮化反应法和酶标法分别检测血清NO含量、NOS活性。结果脑梗死组eNOS基因4号内含子a等位基因(eNOS4a)携带者48例,对照组为12例,携带频率有显著性差异(χ2=8.86,P=0.003);经Logistic回归分析,eNOS4a携带是脑梗死的独立危险因素(P=0.032);脑梗死组NO产物浓度中位数为6.04(3.83～11.49)μmol/L,低于对照组6.89(4.64～12.43)μmol/L(P=0.022)。eNOS4a携带者NO产物浓度中位数为5.07(3.18～7.62)μmol/L,低于非携带者6.86(4.39～11.76)μmol/L(P=0.001)。脑梗死组NOS活性为(2.97±1.47)U/ml,对照组(3.16±1.46)U/ml,无显著性差异(P=0.517)。eNOS4a携带者NOS活性(2.77±1.13)U/ml,与非携带者(3.12±1.54)U/ml无显著性差异(P=0.100)。结论eNOS4a携带可能通过减少NO生成而在脑梗死发生过程中发挥作用。     

精神分裂症患者一氧化氮合酶活性与发病机制相关性

目的通过测定首发精神分裂症患者和正常人的血清一氧化氮合酶(NOS)活性,比较和分析他们之间的差异,探讨NOS活性以及一氧化氮(NO)能神经系统的功能变化与精神分裂症的关系。方法采用比色法分别测定首发未用抗精神病药的精神分裂症患者(研究组)、临床症状缓解的精神分裂症患者(缓解组)和正常对照者的血清NOS活性。结果研究组的血清NOS活性为6.3665±1.2260(n=39),明显高于症状缓解组(4.1204±0.9908,n=27,P<0.01)和正常对照组(3.2660±1.0320,n=27,P<0.01);症状缓解组的NOS活性也明显高于正常对照组(P<0.01)。结论精神分裂症患者血清NOS活性明显增高,L-精氨酸-NO神经通路功能的紊乱可能是精神分裂症的发病机制之一,也可能成为一个新的治疗靶系统。     

Potential Impact of a Targeted Cardiopulmonary Resuscitation Program for Older Adults on Survival from Private-residence Cardiac Arrest

OBJECTIVE: Traditional cardiopulmonary resuscitation (CPR) training programs do not target older adults who are most likely to witness private-residence cardiac arrests and do not reliably result in a bystander who is likely to perform CPR in the event of an arrest. This study was performed to compare targeted CPR training programs for older adults (older than 50 years) that 1) increase numbers of CPR-trained bystanders of private-residence cardiac arrest or 2) increase the percentage of trained bystanders of private-residence cardiac arrest who perform CPR. A simultaneous outcome was to estimate the minimal significant survival benefit associated with each of the training programs. METHODS: A probabilistic simulation model was developed in Fortran95 that incorporated key out-of-hospital cardiac arrest elements, including witnessed arrests, CPR-trained witness, CPR provision, and impact of CPR on ventricular fibrillation. Input data were derived from published or publicly available data, including a large prospective cohort study of outcomes in Oakland County, MI. Monte Carlo simulation (n = 10,000) and sensitivity analyses (n = 40) were used to assess median and the empiric 95% confidence intervals [CIs] for incremental survival with either intervention. RESULTS: The baseline model, calibrated to the characteristics of the input-data community, established that, for private-residence cardiac arrests, 40.8% of cardiac arrest bystanders were trained in CPR; however, only 25.7% performed CPR. This yielded 4.81% survival (95% CI = 4.72 to 4.89). Modeling the impact on the baseline training level with increased CPR performance among trainees indicated that 75% of private-residence trained bystanders would need to perform CPR in order to reach a minimally significant improvement in survival (5.02%; 95% CI = 4.94 to 5.15). Similarly, targeted CPR training that would result in a significant survival benefit (to 5.01%; 95% CI = 4.93 to 5.09) would require that 70.8% of bystanders be trained. CONCLUSIONS: CPR training programs that focus on yielding 75% of trainees who perform CPR in the event of witnessing an arrest would have equivalent results to mass CPR training programs that result in 70% of bystanders being trained in CPR. However, the minimal survival benefit associated with these programs (around 0.2%) may prove either method costly with minimal effect.